Herpes simplex infection in acute myelogenous leukemia and other hematologic malignancies: a prospective study

To better define the frequency and clinical characteristics of herpes simplex virus (HSV) infection in adult patients with acute myelogenous leukemia (AML), the authors prospectively studied 29 patients undergoing remission induction chemotherapy with twice weekly throat wash cultures for an average of 25.3 days. Ten seropositive patients (34.5%) shed HSV at least once. Eight patients were asymptomatic. Two episodes of herpes labialis were severe and persistent, but no visceral dissemination was observed. Reactivation of HSV infections in AML patients presumably with marked immunosuppression occurs, but less frequently and more benignly than has been suggested. Daunomycin and cytosine arabinoside, which can inhibit HSV replication, may have accounted for this lower frequency of reactivation.

Primary disseminated herpes simplex infection with fulminant hepatitis following renal transplantation

A patient had disseminated herpes simplex, type 1, virus infection manifested by fulminant hepatitis and disseminated intravascular coagulation. The diagnosis was established by isolation of the virus from throat, urine, and buffy coat and confirmed at autopsy by the visualization of typical inclusions, demonstration of herpesvirus particles by electron microscopy, and specific immunoperoxidase staining. Therapy with vidarabine did not alter the fatal course. On the basis of clinical features and serologic results, the case represented a disseminated primary infection with herpes simplex, rather than reactivation of an endogenous infection, following renal transplantation.

Opportunistic Trichosporon pneumonia. Association with invasive aspergillosis

Two severely immunocompromised patients suffered extensive pulmonary infection with Trichosporon cutaneum (T beigelii) and Aspergillus species. In one patient, the T cutaneum demonstrated yeast forms in tissue sections. The other patient had T cutaneum fungemia prior to death, and examination of lung tissue demonstrated both yeast and hyphal forms. To our knowledge, these patients are the first described with polymycotic infection involving T cutaneum and Aspergillus species. Trichosporon cutaneum must be added to Candida, Torulopsis, and Cryptococcus species as a cause of visceral opportunistic yeast infection.

Elevated serum 1,25 dihydroxyvitamin D concentrations in rickets of very low-birth-weight infants

Elevated 1,25 dihydroxyvitamin D concentrations were found in five VLBW infants who developed rickets at two to three months postnatal age or term postconceptual age; 25 hydroxyvitamin D concentrations were low. Bone mineralization was found to be extremely low as measured by infant-adapted direct photon absorptiometry. After treatment with a formula supplemented with additional Ca and P, there was a rapid improvement in bone mineralization with a concomitant decrease of 1,25(OH)2D to normal adult values, whereas 250HD values increased and parathyroid hormone values decreased. In the VLBW infants studied, we suggest that rickets may be caused by Ca and P deficiency rather than by a deficiency of vitamin D metabolism.

Response of cloned progeny of clinical isolates of herpes simplex virus to human leukocyte interferon

First- and third-generation cloned progeny viruses were derived from clinical isolates of herpes simplex virus and examined for their sensitivities to human interferon by inhibition of plaque formation in Vero cells. The dose-response curves obtained with the first- and third-generation clones were similar to those obtained with the parental isolates, and both the parent and the clones showed similar sensitivities to interferon. These results suggest that clinical isolates of herpes simplex virus consist of a homogeneous population of virus particles with respect to interferon sensitivity. The dose-response curves obtained with herpes simplex virus demonstrated a shallower slope than those obtained with vesicular stomatitis virus. Vesicular stomatitis virus plaque formation as completely inhibited at high concentrations of interferon, whereas complete inhibition of plaque formation by herpes simplex virus did not occur at the highest concentration of interferon used. Cloned progeny were derived from plaques appearing in the presence of high concentrations of interferon. The dose-response curves and interferon sensitivities of these clones were similar to those of the parent and third-generation clone from which they were derived. There was no evidence for genetic heterogeneity with respect to interferon sensitivity.

