Detecção de anticorpos IgM nas infecções primárias e secundárias pelo citomegalovírus em pacientes submetidos a transplante renal

Pannuti, Cláudio Sergio; Boas, Lucy Santos Vilas; Amato Neto, Vicente; Angelo, Maria José de Oliveira; Sabbaga, Emil

doi:10.1590/S0036-46651987000500009

Resumos

Foram acompanhados 27 pacientes submetidos a transplante renal para avaliação do comportamento dos anticorpos IgM e IgG CMV-específicos. Dos 27 casos estudados, 17 (63,0%) tinham anticorpos IgG, detectados pela reação de fixação de complemento (RFC), antes de serem submetidos ao transplante, e 10 (37,0%) eram soro negativos. A pesquisa de anticorpos IgM (técnica de imunofluorescência indireta) foi negativa em todas as amostras pré transplante. Num período de acompanhamento que variou de 28 a 425 dias (média de 115 dias) após o transplante, observou-se que 20 dos 27 (74,1%) apresentaram evidências sorológicas de infecçáo pelo CMV, ocorrendo a maioria dos casos (14/20, 70%) em pacientes que já tinham anticorpos para o CMV antes do transplante. A pesquisa de anticorpos IgM CMV-específicos foi positiva em 12 dos 14 pacientes com evidências sorológicas de reinfecção ou reativação da infecção pelo CMV, e em 100% (6/6) dos pacientes com infecção primária. Dentre os 10 pacientes acompanhados por mais de 4 meses, somente 1 (10%) negativou o IgM neste período.

Anticorpos IgM anti-citomegalovírus; Infecções primárias e secundarias; Transplante Renal

Twenty-seven patients who underwent renal allograft transplants were periodically screened for the presence of IgM and IgG cytomegalovirus (CMV) antibodies. Before transplantation, 17 (63%) had IgG antibodies by complement fixation and 10 (37%) were seronegative. Immunofluorescent IgM CMV-antibodies were absent in all pre-transplant sera. During a follow-up period of 28 to 425 days (median of 115 days), 20 (74%) developed serologic evidence of CMV infection. Of these, 6 (30%) were primary and 14 (70%) secondary (reactivation or reinfection). IF-IgM antibodies were seen in 12 out of 14 patients with secondary CMV infection and in all patients with primary infection. IgM antibodies became negative in one out of 10 IgM-positive patients who were followed-up for 4 months or more.

ARTIGOS ORIGINAIS

Cláudio Sergio Pannuti^I; Lucy Santos Vilas Boas^I; Vicente Amato Neto^I; Maria José de Oliveira Angelo^II; Emil Sabbaga^III

^IInstituto de Medicina Tropical de São Paulo: Laboratórios de Investigação Médica HC FMUSP Av. Dr. Eneas de Carvalho Aguiar, 470. 05403 São Paulo, SP - Brasil

^IIInstituto de Ciências Biomédicas da Universidade de São Paulo

^IIIUnidade de Transplante Renal do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo

RESUMO

Foram acompanhados 27 pacientes submetidos a transplante renal para avaliação do comportamento dos anticorpos IgM e IgG CMV-específicos.

Dos 27 casos estudados, 17 (63,0%) tinham anticorpos IgG, detectados pela reação de fixação de complemento (RFC), antes de serem submetidos ao transplante, e 10 (37,0%) eram soro negativos. A pesquisa de anticorpos IgM (técnica de imunofluorescência indireta) foi negativa em todas as amostras pré transplante. Num período de acompanhamento que variou de 28 a 425 dias (média de 115 dias) após o transplante, observou-se que 20 dos 27 (74,1%) apresentaram evidências sorológicas de infecçáo pelo CMV, ocorrendo a maioria dos casos (14/20, 70%) em pacientes que já tinham anticorpos para o CMV antes do transplante. A pesquisa de anticorpos IgM CMV-específicos foi positiva em 12 dos 14 pacientes com evidências sorológicas de reinfecção ou reativação da infecção pelo CMV, e em 100% (6/6) dos pacientes com infecção primária. Dentre os 10 pacientes acompanhados por mais de 4 meses, somente 1 (10%) negativou o IgM neste período.

Unitermos: Anticorpos IgM anti-citomegalovírus; Infecções primárias e secundarias; Transplante Renal.

