Cytomegalovirus infection in a splenectomized with <i>β</i>‐thalassemia major: immunocompetent or immunosuppressed?

Liatsos, George D.; Pirounaki, Maria; Лазарева, А. В.; Kikezou, Georgia; Dourakis, Spyridon P.

doi:10.1002/ccr3.1001

Cited by 4 publications

(4 citation statements)

References 7 publications

(12 reference statements)

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“…Many authors have underlined the problematic IgM response observed in primary CMV infection post-splenectomy. [16,20,21,23,25] A remarkable finding in half of our splenectomized cohort also was the low or totally absent anti-CMV IgM antibody titers, anytime tested during the disease course. Considering the numerous literature data mentioned above we could suggest 1 cardinal reason why splenectomized individuals are prone to primary CMV infection: the insufficient production of IgM antibodies in the absence of IgM IgD CD27 + subset of memory B-cells.…”

Section: Discussionmentioning

confidence: 68%

“…Another cardinal observation in our cohort that advocates the immunity defects of splenectomized against CMV is the mature B-cell lymphopenia, [17,20,24] the lowered T-helper (CD3 + CD4 + ), [17,19–25] and the increased T-cytotoxic (CD3 + CD8 + ) [17,19–21,23–25] cells, with inversion of the CD4 + /CD8 + ratio. [19–21,23–25] The post-traumatic splenectomy results in a significant and long-term reduction of the levels of CD45RA + CD4 + T-cells which characterize the subset that has been released from the thymus into the periphery but has not yet encountered an antigen (naïve). [29] Marker analysis with monoclonal antibodies of the peripheral blood of splenectomized individuals revealed normal proportions except for CD4 + and B1 (peripheral B-cells) positive cells.…”

Section: Discussionmentioning

confidence: 99%

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The immunity features and defects against primary cytomegalovirus infection post-splenectomy indicate an immunocompromised status

Liatsos

2019

Medicine

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Background:To evaluate if splenectomy results in severely impaired immune responses against primary cytomegalovirus (CMV) infection compared to the general immunocompetent population.Methods:We performed a systemic literature review to study CMV infections in splenectomized individuals, a special population group presently considered immunocompetent to viral infections. We retrieved 30 cases with established CMV infection post-splenectomy and we recorded their disease manifestations, laboratory findings, immunological studies, and histopathology reports. In addition, we retrieved numerous multidisciplinary articles in view of post-splenectomy immunology defects, as well as of immune responses to primary invading CMV in the absence of the spleen. Two clinical studies directly comparing splenectomized with nonsplenectomized individuals under severe iatrogenic immunosuppression as well as the numerically largest review articles of CMV infections in immunocompetent were retained.Results:Splenectomy results in the loss of spleen's ability to fend-off blood-borne pathogens and impairs the link between innate and adaptive immunity. The major post-splenectomy immune-defects against CMV are: weakened, delayed or absent anti-CMV IgM, and compensatory marked IgG response; severely impaired B-cell and CD4+, CD8+ T-cells function responses; and post-splenectomy, bone marrow compensates for the absence of spleen's immune responses against CMV, mimicking a monoclonal T-cell lymphoproliferative process.Conclusion:The puzzled diagnosis of the CMV syndrome post-splenectomy is of the most challenging and misleading, resulting in risky and costly interventions and a subsequent prolonged hospitalization (2 months). The mounting multi-disciplinary literature evidence renders us to suggest that splenectomized individuals are not only prone to encapsulated bacteria but also behave as immunocompromised to CMV.

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Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 99%

The immunity features and defects against primary cytomegalovirus infection post-splenectomy indicate an immunocompromised status

Liatsos

2019

Medicine

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“…All of them had a long period of high fever, severe interstitial pneumonitis with hypoxemia and marked lymphocytosis with numeral atypical lymphocytes as in our case. While writing this case report, another group published a similar case (6) by making these the first two cases of CMV pneumonitis in patients with β-thalassemia major and splenectomy.…”

Section: Textmentioning

confidence: 98%

Cytomegalovirus Pneumonitis in a Patient with Homozygous β-Thalassemia and Splenectomy

et al. 2018

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“…Previous study revealed significant correlation between CMV infection and β-thalassemia major as red blood cells transfusions in beta-thalassemia major patients increase the probability of CMV infection which in turn cause severe thalassemia complications such reduction of phagocytic and chemotaxis activity of macrophages and neutrophils, reduction in the activity of lymphocytes, and changes in cytokines stimulation (Balouchi et al, 2014). Another study showed significant seroprevalence of CMV with high incidence infection (Liatsos et al, 2017;Nigro et al, 1990).…”

Section: Fig 3: Distribution Of Igm Igg-cmv and Cmv-dna In Age Groupsmentioning

confidence: 98%

Prevalence of Cytomegalovirus and its Roles in Cytokines Stimulation in Immunocompromised Patients in Mosul City, Iraq

Mahmood¹,

AL-Ghazal²

2020

RJS

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Cytomegaloviruses (CMV) cause different infections in humans all over the world with a prevalence exceeds 70% in adults and 90% in poorer communities and developing countries. Two hundred immunocompromised patients (cancer, dialysis, thyroid gland, and thalassemia) infected with CMV were subjected to determine CMV seroprevalence and its effect on cytokines expression using advance molecular test (Real time PCR) and Serological ELISA test. The results showed high CMV seroprevalence rate in immunocompromised patients but in low rate in thalassemia patients in Mosul city compared with other cities near Iraq. CMV stimulates upregulation in expression (mRNA transcripts) of three cytokines genes (IL-10, TNF, and CCL2) which affect four key immune pathways which in turn may cause severe complication on patients such as asthma and cytokine storm.

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Cytomegalovirus infection in a splenectomized with β‐thalassemia major: immunocompetent or immunosuppressed?

Cited by 4 publications

References 7 publications

The immunity features and defects against primary cytomegalovirus infection post-splenectomy indicate an immunocompromised status

The immunity features and defects against primary cytomegalovirus infection post-splenectomy indicate an immunocompromised status

Cytomegalovirus Pneumonitis in a Patient with Homozygous β-Thalassemia and Splenectomy

Prevalence of Cytomegalovirus and its Roles in Cytokines Stimulation in Immunocompromised Patients in Mosul City, Iraq

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