Role of specific cytotoxic lymphocytes in cellular immunity against murine cytomegalovirus

Cytotoxic lymphocytes were generated in vitro against murine cytomegalovirus (MCMV)-infected cells by incubation with ultraviolet light-irradiated, infected fibroblasts. When passively transferred, they reduced virus titers in spleens of mice 1 day after infection with MCMV. Protection was abrogated by anti-theta serum and complement. Spleen cells from mice infected for 6 to 14 days protected mice better than cells from mice after infection for 1, 3, or 30 days. Protection by in vitro- and in vivo-generated cells was H-2K or H-2D restricted. Specific cytotoxic T lymphocytes are therefore present and operative during acute MCMV infection. However, MCMV infection inhibited the development of primary cytotoxic response against ectromelia virus. It also suppressed the ability of lymphocytes from mice with established memory for ectromelia to develop secondary cytotoxic cells in vitro, and it inhibited the development of memory cells for the cytotoxic response to ectromelia virus. In view of these data and the inability of animals recovering from MCMV infection to eliminate all infected cells, the cytotoxic response to MCMV may be qualitatively or quantitatively deficient.

Tuberculous bacillemia, hyperpyrexia, and rapid death

Hyperpyrexia, followed rapidly by multiple organ failure and death, developed in a previously healthy man. Postmortem examination indicated disseminated tuberculosis with adrenal involvement, but also evidence compatible with heat stroke. Mycobacterium tuberculosis was isolated from a routine blood culture. The patient's symptoms may have been the result of his bacillemia or the result of unapparent tuberculous chronic adrenocortical insufficiency that made him unusually sensitive to heat.

Prevention of reactivated herpes simplex infection by human leukocyte interferon after operation on the trigeminal root

Microneurosurgical procedures on the trigeminal-nerve root are often followed by reactivation of herpes simplex virus infection, manifested by herpes labialis or oropharyngeal herpesvirus shedding or both. In a double-blind study of the ability of human leukocyte interferon to prevent this reactivation, patients with a history of herpes labialis were given 7 x 10(4) U of interferon per kilogram of body weight per day or placebo for five days beginning on the day before operation. In 18 patients treated with placebo, herpes labialis developed in 10, and virus shedding in the oropharynx in 15. In 19 patients treated with interferon, lesions developed in five, and shedding in eight. The frequency of reactivation as measured by lesions or positive throat cultures or both was significantly reduced by interferon (P less than 0.05). Of 127 daily throat-wash cultures in the placebo group, 42 per cent were positive for herpesvirus, but of 134 in the interferon group, only 9 per cent were positive (P less than 0.001). We conclude that interferon at a well-tolerated dosage reduces reactivation of latent herpes simplex virus infection after a potent operative stimulus.

Development in vitro of cytotoxic lymphocytes against murine cytomegalovirus

Lymphocytes cytotoxic for mouse embryo fibroblasts (MEF) infected with murine cytomegalovirus (MCMV) were produced by in vitro culture of "memory" spleen cells with UV-irradiated, MCMV-infected, MEF. Cytotoxic lymphocytes were developed from spleen cells of mice 10 to 240 days after infection with MCMV. The cytotoxic cells carried the theta and Ly 2 antigens, and were H-2 restricted in the recognition of infected target cells.

Characteristics of infection of B and T lymphocytes from mice after inoculation with cytomegalovirus

Viremia was produced by inoculating intravenously BALB/c mice with murine cytomegalovirus. Virus was detected in plasma and granulocytes only during the first 8 days after infection. Lymphocyte-associated viremia, detectable by cocultivation on syngeneic or allogeneic fibroblasts, persisted for at least 4 weeks. Eight to 10 days after infection, sonicated lymphocytes had no demonstrable free virus. When whole lymphocytes with no demonstrable free virus were enclosed in a Millipore chamber and placed on a fibroblastic feeder layer, T cells produced free virus but B cells did not. Compared to normal calf serum, specific hyperimmune serum reduced B cell-associated infectious centers by 74% and T cell-associated infectious centers by only 38%. Normal mouse sera reduced by 36% and 30% infectious center production by B cells and T cells, respectively. Lymphocytes enriched with Fc receptor-positive cells produced significantly more infectious centers than receptor-negative cells.

