Clinical characteristics of cytomegalovirus infection in rheumatic diseases

Multicentre survey in a large patient population

Y. Takizawa, S. Inokuma, Y. Tanaka, K. Saito, T. Atsumi, Michito Hirakata, H. Kameda, S. Hirohata, H. Kondo, S. Kumagai, Y. Tanaka

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Abstract

Objective. To survey and elucidate the clinical characteristics of CMV infection in rheumatic disease patients. Methods. A detailed questionnaire survey on CMV infection was carried out against rheumatic disease patients hospitalized in member hospitals, and the obtained clinical and/or laboratory data were analysed. Results. Out of 7377 patients, 151 were diagnosed as having CMV infection. The underlying diseases ranged broadly, but SLE, microscopic polyangiitis, and dermatomyositis were the most common. Four were diagnosed histopathologically, and the others via positive CMV antigenaemia. In addition to oral corticosteroid for all but one patient, 81 were treated with pulsed methylprednisolone (MPSL), 64 with cyclophosphamide (CYC) and 36 with other immunosuppressants. Forty-four had a fatal outcome, for which presence of clinical symptoms, other infectious complications, lymphopenia, an older age (>59.3 yrs) and the use of pulsed MPSL were significant risk factors (P < 0.05) by univariate analysis. Multivariate analysis retained the first three (P < 0.05). The CMV antigenaemia count was significantly higher for the symptomatic than asymptomatic [10.1 (0.0-2998.0) vs 4.0 (1.3-1144.4)/ 105 PMNs, respectively, P < 0.05; threshold count: 5.6/ 105 PMNs]. No treatment benefit by anti-viral agent was observed as for survival. Conclusion. CMV infection was mostly diagnosed by antigenaemia, and occurred among patients under strong immunosuppressive therapy using pulsed MPSL and/or immunosuppressants. Lymphopenia, presence of symptoms and other infections are significant risk factors for a poor outcome and pulsed MPSL and an older age may predict it. Patients were prone to be symptomatic with anti-genaemia count over 5.6/105 PMNs.

Original languageEnglish
Pages (from-to)1373-1378
Number of pages6
JournalRheumatology
Volume47
Issue number9
DOIs
Publication statusPublished - 2008

Fingerprint

Cytomegalovirus Infections
Rheumatic Diseases
Methylprednisolone
Immunosuppressive Agents
Population
Infection
Lymphopenia
Microscopic Polyangiitis
Dermatomyositis
Fatal Outcome
Cyclophosphamide
Surveys and Questionnaires
Adrenal Cortex Hormones
Multivariate Analysis
Survival
Therapeutics

Keywords

  • Cyclophosphamide
  • Cytomegalovirus
  • Cytomegalovirus antigenaemia count
  • Immunosuppressive therapy
  • Lymphopenia
  • Old age
  • Pulsed methylprednisolone
  • Rheumatic diseases

ASJC Scopus subject areas

  • Neuroscience(all)
  • Rheumatology

Cite this

Clinical characteristics of cytomegalovirus infection in rheumatic diseases : Multicentre survey in a large patient population. / Takizawa, Y.; Inokuma, S.; Tanaka, Y.; Saito, K.; Atsumi, T.; Hirakata, Michito; Kameda, H.; Hirohata, S.; Kondo, H.; Kumagai, S.; Tanaka, Y.

In: Rheumatology, Vol. 47, No. 9, 2008, p. 1373-1378.

