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Journal of Venomous Animals and Toxins including Tropical Diseases

On-line version ISSN 1678-9199

J. Venom. Anim. Toxins incl. Trop. Dis vol.13 no.4 Botucatu  2007

http://dx.doi.org/10.1590/S1678-91992007000400016 

SHORT COMMUNICATION

 

Cytomegalovirus and Toxoplasma gondii seroprevalence in a Brazilian liver transplant waiting list

 

 

Almeida R. A. M. B.I, II; Silva G. F.I; Llanos J. C.I; Winckler C. C.I; Gomes M. R. B.I; Biagioni D. S.I; Paula R. C. C.I; Meira D. A.II; Bakonyi A.I

IDivision of Liver and Pancreas Transplantation, Clinic Hospital, Botucatu Medical School, São Paulo State University, UNESP, Botucatu, São Paulo State, Brazil
IIDepartment of Tropical Diseases and Imaging Diagnosis, Botucatu Medical School, UNESP, Botucatu, São Paulo State, Brazil

Correspondence to

 

 


ABSTRACT

Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality in solid organ transplantation. Disseminated toxoplasmosis after liver transplantation is a rare but fatal event. Serologic screening of the donor and the recipient is essential to prophylactic management, early diagnosis and therapeutic strategies to minimize the consequences of these infections. The aim of the present study was to determine the seroprevalence of CMV and Toxoplasma gondii (TG) in a Brazilian liver transplant waiting list (LTWL). Serological data were collected from 44 candidates on the LTWL between May 2003 and November 2004. Serological investigation of antibodies IgM and IgG against CMV (anti-CMV) and TG (anti-T. gondii) was performed using fluorometry commercial kits. IgG anti-CMV was positive in 37 patients (94.9%) out of 39 available results. There were not IgM anti-CMV positive results. Out of 36 analyzed patients, 22 (61.1%) presented positive IgG anti-T. gondii and none had positive IgM anti-T. gondii. The high CMV seroprevalence among our LTWL reinforces the need for appropriate protocols to avoid related complications, like reactivation and superinfection by CMV. Environmental and drug prophylactic strategies against primary infection and reactivation, as well as early diagnosis and treatment of toxoplasmosis complications, are essential for the good outcome of transplant patients.

Key words: Cytomegalovirus, liver transplantation, toxoplasmosis, Toxoplasma gondii, seroprevalence, waiting list.


 

 

INTRODUCTION

Cytomegalovirus (CMV) disease is a major cause of morbidity and mortality in solid organ transplantation. It is also associated with an increased risk of opportunistic infections, allograft injury and also seems to increase the risk of acute and chronic allograft rejection (6). Disseminated toxoplasmosis after liver transplantation is a rare event but in most cases results in a fatal outcome (4). CMV and Toxoplasma gondii (TG) infection complications have been due to primary infection or superinfection from a latently infected donor organ or to reactivation of latent organisms in a seropositive recipient. CMV can also be acquired from blood products (8, 9). Serologic screening of donor and recipient, previous to the transplant, is essential to prophylactic management, early diagnosis and therapeutic strategies to minimize the consequences of these infections (11). The aim of this study was to determine the seroprevalence of CMV and TG among our liver transplant waiting list (LTWL).

Serological data were collected from 44 candidates included on the Brazilian LTWL attended by the Division of Liver and Pancreas Transplantation of Botucatu Medical School Clinic Hospital, São Paulo State University – UNESP, Botucatu, São Paulo State, Brazil (22º 52' 48"S, 48º27' 00" W), between May 2003 and November 2004. Thirty-seven (84%) were men, with an overall mean age of 51.3 years (from 32 to 68 years). The income level was less than US$ 1560.00 per year per patient in 18 (40.9%) subjects. Analysis of antibodies IgM and IgG against CMV (anti-CMV) and TG (anti-T.gondii) was performed with fluorimetry commercial kits. We used the results of the last serological samples obtained near the period of inclusion in the waiting list.

Thirty-nine (88.6%) patients had IgG anti-CMV test performed and it was positive in 37 (94.9%) of them. IgM anti-CMV was available for 38 patients (86.4%), and all of them had negative results. IgG and IgM anti-T.gondii were analyzed in 36 patients (81.8%). Twenty-two patients (61.1%) presented positive IgG anti-T. gondii and none had positive IgM anti-T. gondii, according to Table 1.

 

 

The high CMV seroprevalence among our LTWL was similar to that observed in Brazilian community (1). Seroprevalence was higher than in developed countries, which is probably related to the socioeconomic milieu (7, 12). These results reinforce the need for appropriate protocols to avoid related complications, like reactivation and superinfection by CMV, and to guarantee rational and universal use of more efficient drugs. TG seropositivity was not as high as that evidenced in Europe but it was not as low as of the USA (11). Positivity index was similar to that of other Brazilian population groups and it was lower than that found in chronic renal failure candidates for renal transplant (5, 10). Environmental and drug prophylactic strategies against primary infection and reactivation, as well as early diagnosis and treatment of toxoplasmosis complications are essential for the good outcome of transplant patients (2-4, 11).

 

REFERENCES

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10 REY LC., RAMALHO ILC. Seroprevalence of toxoplasmosis in Fortaleza, Ceará, Brazil. Rev. Inst. Med. Trop. São Paulo, 1999, 41, 171-4.         [ Links ]

11 SCREENING OF DONOR AND RECIPIENT PRIOR TO SOLID ORGAN TRANSPLANTATION. Am. J. Transplant., 2004, 4, Suppl 10, 10-20.        [ Links ]

12 STRAUSS SE. Introduction to Herpesviridae. In: MANDELL GL., BENNET JE. Eds. Mandell, Douglas and Bennett’s principles and practice of infectious diseases. Philadelphia: Harcourt Health Sciences, 2000: 1557-64.        [ Links ]

 

 

Correspondence to:
Ricardo Augusto Monteiro de Barros Almeida
Departamento de Doenças Tropicais e Diagnóstico por Imagem da Faculdade de Medicina de Botucatu – UNESP
Distrito de Rubião Jr S/N
18618-000, Botucatu-SP, Brasil
Email: ralmeida@fmb.unesp.br

Received: May 24, 2007
Accepted: June 29, 2007
Abstract published online: July 2, 2007
Full paper published online: August 31, 2007
Conflicts of interest: There is no conflict.

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