Treatment of septicemic patients with cefoxitin: pharmacokinetics in renal insufficiency

Experience with cefoxitin in the treatment of septicemia of diverse etiologies in 11 patients is reviewed. Results of a small study of the pharmacokinetics of cefoxitin in patients with renal insufficiency, which was used as a guideline for determining the dosage of cefoxitin for severely ill patients with renal insufficiency, are included. In addition, a summary of data on file at Merck Sharp and Dohme Research Laboratories (Rahway, New Jersey) that concern 135 bacteremic patients who were treated with cefoxitin and evaluated is presented. Although information derived from septicemic patients is among the most difficult to interpret in regard to the efficacy of an investigational antibiotic, both our experience and the summary of data confirm that cefoxitin is a potent antibiotic suitable for use in septicemic patients when the etiologic agent is susceptible; the data also demonstrate that cefoxitin has a significantly expanded spectrum of activity as compared with that of cephalothin.

Activation of latent murine cytomegalovirus infection: cocultivation, cell transfer, and the effect of immunosuppression

No free virus was detectable in any organ of DBA/2 mice greater than or equal to 16 weeks after infection with murine cytomegalovirus. Spleens were free of free lytic virus six weeks after infection. Spleen cells from such mice were shown to be latently infected by three methods. First, virus was recovered by cocultivation of spleen cells for two weeks or longer on either syngeneic or allogeneic (CDI) embryonic fibroblast cultures. Second, virus was recovered from salivary glands of either syngeneic (DBA/2) or allogeneic (C57BL/10) mice that received 10(8) spleen cells. Recovery was enhanced by treatment of allogeneic recipients with cyclophosphamide but not with azathioprine. Third, latently infected mice, after treatment with either cyclophosphamide or azathioprine, developed free murine cytomegalovirus in their salivary glands. The last two findings parallel observations of human cytomegalovirus in immunosuppressed patients and in patients receiving latently infected cells during transplantation. Both cyclophosphamide and azathioprine elevated titers of free lytic virus in the salivary glands.

Hyporeactivity factor produced after induction of immune interferon in mice sensitized with BCG

Sera from BCG-sensitized ICR and C57BL/10J mice challenged with BCG were examined. Two types of hyporeactive factor (HF), which produced refractoriness to induction of interferon (IF) by Newcastle disease virus in mouse embryo fibroblasts, were produced in addition to type II immune IF. One was destroyed at pH 2, and the other was not. The acid-labile HF, together with immune IF, appeared 2 h after challenge with BCG. Acid-labile HF and immune IF were not neutralized by antiserum against L-cell IF and may be one substance. On the other hand, acid-stable HF appeared later and was neutralized by antiserum against L-cell IF. Furthermore, acid-stable HF was more stable at 56 degrees C than were immune IF and pH-labile HF. Induction of IF by Newcastle disease virus was also reduced in mice 6 h after receiving one injection of BCG, irrespective of whether the animals were previously sensitized to BCG.

A controlled investigation of the pharmacokinetics of gentamicin and tobramycin in obese subjects

For determination of the best basis on which to calculate dosages of gentamicin or tobramycin to be administered to obese patients, the pharmacokinetics of these drugs were studied in 13 obese subjects and 13 subjects of a normal weight following intravenous infusion of 1 mg/kg. Half-lives, elimination constants, and absolute and relative volumes of distribution were calculated. Concentrations of drug in serum were significantly higher and relative volumes of distribution were significantly lower in obese subjects as compared with controls. However, relative volumes of distribution based on lean body mass of obese subjects were significantly greater than those of normal-weight subjects. These results indicate that gentamicin and tobramycin are distributed less to adipose tissue than to other tissues, but partial distribution to adipose tissue does occur. The mean relative volume of distribution in obese subjects closely approximated that in normal subjects when normalized body mass plus 40% of the adipose mass was used as the total weight in obese subjects.