Research output: Contribution to journalArticle

Takizawa, Y, Inokuma, S, Tanaka, Y, Saito, K, Atsumi, T, Hirakata, M, Kameda, H, Hirohata, S, Kondo, H, Kumagai, S & Tanaka, Y 2008, 'Clinical characteristics of cytomegalovirus infection in rheumatic diseases: Multicentre survey in a large patient population', Rheumatology, vol. 47, no. 9, pp. 1373-1378. https://doi.org/10.1093/rheumatology/ken231
Takizawa, Y. ; Inokuma, S. ; Tanaka, Y. ; Saito, K. ; Atsumi, T. ; Hirakata, Michito ; Kameda, H. ; Hirohata, S. ; Kondo, H. ; Kumagai, S. ; Tanaka, Y. / Clinical characteristics of cytomegalovirus infection in rheumatic diseases : Multicentre survey in a large patient population. In: Rheumatology. 2008 ; Vol. 47, No. 9. pp. 1373-1378.
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abstract = "Objective. To survey and elucidate the clinical characteristics of CMV infection in rheumatic disease patients. Methods. A detailed questionnaire survey on CMV infection was carried out against rheumatic disease patients hospitalized in member hospitals, and the obtained clinical and/or laboratory data were analysed. Results. Out of 7377 patients, 151 were diagnosed as having CMV infection. The underlying diseases ranged broadly, but SLE, microscopic polyangiitis, and dermatomyositis were the most common. Four were diagnosed histopathologically, and the others via positive CMV antigenaemia. In addition to oral corticosteroid for all but one patient, 81 were treated with pulsed methylprednisolone (MPSL), 64 with cyclophosphamide (CYC) and 36 with other immunosuppressants. Forty-four had a fatal outcome, for which presence of clinical symptoms, other infectious complications, lymphopenia, an older age (>59.3 yrs) and the use of pulsed MPSL were significant risk factors (P < 0.05) by univariate analysis. Multivariate analysis retained the first three (P < 0.05). The CMV antigenaemia count was significantly higher for the symptomatic than asymptomatic [10.1 (0.0-2998.0) vs 4.0 (1.3-1144.4)/ 105 PMNs, respectively, P < 0.05; threshold count: 5.6/ 105 PMNs]. No treatment benefit by anti-viral agent was observed as for survival. Conclusion. CMV infection was mostly diagnosed by antigenaemia, and occurred among patients under strong immunosuppressive therapy using pulsed MPSL and/or immunosuppressants. Lymphopenia, presence of symptoms and other infections are significant risk factors for a poor outcome and pulsed MPSL and an older age may predict it. Patients were prone to be symptomatic with anti-genaemia count over 5.6/105 PMNs.",
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AU - Saito, K.

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AU - Hirakata, Michito

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N2 - Objective. To survey and elucidate the clinical characteristics of CMV infection in rheumatic disease patients. Methods. A detailed questionnaire survey on CMV infection was carried out against rheumatic disease patients hospitalized in member hospitals, and the obtained clinical and/or laboratory data were analysed. Results. Out of 7377 patients, 151 were diagnosed as having CMV infection. The underlying diseases ranged broadly, but SLE, microscopic polyangiitis, and dermatomyositis were the most common. Four were diagnosed histopathologically, and the others via positive CMV antigenaemia. In addition to oral corticosteroid for all but one patient, 81 were treated with pulsed methylprednisolone (MPSL), 64 with cyclophosphamide (CYC) and 36 with other immunosuppressants. Forty-four had a fatal outcome, for which presence of clinical symptoms, other infectious complications, lymphopenia, an older age (>59.3 yrs) and the use of pulsed MPSL were significant risk factors (P < 0.05) by univariate analysis. Multivariate analysis retained the first three (P < 0.05). The CMV antigenaemia count was significantly higher for the symptomatic than asymptomatic [10.1 (0.0-2998.0) vs 4.0 (1.3-1144.4)/ 105 PMNs, respectively, P < 0.05; threshold count: 5.6/ 105 PMNs]. No treatment benefit by anti-viral agent was observed as for survival. Conclusion. CMV infection was mostly diagnosed by antigenaemia, and occurred among patients under strong immunosuppressive therapy using pulsed MPSL and/or immunosuppressants. Lymphopenia, presence of symptoms and other infections are significant risk factors for a poor outcome and pulsed MPSL and an older age may predict it. Patients were prone to be symptomatic with anti-genaemia count over 5.6/105 PMNs.

AB - Objective. To survey and elucidate the clinical characteristics of CMV infection in rheumatic disease patients. Methods. A detailed questionnaire survey on CMV infection was carried out against rheumatic disease patients hospitalized in member hospitals, and the obtained clinical and/or laboratory data were analysed. Results. Out of 7377 patients, 151 were diagnosed as having CMV infection. The underlying diseases ranged broadly, but SLE, microscopic polyangiitis, and dermatomyositis were the most common. Four were diagnosed histopathologically, and the others via positive CMV antigenaemia. In addition to oral corticosteroid for all but one patient, 81 were treated with pulsed methylprednisolone (MPSL), 64 with cyclophosphamide (CYC) and 36 with other immunosuppressants. Forty-four had a fatal outcome, for which presence of clinical symptoms, other infectious complications, lymphopenia, an older age (>59.3 yrs) and the use of pulsed MPSL were significant risk factors (P < 0.05) by univariate analysis. Multivariate analysis retained the first three (P < 0.05). The CMV antigenaemia count was significantly higher for the symptomatic than asymptomatic [10.1 (0.0-2998.0) vs 4.0 (1.3-1144.4)/ 105 PMNs, respectively, P < 0.05; threshold count: 5.6/ 105 PMNs]. No treatment benefit by anti-viral agent was observed as for survival. Conclusion. CMV infection was mostly diagnosed by antigenaemia, and occurred among patients under strong immunosuppressive therapy using pulsed MPSL and/or immunosuppressants. Lymphopenia, presence of symptoms and other infections are significant risk factors for a poor outcome and pulsed MPSL and an older age may predict it. Patients were prone to be symptomatic with anti-genaemia count over 5.6/105 PMNs.

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