Discover and read the best of Twitter Threads about #cmv
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Too early to say what this means for @Moderna's #CMV (cytomegalovirus) mRNA vaccine candidate, which is already in Phase III trials. However, this preprint suggests CMV's pentameric gH/gL complex is not important for transplacental infection. #StopCMV 🤰 🧵biorxiv.org/content/10.110…
CMV is notoriously difficult to vaccinate against. When he was still @pfizer, Phil Domitzer & colleagues "threw the book" at rhesus CMV --trying all leading vaccine strategies. The virus still infected, shed and transmitted horizontally just fine. 2/ academic.oup.com/jid/article/22…
Moderna has focused its mRNA vaccine on gB (the viruses' membrane fusion protein, functionally analogous to the S2 domain of a coronavirus' Spike)..and on the receptor binding gH/gL complex that's commonly referred to as "the Pentamer" because it's made up of 5 glycoproteins. 3/
Not a "bhosad piller"and I firmly believe reservations should stay. Infact I believe existing reservations reduced a bit and a full 5-10% given to children of inter caste marriages. Incl maybe full sponsorship of children born to such parents. The numbers are negligible rn
1/n that said. These are very vague and tenuous arguments. Correlation is not equal to causation.
Take a foundational metric, both Kerala and TN (to name the few key South Indian states one associates with higher standards of living) had much higher literacy rates
Take a foundational metric, both Kerala and TN (to name the few key South Indian states one associates with higher standards of living) had much higher literacy rates
2/n as opposed to the "backward" states. Kerala was @ 56%, TN @ 36%, Pondy 46%, compare this with the erstwhile "Bimaru" states that ranged from 18-20% in the 61 census. This was much before when the 69% reservations were rolled out. Clearly the social infra in edu 
Hey #hematology aspirants, let's talk about #CMV today !! Post allogenic transplant CMV prophylaxis and pre-emptive therapy to be precise.
A short thread 🧵
1/n
#MedTwitter #MedEd #hematology
A short thread 🧵
1/n
#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.
2/n
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.
2/n
The risk of reactivation depends on CMV sero status:
D-/R+ > D+/R+ > D+/ R- > D- / R -
Other risk factors are:
1️⃣T cell depletion
2️⃣HaploSCT
3️⃣UCB SCT
4️⃣GVHD requiring steroids
So why not give prophylaxis to these "high-risk" patients ??
3/n
D-/R+ > D+/R+ > D+/ R- > D- / R -
Other risk factors are:
1️⃣T cell depletion
2️⃣HaploSCT
3️⃣UCB SCT
4️⃣GVHD requiring steroids
So why not give prophylaxis to these "high-risk" patients ??
3/n
🧵1/5 #IDtwitter, this is our weekly #IDtrivia 📚
39y/M with no PMH, presents to the ED for evaluation of fatigue, anorexia, and diarrhea of 3 weeks duration. ROS is positive for weight loss, night sweats and an intermittent maculopapular rash located on his chest
39y/M with no PMH, presents to the ED for evaluation of fatigue, anorexia, and diarrhea of 3 weeks duration. ROS is positive for weight loss, night sweats and an intermittent maculopapular rash located on his chest
2/5 Patient denies recent travel, sick contacts. He works as a bus driver. Sexually active with cis male partners, no condom use, takes PrEP occasionally. Hx of treated syphilis, last HIV and QuantiFERON-TB 6 months ago negative
3/5 On presentation BP88/68 HR90 RR20, T98.7,lethargic, AOx3. Chest clear to auscultation,normal heart sounds, abdomen tender to palpation of mesogastrium. He also had a diffuse rash (pic)
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.
@cmvactionuk
…eening-recommendations.service.gov.uk/cytomegaloviru…
My son has CMV, if it had been screened for, early treatment could've reduce complications.
@cmvactionuk
…eening-recommendations.service.gov.uk/cytomegaloviru…
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.
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.
Neonatal CMV Screening could prevent children going deaf.
🔥On en est des vaccins #COVID19 ?
Un petit thread sur les 5 vaccins dont on parle le plus
#Pfizer/#BioNtech
#Moderna
#Oxford/#AstraZeneca
#Sputnik5
#Sinovac - #CNBG
👇👇
Un petit thread sur les 5 vaccins dont on parle le plus
#Pfizer/#BioNtech
#Moderna
#Oxford/#AstraZeneca
#Sputnik5
#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
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 !
Il s’agit d’un vaccin à ARN : petit rappel sur le procédé avant de commencer
Spoiler : ce n'est ni nouveau ni dangereux !
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
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
2/
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.
doi.org/10.1111/tid.13…
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.
doi.org/10.1111/tid.13…
3/
#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?
#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?
#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
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
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
⚡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
3️⃣ UCB SCT
4️⃣ GVHD requiring Rx
⚡ So why not give prophylaxis to these patients ??
D-/R+ > D+/R+ > D+/ R- > D- / R -
⚡The other risk factors are
1️⃣ T cell depletion
2️⃣ HaploSCT
3️⃣ UCB SCT
4️⃣ GVHD requiring Rx
⚡ So why not give prophylaxis to these patients ??
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: researchsquare.com/article/rs-215…
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?: ncbi.nlm.nih.gov/pmc/articles/P…
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: nejm.org/doi/full/10.10… @ALNeehus @BigioBenedetta @BustamanteJaci1 @LaurentAbel4 @BoissonDupuis @BeziatV
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: ncbi.nlm.nih.gov/pmc/articles/P… 3/x