Protective effect of early serum from mice after cytomegalovirus infection

Serum obtained from mice 3 to 5 days after cytomegalovirus infection contained complement-requiring neutralizing antibody, which, when passively transferred, protected mice from lethal infection with the homologous virus. The active substance was largely heat-stable 7s immunoglobulin.

Reactivation of herpes simplex virus after decompression of the trigeminal nerve root

Reactivation of herpes simplex virus was prospectively studied in patients after microneurosurgical decompression of the trigeminal sensory root, a new operation for trigeminal neuralgia in which the nerve is not sectioned. Reactivation was detected in 28 (50%) of 56 patients. Virus was cultured from oropharyngeal secretions in 25 patients, and 21 patients developed cutaneous herpetic lesions. Seven patients had positive throat-wash (TW) cultures but did not develop lesions, and the converse occurred in three patients. Eighteen patients had both positive TW cultures and herpetic lesions. In eight of nine instances in which a sequence was determinable, TW cultures were positive before lesions developed. A history of recurrent herpes labialis was associated with a higher risk of developing reactivation postoperatively (59.4% vs. 31.6%, P less than 0.05). These observations suggest that minimal stimulation or inapparent trauma to the trigeminal sensory root is sufficient to activate latent herpes simplex virus in humans. These patients provide unique opportunities to study immunologic responses and therapeutic measures.

Production of interferon and serum hyporeactivity factor in mice infected with murine cytomegalovirus

Mice injected intraperitoneally with murine cytomegalovirus produced as many as 1,000 U of serum interferon. The response appeared biphasic, with maximum titers in the first phase detectable from 2 through 4 days after infection. A second phase peaked 10 days after infection. By carboxyhexyl-Sepharose affinity chromatography, the serum interferon behaved like lymphocyte interferon. The infected mice also produced substantial quantities of serum hyporeactivity factor (D.A. Stringfellow, E.R. Kern, D.K. Kelsey, and L.A. Glasgow, J. Infect. Dis. 135:540-551, 1977), although always in the presence of interferon. This factor was separated from the serum interferon by concanavalin A-Sepharose affinity chromatography.

Evaluation of anti-complement immunofluorescence test in cytomegalovirus infection

The anti-complement immunofluorescence (ACIF) technique was evaluated for the diagnosis of human cytomegalovirus (CMV) infection in a group of sera derived from renal transplant recipients and donors by comparing it with the indirect immunofluorescence (FA) and complement fixation (CF) TESTS. The ACIF and FA tests yielded similar results. However, the ACIF test had a distinct advantage over the indirect FA test, since it eliminated the nonspecific cytoplasmic staining that may result in false positive readings in inexperienced hands. Both the indirect FA and ACIF tests were more sensitive than the CF test. In primary CMV infection, the FA and ACIF antibodies appeared earlier and had significantly higher titer than corresponding CF titers. This difference in titers was not seen in seropositive individuals who lacked overt infection. Our previously reported correlation between the seropositivity of the donor and CMV infection in seronegative recipients has been confirmed.

Effect of metabolic alkalosis on respiratory function in patients with chronic obstructive lung disease

Eleven instances of a mixed acid-base disorder consisting of chronic respiratory acidosis and metabolic alkalosis were recognized in eight patients with chronic obstructive lung disease and carbon dioxide retention. Correction of the metabolic alkalosis led to substantial improvement in blood gas values and clinical symptoms. Patients with mixed chronic respiratory acidosis and metabolic alkalosis constitute a common subgroup of patients with chronic obstructive lung disease and carbon dioxide retention; these patients benefit from correction of the metabolic alkalosis.

