Open Access Medical Books



Edited by Patricia Price, Nandini Makwana and Samantha Brunt .

Open Access .
140 pages .

CMV is a prevalent viral pathogen that rarely causes recognisable symptoms in immunocompetent hosts. CMV is the strangest virus. It has 200 genes but needs only 30 to replicate. It infects everyone but few people have heard of it. We carry it all our lives but it can rarely be isolated from blood. Up to 23% of CD8 T-cells can be specific for CMV in older healthy adults, despite undetectable viral load. CMV-specific T-cells have a “worn out” phenotype, likely gained from lifelong surveillance of persistent CMV which re-awakens in response to stresses or inflammation. CMV causes distinct patterns of disease in different classes of immunodeficient patients.
This includes retinitis in HIV patients, pneumonitis after transplantation and  deafness in babies. This book includes chapters focussing on different groups of individuals at risk.
CMV reactivation (in previously seropositive recipients) or primary infection (in any recipient) is the most common infectious complication in renal transplantation. In the 1970’s one in three recipients experienced pathologies associated with CMV. In most countries, prophylaxis (valganciclovir) is routinely administered for 12-26 weeks after transplantation. However CMV remains a significant cause of graft loss and the optimal duration of prophylaxis is unclear. In the longer term, CMV reactivations are implicated in deterioration in renal function, cardiovascular disease and perhaps type II diabetes.
CMV has also been anecdotally linked with cardiovascular disease and in vitro studies show increased expression of adhesion molecules in endothelial tissues infected with CMV. One study linked T-cell responses to CMV with cardiovascular symptoms (atherosclerosis) in HIV patients. CMV-DNA has been found in tissues removed during surgery for abdominal aortic aneurysm and CMV seropositivity is more frequent in coronary artery disease requiring surgery. In HIV patients, stronger T-cell responses to CMV (considered an indication of exposure to CMV rather protection) associate with cardiovascular changes.
In this book we also consider CMV in the developing world where it has been comprehensively ignored. However this must change as ART is rolled out for HIV patients worldwide and transplantation becomes feasible in South America, Africa and Asia.
We need to understand the dynamic role of CMV in these populations. Finally we need to understand how infection of so few cells with CMV has such dramatic effects. Perhaps CMV has effects even broader than we realise. CMV is a highly evolved virus. The last chapter discusses the need for novel therapeutics to reduce the impact of CMV infection in at risk groups.

Patricia Price
University of Western Australia, Australia

Nandini Makwana
Pune University, India
Samantha Brunt
University of Western Australia, Australia


 1 Hearing Loss in Children with Congenital Cytomegalovirus Infection 1 Satoshi Iwasaki and Shin-ich Usami

 2 Human Cytomegalovirus (HCMV) Infection in Sub-Saharan Africa 17 Matthew Bates, Kunda Musonda and Alimuddin Zumla

 3 Management of CMV-Associated Diseases in Immunocompromised Patients 41 A.L. Corona-Nakamura and M.J. Arias-Merino

 4 Cytomegalovirus Infection in Liver Transplantation 63 Ana Maria Sampaio, Ana Carolina Guardia, Arlete Milan, Elaine Cristina AtaĆ­de, Rachel Silveira Bello Stucchi, Sandra Botelho Cecilia Costa and Ilka de Fatima Santana Ferreira Boin

 5 The Footprint of CMV Infection May Last a Lifetime 77 Patricia Price

 6 The Oncogenicity of Human Cytomegalovirus 95 Prakash Vishnu and David M. Aboulafia

 7 Cytomegalovirus Tegument Proteins and the Development of Novel Antiviral Therapeutics 111 John Paul III Tomtishen

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Published by: Unknown - Wednesday, May 29, 2013


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