Discover and read the best of Twitter Threads about #CMV

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Hey #hematology aspirants, let's talk about #CMV today !! Post allogenic transplant CMV prophylaxis and pre-emptive therapy to be precise.

A short thread 🧵


#MedTwitter #MedEd #hematology
CMV a DNA virus, one of the commonest causes of infections post HSCT

Has the largest genome of any known human virus [200 genes]

Most humans harbour latent CMV, infection aquired in childhood.

Site of latency in humans-❓
In murine models- hepatic sinusoidal cells.

The risk of reactivation depends on CMV sero status:
D-/R+ > D+/R+ > D+/ R- > D- / R -

Other risk factors are:
1️⃣T cell depletion
4️⃣GVHD requiring steroids

So why not give prophylaxis to these "high-risk" patients ??

Read 11 tweets
Cytomegalovirus is a common virus. It can be serious if a woman catches it during pregnancy as she may pass the virus on to her baby.

My son has CMV, if it had been screened for, early treatment could've reduce complications.

2/ A randomised control trial demonstrated a 71% reduction in the risk of foetal transmission when a high dose of Valaciclovir was given to women who seroconvert #CMV, (pass to foetus), in pregnancy.

1st Trimester Screening is a no brainer.
3/ The Valgan Toddler Study, a randomised control trial, showed no efficacy of late treatment where there is hearing loss caused by CMV, so the only opportunity to preserve hearing is by treatment in the new-born period.

Neonatal CMV Screening could prevent children going deaf.
Read 6 tweets
🔥On en est des vaccins #COVID19 ?

Un petit thread sur les 5 vaccins dont on parle le plus

#Sinovac - #CNBG

1er point : TOUS ces vaccins évaluent efficacité pour empêcher la MALADIE (donc les symptômes / la pneumonie) mais pas l’INFECTION (donc le risque de transmission)

2ème point : ces données proviennent de COMMUNIQUES DE PRESSE (course entre les acteurs) pas de données publiées
Pfizer/BioNtech : le vaccin BNT162b2

Il s’agit d’un vaccin à ARN : petit rappel sur le procédé avant de commencer

Spoiler : ce n'est ni nouveau ni dangereux !
Read 32 tweets
Images of Infectious Diseases

6 mo post-tx: H&E (400x) of cervical biopsy of 46F s/p living unrelated donor kidney tx for adult PCKD.

Belatacept. MMF. Prednisone.
Acute cellular + antibody-mediated rejection.

CMV D+/R-. valganciclovir prophylaxis.

DDx / Rx? #MayoIDQ next Image
Case diagnosis: breakthrough CMV disease with cervicitis

H&E intranuclear / intracytoppasmic inclusions within endothelial cells in ectocervical stroma.

Immunohistochemistry stain for CMV shows infected endothelial cells with CMV inclusions.… Image
#MayoIDQ Breakthrough CMV disease, while receiving valGCV prophylaxis, is concerning for over-immunosuppression, under-dosing of val GCV, and/or drug-resistant virus.

If gene sequencing shows the most common CMV gene mutation, what drug would be recommended Rx?
Read 9 tweets
#ToughTxCase I am going to start an educational series for #transplant professionals/trainees on complex cases I have the privilege to see @UWHealth Patients have provided informed consent for us to discuss their condition in order to help other similar cases @uw_nephrology
#ToughTxCase #1 is the story of Tom, a 73 year old man, who received a living unrelated #kidney tx for #ESRD due to an unknown etiology. Low immunological risk, VXM (-), #CMV D+/R-, basiliximab induction, standard TAC/MPA/P maintenance Rx on Valgan prophylaxis x 6M @TxPharmD
At his 3M visit, Tom complains of #diarrhea, weight loss (4 lbs in 1 month) and poor energy. His kidney fxn is at baseline Scr 1.3 mg/dL. What is the most likely diagnosis? Please feel free to discuss! @uw_IMresidency @askrenal @Nephro_Sparks
Read 35 tweets
Humanity has always struggled to fight #viruses , best exemplified by the ongoing #Covid_19 #pandemic ,so I thought of doing a thread on a #virus which frequently troubles #hematology patients

It's called #CMV or #HHV5
It wrecks havoc #posttransplant

#MedTwitter @BloodJournal
⚡DNA virus ,1 of the MC infections post SCT

⚡It has the largest genome of any known human virus [230kb /200 genes]

⚡Most humans harbour latent CMV, infection MC aquired in childhood.

⚡Site of latency in humans- Not Known
In murine models - hepatic sinusoidal cells
⚡The risk of reactivation depends on CMV sero status and is as follows:
D-/R+ > D+/R+ > D+/ R- > D- / R -

⚡The other risk factors are
1️⃣ T cell depletion
2️⃣ HaploSCT
4️⃣ GVHD requiring Rx

⚡ So why not give prophylaxis to these patients ??
Read 10 tweets
This study found that Epstein Barr #Virus (EBV) IgM antibody seropositive #COVID-19 patients had a 3.09-fold increased risk of fever compared to EBV seronegative patients. Inflammatory markers like C-reactive protein were also higher in the EBV+ patients:…
2/ The study is a small, but good example of the how already-acquired persistent #pathogens can influence how a person responds to a new #infection: the existing pathogen(s) might cause additional symptoms or influence how the #immune system can respond to the new infection
3/ For example this study found that persistent Cytomegalovirus (CMV) infection caused ~10% of all T cells in CMV+ individuals to be directed against that virus. Could harboring CMV then change how the adaptive immune system responds to COVID-19?:…
Read 10 tweets
Death from #CMV primary infection in humans without any medical history was unexplained and the role of human inducible nitric oxide synthase (#NOS2) was unknown.
Our study reported in @NEJM today provided the first answer to both questions:… @ALNeehus @BigioBenedetta @BustamanteJaci1 @LaurentAbel4 @BoissonDupuis @BeziatV
It also connected 2 old friends of the lab, Davood Mansouri in Tehran (who attended a patient who died of #CMV at age 54) & Carl Nathan in NY (who discovered #NOS2 & characterized its function in mice). We found that the patient died of CMV because of AR complete NOS2 deficiency.
Read 3 tweets
The surge in #measles and #mumps are newsworthy, hot-topic attention grabbers. However, can I make a quick plug for something that is almost certainly going to be an issue in the near future? 1/x
The declines in MMR #vaccine coverage have led to increased outbreaks, several of which have been close to home (looking at you, #Texas). Therefore, coverage for "R" - rubella - is declining in parallel with measles and mumps in the same zip codes. 2/x
The reproductive number (R0), a measure of how infectious a given pathogen is, is highest for measles, medium for mumps, and lowest for rubella. So rubella will show up last... but it's coming. Good review:… 3/x
Read 12 tweets

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