Differences in mouse interferons according to cell source and mode of induction

Mouse interferon induced by ultraviolet-irradiated Newcastle disease virus or polyriboinosinic-polyribocytidylic acid in T lymphocytes, B lymphocytes, macrophages, and primary mouse embryonic cell culture was studied. Irrespective of the inducer, interferons produced by T or B lymphocytes were relatively heat stable and of low antigenicity when reacted with antiserum against L-cell interferon (ALI), whereas interferons produced by macrophages and mouse embryo cells were heat labile and of high antigenicity against ALI. Mouse interferons induced by ultraviolet-irradiated Newcastle disease virus were separated into three components by chromatography on CH-Sepharose 4B. Interferons produced by T and B lymphocytes consisted primarily of component 1 (unbound fraction), whereas interferons produced by macrophages or mouse embryo cells consisted primarily of component 3 (eluted by 0.5 M NaCl). Component 1 was heat stable and of low antigenicity against ALI, properties characteristic of T- and B-cell interferon. Components 2 and 3 were heat labile and of high antigenicity against ALI, properties characteristic of macrophage and mouse embryo cell interferon. In contrast, interferon induced in mice sensitized with BCG differed from these interferons induced in B cells, T cells, macrophages, and fibroblasts in being extremely acid labile and nonreactive against ALI.

Primary and secondary cytomegalovirus infection

Forty-seven patients who underwent renal transplants were followed clinically and were examined for serologic or virologic evidence of cytomegalovirus (CMV) infection. There were 18 cases of primary infection and ten cases of secondary infection. These findings were based on whether the patient was seronegative or seropositive prior to transplantation. Thirteen patients with primary infection and only one patient with secondary infection had two or more of the following manifestations that are temporally associated with laboratory evidence of infection: fever, leukopenia, atypical lymphocytes, lymphocytosis, hepatosplenomegaly, myalgia, arthralgia, and pneumonitis. Five patients with primary infections, one of whom died with disseminated disease, were recognized by attending physicians as having CMV disease. Since primary infection is though to be largely due to virus transmitted by the kidney of a seropositive donor, it may be possible to prevent symptomatic primary infection by using only seronegative donors for seronegative recipients.

The adrenal medulla may mediate the increase in pineal melatonin synthesis induced by stress, but not that caused by exposure to darkness

As previously shown (Lynch et al.: Proc. Nat. Acad. Sci. [U.S.A.] 70, 1704-1707 [1973]), the activity of the enzyme serotonin-N-acetyltransferase (NAT) in the rat pineal increases when the animal is placed in darkness or is subjected to the stress of physical immobilization; partial sympathetic denervation (i.e., pretreatment of the animal with intravenous 6-hydroxydopamine [6-OHDA]) does not block either response. The present studies explored the roles of the pineal sympathetic nerves and the adrenal medullas in mediating these responses. The stress-induced increase in pineal NAT activity was blocked by bilateral adrenalectomy, but not by bilateral superior cervical ganglionectomy or by treatment with 6-OHDA (both of which potentiate the NAT response in normal rats and restore it in adrenalectomized ones). The increase in pineal melatonin content caused by immobilization was also blocked by adrenalectomy, but potentiated by pineal sympathetic denervation. In contrast, bilateral adrenalectomy did not affect the darkness-induced rise in pineal NAT activity, although pineal sympathetic denervation (by bilateral superior cervical ganglionectomy) did block this response. 6-OHDA pretreatment neither blocked the response to darkness nor restored it in ganglionectomized animals; thus, this treatment apparently fails to produce a complete pineal denervation. The pineal response to stress has previously been shown to be blocked by beta-adrenergic blocking agents. The present studies demonstrate that alpha-adrenergic blockade (with phenoxybenzamine) potentiates this response in intact animals and restores it in adrenalectomized rats (possibly by acting presynaptically on receptors on pineal sympathetic terminals and thereby augmenting norepinephrine release). These observations show that the rat pineal organ normally receives information from two "channels", i.e., trans-synaptically (from pineal sympathetic nerves) and via the circulation (from the adrenal medullas and, perhaps, from distant sympathetic nerves).

Enhancement of murine cytomegalovirus infection during graft-vs.-host reaction

A mouse model was used for elucidation of the role of a graft-vs-host reaction in promoting cytomegalovirus infection. F1 (DBA/2 X C3H/He) hybrid mice were infected with murine cytomegalovirus. Five weeks later, a graft-vs.-host reaction was produced in the chronically infected animals by the administration of multiple doses of DBA/2 parental splenocytes. Cytomegalovirus was recovered more often from the organs of mice undergoing graft-vs.-host reaction than from those of control animals (P less than 0.001). These results indicate that the graft-vs.-host reaction alone can enhance murine cytomegalovirus infection in a chronically infected host and may help explain the high incidence of cytomegalovirus infection after bone marrow allograft transplantation in man.