SUMMARY

Twenty-seven patients who underwent renal allograft transplants were periodically screened for the presence of IgM and IgG cytomegalovirus (CMV) antibodies.

Before transplantation, 17 (63%) had IgG antibodies by complement fixation and 10 (37%) were seronegative. Immunofluorescent IgM CMV-antibodies were absent in all pre-transplant sera.

During a follow-up period of 28 to 425 days (median of 115 days), 20 (74%) developed serologic evidence of CMV infection. Of these, 6 (30%) were primary and 14 (70%) secondary (reactivation or reinfection). IF-IgM antibodies were seen in 12 out of 14 patients with secondary CMV infection and in all patients with primary infection.

IgM antibodies became negative in one out of 10 IgM-positive patients who were followed-up for 4 months or more.

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REFERÊNCIAS BIBLIOGRÁFICAS 2. BACH, M. C; BAGWELL, S. P.; KNAPP, N. P.; DAVIS, K. M. & HEDSTROM, P. S. - 9 (1,3-dihydroxy-2-propoxy methyl) guanine for acquired immunodeficiency syndrome. Ann. Intern. Med., 103: 381-382, 1985. 3. BETTS, R. F.; FREEMAN, R. B.; DOUGLAS JR., R. G. & TALLEY, T. E. - Clinical manifestations of renal allograft derived primary cytomegalovirus infection. Amer. J. Dis. Child., 131: 759-763, 19774. CHATTERJEE, S. N.; FIALA, M.; WEINER, J.; STEWART, J. A.; STACEY, B. & WARNER, N. - Primary cytomegalovirus and opportunistic infections. Incidence in renal transplant recipients. J. Amer. med. Ass., 240: 2446-2449, 1978. 5. COLLABORATIVE DHPG TREATMENT STUDY GROUP - Treatment of serious cytomegalovirus infections with 9-(1, 3 dihydroxy-2 propoxymethyl) guanine in patients with AIDS and other immunodeficiencies. New Engl. J. Med., 314: 801-805, 1986. 6. FELSENTEIN, D., D'AMICO, D. J., HIRSCH, M. S., NEUMEYER, D. A.; CEDERBERG, D. M.; MIRANDA, P. & SCHOOLEY. R. T. - Treatment of cytomegalovirus retinitis with 9- \ 2-hydroxy-1-(hydroxymethyl) ethoxymethyl guanine. Ann. intern. Med., 103: 377-380, 1985. 7. FRYD, D. S., PETERSON, P. K., FERGUSON, R. M.; SIMMONS, R. L.; BALFOUR JR., H. H. & NAJARIAN, J. S. - Cytomegalovirus as a risk factor in renal transplantation . Transplantation, 30: 436-439, 1980. 8. GLENN, J. - Cytomegalovirus infections following renal transplantation. Rev. infec. Dis., 3: 1151-1178, 1981. 9. HANSHAW, J. B.; NIEDERMAN, J. C. & CHESSIN, L. N. - Cytomegalovirus macroglobulin in cell-associated herpevirus infections. J. infect. Dis., 125: 304 306, 1972. 10. HANSHAW, J. B.; STEINFELD, H. J. & WHITE, C. J. - Fluorescent-antibody test for cytomegalovirus macroglobulin. New Engl. J. med., 279: 566-570, 1968. 11. HEKKER, A. C.; BRAND-SAATHOF, B.; VIS, J. & MEIJERS, R. C. - Indirect immunofluorescence test for detection of IgM antibodies to cytomegalovirus. J. infect. Dis., 140: 596, 600, 1979. 12. HENLE, G. & HENLE, W. - Immunofluorescence in cells derived from Burkitt's lymphoma. J. Bact., 91: 1248-1256, 1966. 13. HO, M. - Human cytomegalovirus infections in immuno supressed patients. In: HO, M. - Cytomegalovirus: biology and infection. New York, Plenum Medical Book Company, 1982. p. 171-204. 14. HO, M.; SUWANSIRIKUL, S.; DOWLING, J. N.; YOUNG-BLOOD , L. A. & ARMSTRONG, J. A. - The transplanted kidney as a source of cytomegalovirus infection. New Engl. J. Med., 293: 1109-1112, 1975. 15. IANHEZ, L. E.; SARTURI, P. S.; PAULA, F. J. & SABBAGA, E. - Infecçáo por citomegalovírus pós-transplante renal. Rev. Hosp. Clin. Fac. Med. S. Paulo, 39: 47-53, 198416. KANGRO, H. O. - Evaluation of a radioimmunoassay for IgM-class antibodies against cytomegalovirus. Brit. J. exp. Path., 61: 512-520, 1980. 17. KLINTMALM, G.; LONNQVIST, B.; OBERG.; GAHRTON, G.; LERNESTEDT, J-O., LUNDGREN, G.; RINGDEN, O.; ROBERT, K-H.; WAHREN, B. & GROTH, C-G. - Intravenous foscarnet for the treatment of severe cytomegalovirus infection in allograft recipients. Scand. J. infect. Dis., 17: 157-163, 1985. 18. KNEZ, V.; STEWART, J. A. & ZIEGLER, D. W. - Cytomegalovirus specific IgM and IgG response inhumans studies by radioimmunoassay. J. Immunol., 117: 2006-2013, 1976. 19. LANGEHUYSEN, M. M. A. C; THE, T. H.; NIEWEG, H. O. & KAPSENBERG, J. G. - Demonstration of IgM cytomegalovirus antibodies as an aid to early diagnosis in adults. Clin. exp. Immunol., 6: 387-393, 1970.

