Diagnosis and Treatment of Cytomegalovirus Infection in High Risk Patients

Human cytomegalovirus (hCMV) is a common latent virus that causes a wide range of clinical syndromes with varying severity. Infection in the majority of immunocompetent individuals is self-limited without significant complications. On the other hand, neonates are at risk of acquiring congenital CMV infection during pregnancy period. These intrauterine infections can lead to a significant morbidity, life-long sequelae, and even death. Patients with immunodeficiency need an appropriate and timely antiviral prophylaxis and therapy to prevent and treat serious hCMV diseases. There are novel and growing aspects of pathogenesis in hCMV infections and important challenges in diagnosis and treatment of such infections in various clinical settings, especially in patients undergoing transplantation and those receiving immunosuppressant drugs affecting T-cell immunity. Conducting high qualified research to respond these important controversial questions and providing and performing timely and proper laboratory tests for the early and accurate diagnosis and proper treatment demands close cooperation of medical virologists and immunologist, and physicians in different fields such as infectious diseases specialists, obstetricians, pediatricians, medical specialists and surgeons. Topics has been recently investigated in pathogenesis were the impact of CMV upon immune aging, the effect of early primed KLRG1- CMV-specific T cells on the size of the inflationary T cell pool, CMV memory inflation and immune protection, Cell Tropism, Inflammation, and Immunity in CMV Pneumonitis, the role of Caspase-8 on NK- and T cell responses during cytomegalovirus infection, and the genotypes hCMV infections in the different setting, the oncogenic role of HCMV, the effect of co-inhibitory molecules on CMV-specific T-cells (TCMV) in patients after transplantation. Some topics in diagnosis were the utility of plasma CMV microRNA detection in diagnosis, identifying factors predicting the occurrence and features of cytomegalovirus DNAemia episodes after transplantation such as the presence of IL28B rs12979860 T allele in patients, use of kinetics of biomarkers, and 5-hydroxyvitamin D Levels, and diagnostic performance of CMV immune monitoring with ELISPOT and QuantiFERON-CMV assay after transplant. Some topics regarding prevention and treatment were the use of replication-defective human CMV vaccine, the role of T cell therapy in treatment, especially the use of CD45RA+ depleted donor lymphocyte infusion in treatment of refractory cases, the role of a mini bank of donor-derived CMV-specific T cells in treatment after transplant, new antiviral drugs effective in prophylaxis and treatment, such as Letermovir. Topics regarding congenital CMV infections were the long-term hearing outcomes of children with symptomatic congenital CMV treated with valganciclovir, the role of antioxidants in the treatment of congenital CMV-related hearing loss, prevention of maternal-fetal transmission of cytomegalovirus after primary maternal infection in the first trimester by biweekly hyperimmunoglobulin administration, diagnosis of congenital CMV infection via dried blood spots (DBSs) samples testing and neonatal hearing screening, the universal vs. target screening for congenital CMV infection, assessment of knowledge of congenital CMV in pregnant women.