Cellular origin of interferon induced by bacterial lipopolysaccharide

Bacterial lipopolysaccharide (LPS) induces interferons with different properties in mouse macrophages and B lymphocytes. Macrophage interferon is labile at 56 degrees C and is neutralized by anti-mouse fibroblast interferon at a dilution of 1:6,142. B cell interferon is more heat stable and is neutralized by the same antiserum only at a dilution of 1:276. Serum obtained early (1 h) after an intravenous injection of 100 mug of LPS resembled macrophage interferon, whereas serum obtained at later times resembled more and more B cell interferon. The diverse cellular origin of LPS-induced interferon may explain the broad hyporesponsiveness produced by LPS in animals.

Viral infections in renal transplant recipients

Cytomegalovirus (CMV) infections are common in renal transplant recipients. We studied 23 recipients prospectively to determine whether infections by other herpes-group and non-herpes-group viruses were also present. Sera, obtained at the time of surgery and periodically thereafter, were tested for antibody to CMV, herpes simplex virus (HSV), Epstein-Barr virus (EBV), parainfluenza viruses types 1, 2, and 3, and the viruses of measles and rubella. We found no evidence of an unusual incidence of primary or secondary infection by the non-herpesviruses tested. Rises to CMV, HSV, and EBV antibody titers occurred in 43, 38, and 32% of patients, respectively. All serological rises to herpes-group viruses occurred in patients seropositive at the time of transplantation, with the exception of three patients who experienced primary CMV infections. We conclude that reactivation of all herpes-group viruses tested may occur in transplant recipients. Morbidity was associated only with primarly CMV infection.

Cellular basis of interferon formation and hyporeactivity after exposure to bacterial lipopolysaccharide

Endotoxin apparently induces interferon in only a few types of cell, yet it produces strong hyporesponsiveness to a large number of agents. After incubation for 24 hr with endotoxin in vitro, tissue cultures of thymus, spleen, mesenteric lymph nodes, and to a lesser extent, liver and lung produced interferon. Lymphoid tissues of bone marrow-derived (B-) cells (sacculus rotundus, appendix, and Peyer's patches) and kidney did not produce interferon. Adherent spleen cells produced more interferon than nonadherent cells. Purification of spleen cells on a bovine serum albumin gradient showed that light, DNA-synthesizing cells made interferon in response to endotoxin or polyriboinosinic-polyribocytidylic acid. Mouse spleen cells produced a "late" interferon 24-48 hr after exposure to endotoxin, which, in contrast to "early" interferon (produced at 0-24 hr) from spleen and other tissues, is stable at 56 C for 60 min. It is suggested that this late interferon represents a "B-cell" interferon. Hyporeactivity was produced in vitro by endotoxin only in tissues that make endotoxin-induced interferon, a fact consistent with the theory that the interferon-inducing mechanism must be initiated before hyporeactivity results. The fact that endotoxin has been found to act on a fairly large range of cells (i.e., macrophages, thymus-derived cells, and probably B-lymphocytes) explains its ability to produce broad hyporesponsiveness.

Cytomegalovirus infection in patients receiving immunosuppressive therapy for rheumatologic disorders