20. LINNEMANN JR., C. C; DUNN, C. R.; FIRST, M. R.; ALVIRA, M. & SCHIFF, G. M. - Late onset of fatal cytomegalovirus infection after renal transplantation. Arch. intern. Med., 138: 1247-1250, 1978.

21. MASUR, H.; LANE, H. C; PALESTINE, A.; SMITH, P. D.; MANISCHEWITZ, J.; STEVENS, G.; FUJIKAWA, L.; MACHER, A. M., NUSSENBLATT, R.; BAIRD, B ; MEGILL, M.; WITTEK, A.; QUINNANN, G. V.; PARRILLO, J. E.; ROOK, A. H.; ERON, L. J.; PORETZ, D. M.; GOLDENBERG, R. I.; FAUCI, A. S. & GELMANN, E. P. - Effect of 9 (1,3-dihydroxy-2-propoxymethyl) guanine on serious cytomegalovirus disease in eight immunosuppressed homosexual men. Ann. intern. Med., 104: 41-44, 1986.

22. NAGINGTON, J. - Cytomegalovirus antibody production in renal transplant patients. J. Hyg. (Lond.), 69: 645-660, 1971.

23. PANNUTI, C. S.; CARVALHO, R. P. S.; AMATO NETO , V.; SABBAGA, E. & ANGELO, M. J. O. - Infecções por virus do grupo Herpes em pacientes submetidos a transplante renal. Rev. Inst. Med. trop. S. Paulo, 20: 353-358, 1978.

24. PANNUTI, C. S.; STEWIEN, K. E.; CARVALHO, R. P. S.; MIRANDA, M. N.; ÂNGELO, M. J. O.; VILAS BOAS, L. S. & AMATO NETO, V. - Síndrome "mononucleose simile" na infância. Incidência da infecçáo por citomegalovírus diagnosticado através da detecção imunoenzimática de anticorpos IgM. Rev. Inst. Med. trop. S. Paulo, 25: 300-304, 1983.

25. PANNUTI, C. S., VILAS BOAS, L. S.; ANGELO, M. J. O.; AMATO NETO, V.; LEVI, G. C; MENDONÇA, J. S. & GODOY, C. V. F. - Cytomegalovirus mononucleosis in children and adults differences in clinical presentation. Scand. J. infect. Dis., 17: 153-156, 1985

26. PASS, R. F.; GRIFFITHS, P. D. & AUGUST, A. M. - Antibody response of cytomegalovirus after renal transplantation: comparison of patients with primary and recurrent infections. J. infect. Dis., 147: 40-46, 1983.

27. SHEP, D. H.; DANDLIKER, P. S.; MIRANDA, P.; BURNETTE, T. C; CEDERBERG, D. M.; KIRK, L. E. & MEYERS, J. D. - Activity of 9-|2 hydroxy 1 (hydroxymethyl) ethoxymethyl guanine in the treatment of cy tomegalovirus pneumonia. Ann. intern. Med., 103: 368-373, 1985.

