Incidence of Cytomegalovirus Antigenemia in patients with autoimmune rheumatic diseases: a 3-year retrospective study

Abstract

Objective: To determine the incidence of positive CMV antigenemia (CMV-Ag) in patients with autoimmune rheumatic diseases (AIRD) and to describe the outcomes of these patients. Methods: From January 2011 to December 2014, a total of 443 patients with AIRD were enrolled in this retrospective analysis. Demographic, clinical and laboratory data, current clinical manifestations, organs affected by CMV infection, therapeutic management and outcomes were evaluated. The CMV-Ag was considered positive when one cell was detected at least. Results: CMV-Ag was requested in 70 (15.8%) patients with suspicious CMV infection and was positive in 24 (34. 3%). The incidence rate of positive CMV-Ag was 4.97% (95% CI 3.1-7.4%). Systemic lupus erythematosus (SLE) (59%), followed by ANCA-related vasculitis (18.2%) and rheumatoid arthritis (9%) were the diseases more associated with positive CMV-Ag. At the time of CMV infection, SLE patients had moderate to severe disease activity, with high frequency of positive anti-dsDNA antibody (69.2%) and complement consumption (61.5%), as well as high doses of corticosteroids and use of immunosuppressants. The main CMV sites involved were lung (45.5%), bone marrow (40. 9%) and gut (27.3%). Mortality rate was 45.5%, especially in those with higher doses of daily oral corticosteroids (107 ± 55.4 mg vs. 71.7 ± 46.3 mg; p = 0.07) and lower number of lymphocytes (309 ± 368.2/mm 3 vs. 821 ± 692.9/ mm 3 ; p = 0.06). Conclusions: Our data showed high incidence of CMV-Ag in AIRD patients, particularly those with SLE and greater disease severity. In addition, it was observed high mortality in these patients, highlighting the CMV infection should be included in differential diagnosis.

Repertoire characterization and validation of gB-specific human IgGs directly cloned from humanized mice vaccinated with dendritic cells and protected against HCMV

“…This implied that gB-specific responses spared T cells from HCMV chronicity-generated over-activation or exhaustion, previously observed in our HIS/HCMV model [ 16 ] and seen in patient-based studies [ 40 ]. Further, HCMV has been implicated with the onset and severity of autoimmune diseases, for instance rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE) [ 41 ] and autoantibodies can play an essential role in disease progression [ 42 , 43 ]. Using immune fluorescence analyses, we showed that the majority of the HIS mice protected against HCMV reactivation after iDCgB immunization rarely developed auto-reactivity, whereas non-protected mice showing HCMV reactivation showed frequently signs of humoral auto-immunity.…”

Association between mortality and cytomegalovirus reactivation during remission induction therapy in patients with rheumatic diseases

“…CMV reactivation is a highly problematic opportunistic infection that occurs in patients with rheumatic diseases undergoing intensive immunosuppressive treatment. The incidence of CMV reactivation in immunosuppressed patients with rheumatic diseases is 31-50%, which varies depending on the patient's background, treatment regimen, and diagnostic methods for CMV (5)(6)(7)(8)(9). While there is significant evidence on CMV reactivation in transplant patients and patients infected with human immunodeficiency virus, little is known about the risk and optimal management for CMV reactivation and disease in patients with rheumatic disease (7)(8)(9).…”

“…The incidence of CMV reactivation in immunosuppressed patients with rheumatic diseases is 31-50%, which varies depending on the patient's background, treatment regimen, and diagnostic methods for CMV (5)(6)(7)(8)(9). While there is significant evidence on CMV reactivation in transplant patients and patients infected with human immunodeficiency virus, little is known about the risk and optimal management for CMV reactivation and disease in patients with rheumatic disease (7)(8)(9). The aim of this study is to clarify the characteristics of patients with rheumatic diseases with CMV reactivation.…”

Factors associated with cytomegalovirus antigenemia in patients with rheumatic disease: A retrospective study

“…In patients with rheumatic diseases, CMV infection is a major opportunistic infection with high morbidity and mortality rates [15,16]. Reported risk factors of CMV reactivation in patients with rheumatic diseases include low lymphocyte count, hypoalbuminemia, high CMV antigen-positive cell count, systemic lupus erythematosus (SLE), dermatomyositis/polymyositis (DM/PM), antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis, immunosuppressive therapy, daily oral corticosteroids, steroid pulse therapy, intravenous cyclophosphamide, oral candida, and pneumocystis pneumonia [17][18][19][20][21][22]. Various factors have been identified; however, further studies are required to fully understand CMV reactivation.…”