New strategies for prevention and therapy of cytomegalovirus infection and disease in solid-organ transplant recipients

Abstract

In the past three decades since the inception of human organ transplantation, cytomegalovirus (CMV) has gained increasing clinical import because it is a common pathogen in the immunocompromised transplant recipient. Patients may suffer from severe manifestations of this infection along with the threat of potential fatality. Additionally, the dynamic evolution of immunosuppressive and antiviral agents has brought forth changes in the natural history of CMV infection and disease. Transplant physicians now face the daunting task of recognizing and managing the changing spectrum of CMV infection and its consequences in the organ recipient. For the microbiology laboratory, the emphasis has been geared toward the development of more sophisticated detection assays, including methods to detect emerging antiviral resistance. The discovery of novel antiviral chemotherapy is an important theme of clinical research. Investigations have also focused on preventative measures for CMV disease in the solid-organ transplant population. In all, while much has been achieved in the overall management of CMV infection, the current understanding of CMV pathogenesis and therapy still leaves much to be learned before success can be claimed.

FIG. 1

CMV is visualized by the in situ hybridization technique on a sample of lung tissue.

FIG. 2

On a standard cell culture inoculated onto a human fibroblast monolayer at 37°C, CMV characteristically exhibits cytopathic effects, appearing as foci of flat, swollen cells.

FIG. 3

Detection of CMV-specific early-antigen fluorescent foci in the shell vial assay indicates the presence of the virus.

FIG. 4

Expression of CMV pp65 antigen in polymorphonuclear leukocytes on a cytospin slide detected by immunoperoxidase staining. Courtesy of K. St. George and C. Rinaldo, University of Pittsburgh Medical Center.