28. SHIRODARIA, P. V.; FRASER, K. B. & STANFORD, F. - Secondary fluorescent staining of virus antigens by rheumatoid factor and fluorescein-conjugated anti-IgM. Ann. rheum. Dis., 32: 53-57, 1973.

29. SPENCER, E. S. - Clinical aspects of cytomegalovirus infection in kidney-graft recipients. Scand. J. infect, Dis., 6: 315-323, 1974.

30. SUWANSIRIKUL, S.; RAO, N.; DOWLING, J. N. & HO, M. - Primary and secondary cytomegalovirus infection. Clinical manifestations after renal transplantation. Arch. intern. Med., 137: 1026-1029, 1977.

31. WINSTON, D. J.; HUANG, E-S.; MILLER, M. J.; LIN, C-H.; HO, W. G.; GALE, R. P. & CHAMPLIN, R. E. - Molecular epidemiology of cytomegalovirus infections associated with bone marrow transplantation. Ann. intern. Med., 102: 16-20, 1985.

Recebido para publicação em 08/07/87.

REFERÊNCIAS BIBLIOGRÁFICAS 1. APPERLEY, J. F.; MARCUS, R. E.; GOLDMAN, J. M.; WARDLE, D. G.; GRAVETT, P. J. & CHANAS, A. - Fos carnet for cytomegalovirus pneumonitis. Lancet, 1: 1151, 1985.
2. BACH, M. C; BAGWELL, S. P.; KNAPP, N. P.; DAVIS, K. M. & HEDSTROM, P. S. - 9 (1,3-dihydroxy-2-propoxy methyl) guanine for acquired immunodeficiency syndrome. Ann. Intern. Med., 103: 381-382, 1985.
3. BETTS, R. F.; FREEMAN, R. B.; DOUGLAS JR., R. G. & TALLEY, T. E. - Clinical manifestations of renal allograft derived primary cytomegalovirus infection. Amer. J. Dis. Child., 131: 759-763, 19774.
CHATTERJEE, S. N.; FIALA, M.; WEINER, J.; STEWART, J. A.; STACEY, B. & WARNER, N. - Primary cytomegalovirus and opportunistic infections. Incidence in renal transplant recipients. J. Amer. med. Ass., 240: 2446-2449, 1978.
5. COLLABORATIVE DHPG TREATMENT STUDY GROUP - Treatment of serious cytomegalovirus infections with 9-(1, 3 dihydroxy-2 propoxymethyl) guanine in patients with AIDS and other immunodeficiencies. New Engl. J. Med., 314: 801-805, 1986.
6. FELSENTEIN, D., D'AMICO, D. J., HIRSCH, M. S., NEUMEYER, D. A.; CEDERBERG, D. M.; MIRANDA, P. & SCHOOLEY. R. T. - Treatment of cytomegalovirus retinitis with 9- \ 2-hydroxy-1-(hydroxymethyl) ethoxymethyl guanine. Ann. intern. Med., 103: 377-380, 1985.
7. FRYD, D. S., PETERSON, P. K., FERGUSON, R. M.; SIMMONS, R. L.; BALFOUR JR., H. H. & NAJARIAN, J. S. - Cytomegalovirus as a risk factor in renal transplantation . Transplantation, 30: 436-439, 1980.
8. GLENN, J. - Cytomegalovirus infections following renal transplantation. Rev. infec. Dis., 3: 1151-1178, 1981.
9. HANSHAW, J. B.; NIEDERMAN, J. C. & CHESSIN, L. N. - Cytomegalovirus macroglobulin in cell-associated herpevirus infections. J. infect. Dis., 125: 304 306, 1972.
10. HANSHAW, J. B.; STEINFELD, H. J. & WHITE, C. J. - Fluorescent-antibody test for cytomegalovirus macroglobulin. New Engl. J. med., 279: 566-570, 1968.
11. HEKKER, A. C.; BRAND-SAATHOF, B.; VIS, J. & MEIJERS, R. C. - Indirect immunofluorescence test for detection of IgM antibodies to cytomegalovirus. J. infect. Dis., 140: 596, 600, 1979.
12. HENLE, G. & HENLE, W. - Immunofluorescence in cells derived from Burkitt's lymphoma. J. Bact., 91: 1248-1256, 1966.
13. HO, M. - Human cytomegalovirus infections in immuno supressed patients. In: HO, M. - Cytomegalovirus: biology and infection. New York, Plenum Medical Book Company, 1982. p. 171-204.
14. HO, M.; SUWANSIRIKUL, S.; DOWLING, J. N.; YOUNG-BLOOD , L. A. & ARMSTRONG, J. A. - The transplanted kidney as a source of cytomegalovirus infection. New Engl. J. Med., 293: 1109-1112, 1975.
15. IANHEZ, L. E.; SARTURI, P. S.; PAULA, F. J. & SABBAGA, E. - Infecçáo por citomegalovírus pós-transplante renal. Rev. Hosp. Clin. Fac. Med. S. Paulo, 39: 47-53, 198416.
