Therefore, functional assessment of the individuals CMV-specific T cell response early, within a couple of weeks, following HSCT could provide a mechanism to establish a patient risk stratification for those likely to develop CMV infection or CMV disease
, from those for whom their immune response is sufficient to provide protection.
Of the 250 endoscopic events, 82 (33%) had evidence of CMV disease
(eg, positive CMV PCR and/or positive CMV IHC results).
There are approved protocols to prevent or treat CMV disease
but because of the obstacles including economic shortcomings, insurance unaffordability, and medication nonavailability, some transplant centers cannot completely follow these protocols in the mentioned circumstances.
We have extrapolated the treatment approach used in HIV-infected children with CMV disease
in this case.
Male sex, lower body mass index, lymphopenia, hematological malignancy, steroid use, and red blood cell transfusion within one month prior to CMV disease
were risk factors for the development of CMV gastrointestinal infection in adult patients with cancer .
 The disease is diagnosed presumptively by means of fundoscopy, unlike systemic CMV disease
, which requires confirmation by biopsy.
While preemptive therapy (treatment when CMV DNA is detected in the blood) with antiviral medicines can reduce the incidence of CMV disease
, CMV reactivation post-HSCT is associated with higher mortality despite the use of preemptive therapy.
Primary CMV infection occurs in up to 30% of seronegative patients transplanted with a seropositive graft and CMV disease
occurs in up to 20% in patients without prophylaxis or preemptive treatment (3,4).
No clinical or laboratory findings of CMV disease
were found in any of the patients.
In a recent meta-analysis, ganciclovir was found to be comparable to either valganciclovir or valacyclovir regarding the prevention of CMV disease
. (28) In the present study, universal prophylaxis, when implemented with intravenous ganciclovir, was found to be inferior to preemptive therapy: the rate of HCMV infection was not reduced and the morbidity of the infection was substantially higher with universal prophylaxis.
It has been reported that low anti-CMV titer before transplant or at 1 month after transplant was associated with a higher risk of CMV disease
in heart transplant recipients .
The spectrum of CMV disease
is wide, including congenital infections, disease in transplant recipients, and ocular and esophageal diseases in HIV-patients.
Rollag et al., "Virologic suppression measured by a cytomegalovirus (CMV) DNA test calibrated to the World Health Organization International Standard is predictive of CMV disease
resolution in transplant recipients," Clinical Infectious Disease, vol.
Finally, it is imperative that pediatricians and team members understand that CMV disease