Evidence of cytomegalovirus infection was sought in 131 patients attending a rheumatology clinic, 211 blood donors, and 14 patients before and after the initiation of cytotoxic immunosuppressive therapy for a rheumatologic condition. The titer of complement-fixing antibody to cytomegalovirus was significantly related to age and sex, but not to rheumatologic disease. After adjustment for age and sex differences, the proportion of patients treated with corticosteroids who had measurable antibody was lower than that of controls (P less than 0.025). Immunosuppressive therapy with azathioprine or cyclophosphamide did not affect the proportion of patients with antibody, but there was a significantly increased titer of antibody in those who were seropositive (P = 0.04). Cytomegalovirus was isolated from the urine of 20% of patients receiving cytotoxic immunosuppressive drugs, but not from any of the patients receiving corticosteroids or neither form of therapy (P = 0.001). Eight of 14 patients followed prospectively after the initiation of therapy with immunosuppressive drugs became infected with cytomegalovirus as demonstrated by a fourfold or greater rise in complement-fixing titer, viruria, or both. Seven of the eight patients were seropositive before therapy, a finding suggesting that immunosuppression acts largely by reactivating latent infection. It is postulated that immunosuppressive agents alone may account for a large proportion of cytomegalovirus infections seen after allograft transplantation.

Use of biological characteristics to type Herpesvirus hominis types 1 and 2 in diagnostic laboratories

Fifty clinical isolates of Herpesvirus hominis were typed by pock size on chicken embryo chorioallantoic membranes, sensitivity to heparin, and plaque formation on chicken embryo cell cultures. Of 19 isolates that were typed serologically, there was 100% concordance with respect to plaque formation. Pock size was incorrect in one instance and indeterminate in another. Heparin sensitivity was incorrect for one. Of 31 strains that were only biologically characterized, there were four for which heparin sensitivity did not agree with the other two characteristics. Of the three biological tests, the ability to form plaques in chick cell monolayer was the most reliable indicator type.

Cytomegalovirus infection in children undergoing open-heart surgery

A group of 124 children undergoing open-heart surgery was followed prospectively in order to estimate the risk of cytomegalovirus (CMV) infection due to transfused blood.Ninety-three patients (75%) had complement fixation (CF) titers of < 1:4 against CMV on admission. Of this seronegative subgroup, nine patients (9.7%) subsequently became infected with CMV. All nine showed seroconversion, and six were viruric 12-14 weeks after surgery. Comparative seroepidemiological studies of the hospital population showed that in the age ranges studied (3-16 yr), the infections seen in the study group represented a significant excess over expectation. This infection rate was consistent with a model of transmission by blood transfusion with a risk of 2.7% per unit but not proven.Thirty-one patients had CF antibody to CMV on admission. CMV was isolated from 14% of urines of seropositive children both before and after surgery, but only two patients showed CF antibody rises to CMV. Thus the frequency of CMV infection associated with open-heart surgery and transfusion could not be calculated in the seropositive subgroup.CMV infection was not related to the primary diagnosis or to Down's syndrome.

The transplanted kidney as a source of cytomegalovirus infection

To determine the incidence of cytomegalovirus infection in renal-transplant recipients we followed 32 prospectively for six months after operation. As judged by serologic change and virus isolation the infection rate for the entire group was 66 per cent (21 of 32 patients) - 59 per cent (13 of 22) for seronegative patients and 80 per cent (eight of 10) for seropositive patients. Of 10 seronegative patients who received kidneys from seronegative donors, only three became infected. However, of 12 seronegative patients who received kidneys from seropositive donors, 10 became infected. Thus, there was a significant correlation between development of infection and seropositivity of the donor (P = 0.03), particularly when the recipient was seronegative (P = 0.02). Five possible and four definite recognizable clinical illnesses were associated with cytomegalovirus infection; all except two were in initially seronegative subjects who received kidneys from seropositive donors. Primary infection and disease in nonimmune recipients may be caused by cytomegalovirus transmitted by the kidneys of latently infected seropositive donors.

Enhancement of mouse cytomegalovirus infection during host-versus-graft reaction

C3H/He mice chronically infected with murine cytomegalovirus were given skin allografts from histoincompatible BALB/c donors. A significant increase in cytomegalovirus titers occurred within 3 days after placement of the graft in the spleens and kidneys of the allograft recipients as compared with control animals. No significant changes in virus titers were detected in the salivary gland, lung, liver, or blood of allograft recipients. These results indicate that the host-versus-graft reaction alone can enhance murine cytomegalovirus in a chronically infected host and may help explain the high incidence of cytomegalovirus infection seen after renal and other allograft transplantation in man.