KANGRO, H. O. - Evaluation of a radioimmunoassay for IgM-class antibodies against cytomegalovirus. Brit. J. exp. Path., 61: 512-520, 1980.
17. KLINTMALM, G.; LONNQVIST, B.; OBERG.; GAHRTON, G.; LERNESTEDT, J-O., LUNDGREN, G.; RINGDEN, O.; ROBERT, K-H.; WAHREN, B. & GROTH, C-G. - Intravenous foscarnet for the treatment of severe cytomegalovirus infection in allograft recipients. Scand. J. infect. Dis., 17: 157-163, 1985.
18. KNEZ, V.; STEWART, J. A. & ZIEGLER, D. W. - Cytomegalovirus specific IgM and IgG response inhumans studies by radioimmunoassay. J. Immunol., 117: 2006-2013, 1976.
19. LANGEHUYSEN, M. M. A. C; THE, T. H.; NIEWEG, H. O. & KAPSENBERG, J. G. - Demonstration of IgM cytomegalovirus antibodies as an aid to early diagnosis in adults. Clin. exp. Immunol., 6: 387-393, 1970.
20. LINNEMANN JR., C. C; DUNN, C. R.; FIRST, M. R.; ALVIRA, M. & SCHIFF, G. M. - Late onset of fatal cytomegalovirus infection after renal transplantation. Arch. intern. Med., 138: 1247-1250, 1978.
21. MASUR, H.; LANE, H. C; PALESTINE, A.; SMITH, P. D.; MANISCHEWITZ, J.; STEVENS, G.; FUJIKAWA, L.; MACHER, A. M., NUSSENBLATT, R.; BAIRD, B ; MEGILL, M.; WITTEK, A.; QUINNANN, G. V.; PARRILLO, J. E.; ROOK, A. H.; ERON, L. J.; PORETZ, D. M.; GOLDENBERG, R. I.; FAUCI, A. S. & GELMANN, E. P. - Effect of 9 (1,3-dihydroxy-2-propoxymethyl) guanine on serious cytomegalovirus disease in eight immunosuppressed homosexual men. Ann. intern. Med., 104: 41-44, 1986.
22. NAGINGTON, J. - Cytomegalovirus antibody production in renal transplant patients. J. Hyg. (Lond.), 69: 645-660, 1971.
23. PANNUTI, C. S.; CARVALHO, R. P. S.; AMATO NETO , V.; SABBAGA, E. & ANGELO, M. J. O. - Infecções por virus do grupo Herpes em pacientes submetidos a transplante renal. Rev. Inst. Med. trop. S. Paulo, 20: 353-358, 1978.
24. PANNUTI, C. S.; STEWIEN, K. E.; CARVALHO, R. P. S.; MIRANDA, M. N.; ÂNGELO, M. J. O.; VILAS BOAS, L. S. & AMATO NETO, V. - Síndrome "mononucleose simile" na infância. Incidência da infecçáo por citomegalovírus diagnosticado através da detecção imunoenzimática de anticorpos IgM. Rev. Inst. Med. trop. S. Paulo, 25: 300-304, 1983.
25. PANNUTI, C. S., VILAS BOAS, L. S.; ANGELO, M. J. O.; AMATO NETO, V.; LEVI, G. C; MENDONÇA, J. S. & GODOY, C. V. F. - Cytomegalovirus mononucleosis in children and adults differences in clinical presentation. Scand. J. infect. Dis., 17: 153-156, 1985
26. PASS, R. F.; GRIFFITHS, P. D. & AUGUST, A. M. - Antibody response of cytomegalovirus after renal transplantation: comparison of patients with primary and recurrent infections. J. infect. Dis., 147: 40-46, 1983.
27. SHEP, D. H.; DANDLIKER, P. S.; MIRANDA, P.; BURNETTE, T. C; CEDERBERG, D. M.; KIRK, L. E. & MEYERS, J. D. - Activity of 9-
28. SHIRODARIA, P. V.; FRASER, K. B. & STANFORD, F. - Secondary fluorescent staining of virus antigens by rheumatoid factor and fluorescein-conjugated anti-IgM. Ann. rheum. Dis., 32: 53-57, 1973.
29. SPENCER, E. S. - Clinical aspects of cytomegalovirus infection in kidney-graft recipients. Scand. J. infect, Dis., 6: 315-323, 1974.
30. SUWANSIRIKUL, S.; RAO, N.; DOWLING, J. N. & HO, M. - Primary and secondary cytomegalovirus infection. Clinical manifestations after renal transplantation. Arch. intern. Med., 137: 1026-1029, 1977.
31. WINSTON, D. J.; HUANG, E-S.; MILLER, M. J.; LIN, C-H.; HO, W. G.; GALE, R. P. & CHAMPLIN, R. E. - Molecular epidemiology of cytomegalovirus infections associated with bone marrow transplantation. Ann. intern. Med., 102: 16-20, 1985.

Detecção de anticorpos IgM nas infecções primárias e secundárias pelo citomegalovírus em pacientes submetidos a transplante renal

Specific IgM antibodies in primary and secundary cytomegalovirus infections after renal transplantation

Datas de Publicação

Publicação nesta coleção
17 Fev 2011
Data do Fascículo
Out 1987

Histórico

Recebido
08 Jul 1987

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] REFERÊNCIAS BIBLIOGRÁFICAS 1. APPERLEY, J. F.; MARCUS, R. E.; GOLDMAN, J. M.; WARDLE, D. G.; GRAVETT, P. J. & CHANAS, A. - Fos carnet for cytomegalovirus pneumonitis. Lancet, 1: 1151, 1985.

[2] 2. BACH, M. C; BAGWELL, S. P.; KNAPP, N. P.; DAVIS, K. M. & HEDSTROM, P. S. - 9 (1,3-dihydroxy-2-propoxy methyl) guanine for acquired immunodeficiency syndrome. Ann. Intern. Med., 103: 381-382, 1985.

[3] 3. BETTS, R. F.; FREEMAN, R. B.; DOUGLAS JR., R. G. & TALLEY, T. E. - Clinical manifestations of renal allograft derived primary cytomegalovirus infection. Amer. J. Dis. Child., 131: 759-763, 19774.

[4] CHATTERJEE, S. N.; FIALA, M.; WEINER, J.; STEWART, J. A.; STACEY, B. & WARNER, N. - Primary cytomegalovirus and opportunistic infections. Incidence in renal transplant recipients. J. Amer. med. Ass., 240: 2446-2449, 1978.

[5] 5. COLLABORATIVE DHPG TREATMENT STUDY GROUP - Treatment of serious cytomegalovirus infections with 9-(1, 3 dihydroxy-2 propoxymethyl) guanine in patients with AIDS and other immunodeficiencies. New Engl. J. Med., 314: 801-805, 1986.

[6] 6. FELSENTEIN, D., D'AMICO, D. J., HIRSCH, M. S., NEUMEYER, D. A.; CEDERBERG, D. M.; MIRANDA, P. & SCHOOLEY. R. T. - Treatment of cytomegalovirus retinitis with 9- \ 2-hydroxy-1-(hydroxymethyl) ethoxymethyl guanine. Ann. intern. Med., 103: 377-380, 1985.

[7] 7. FRYD, D. S., PETERSON, P. K., FERGUSON, R. M.; SIMMONS, R. L.; BALFOUR JR., H. H. & NAJARIAN, J. S. - Cytomegalovirus as a risk factor in renal transplantation . Transplantation, 30: 436-439, 1980.

[8] 8. GLENN, J. - Cytomegalovirus infections following renal transplantation. Rev. infec. Dis., 3: 1151-1178, 1981.

[9] 9. HANSHAW, J. B.; NIEDERMAN, J. C. & CHESSIN, L. N. - Cytomegalovirus macroglobulin in cell-associated herpevirus infections. J. infect. Dis., 125: 304 306, 1972.

[10] 10. HANSHAW, J. B.; STEINFELD, H. J. & WHITE, C. J. - Fluorescent-antibody test for cytomegalovirus macroglobulin. New Engl. J. med., 279: 566-570, 1968.

[11] 11. HEKKER, A. C.; BRAND-SAATHOF, B.; VIS, J. & MEIJERS, R. C. - Indirect immunofluorescence test for detection of IgM antibodies to cytomegalovirus. J. infect. Dis., 140: 596, 600, 1979.

[12] 12. HENLE, G. & HENLE, W. - Immunofluorescence in cells derived from Burkitt's lymphoma. J. Bact., 91: 1248-1256, 1966.

[13] 13. HO, M. - Human cytomegalovirus infections in immuno supressed patients. In: HO, M. - Cytomegalovirus: biology and infection. New York, Plenum Medical Book Company, 1982. p. 171-204.

[14] 14. HO, M.; SUWANSIRIKUL, S.; DOWLING, J. N.; YOUNG-BLOOD , L. A. & ARMSTRONG, J. A. - The transplanted kidney as a source of cytomegalovirus infection. New Engl. J. Med., 293: 1109-1112, 1975.

[15] 15. IANHEZ, L. E.; SARTURI, P. S.; PAULA, F. J. & SABBAGA, E. - Infecçáo por citomegalovírus pós-transplante renal. Rev. Hosp. Clin. Fac. Med. S. Paulo, 39: 47-53, 198416.

[16] KANGRO, H. O. - Evaluation of a radioimmunoassay for IgM-class antibodies against cytomegalovirus. Brit. J. exp. Path., 61: 512-520, 1980.

[17] 17. KLINTMALM, G.; LONNQVIST, B.; OBERG.; GAHRTON, G.; LERNESTEDT, J-O., LUNDGREN, G.; RINGDEN, O.; ROBERT, K-H.; WAHREN, B. & GROTH, C-G. - Intravenous foscarnet for the treatment of severe cytomegalovirus infection in allograft recipients. Scand. J. infect. Dis., 17: 157-163, 1985.

[18] 18. KNEZ, V.; STEWART, J. A. & ZIEGLER, D. W. - Cytomegalovirus specific IgM and IgG response inhumans studies by radioimmunoassay. J. Immunol., 117: 2006-2013, 1976.

[19] 19. LANGEHUYSEN, M. M. A. C; THE, T. H.; NIEWEG, H. O. & KAPSENBERG, J. G. - Demonstration of IgM cytomegalovirus antibodies as an aid to early diagnosis in adults. Clin. exp. Immunol., 6: 387-393, 1970.

[20] 20. LINNEMANN JR., C. C; DUNN, C. R.; FIRST, M. R.; ALVIRA, M. & SCHIFF, G. M. - Late onset of fatal cytomegalovirus infection after renal transplantation. Arch. intern. Med., 138: 1247-1250, 1978.

[21] 21. MASUR, H.; LANE, H. C; PALESTINE, A.; SMITH, P. D.; MANISCHEWITZ, J.; STEVENS, G.; FUJIKAWA, L.; MACHER, A. M., NUSSENBLATT, R.; BAIRD, B ; MEGILL, M.; WITTEK, A.; QUINNANN, G. V.; PARRILLO, J. E.; ROOK, A. H.; ERON, L. J.; PORETZ, D. M.; GOLDENBERG, R. I.; FAUCI, A. S. & GELMANN, E. P. - Effect of 9 (1,3-dihydroxy-2-propoxymethyl) guanine on serious cytomegalovirus disease in eight immunosuppressed homosexual men. Ann. intern. Med., 104: 41-44, 1986.

[22] 22. NAGINGTON, J. - Cytomegalovirus antibody production in renal transplant patients. J. Hyg. (Lond.), 69: 645-660, 1971.

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