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A boy, aged 6 years and 11 months, was admitted due to nephrotic syndrome for 2 years, cough for 1 month, and shortness of breath for 15 days. The boy had a history of treatment with hormone and immunosuppressant. Chest CT after the onset of cough and shortness of breath showed diffuse ground-glass opacities in both lungs. Serum (1, 3)-beta-D glucan was tested positive, and the nucleic acid of cytomegalovirus was detected in respiratory secretions. After the anti-fungal and anti-viral treatment, the child improved temporarily but worsened again within a short period of time. Pneumocystis jirovecii was identified by Gomori's methenamine silver staining in bronchoalveolar lavage fluid. The child was diagnosed with severe pneumonia ( Pneumocystis jirovecii and cytomegalovirus infection), acute respiratory distress syndrome, and nephrotic syndrome. After anti-infective therapy with sulfamethoxazole/trimethoprim and ganciclovir and respiratory support, the child still experienced progressive aggravation of dyspnea and tension pneumothorax, and extracorporeal membrane oxygenation (ECMO) was given on day 13 of invasive ventilation. Anti-infective therapy with sulfamethoxazole/trimethoprim, ganciclovir, and linezolid, anticoagulation therapy, sedation therapy, nutrition, and comprehensive management of the respiratory tract were given during ECMO. The child was successfully weaned from ECMO after 72 days, resulting in a length of hospital stay of 134 days. The child was followed up for 6 months after discharge, and there was a significant improvement on lung CT, without organ dysfunction. It is concluded that Pneumocystis jirovecii pneumonia is a potential lifethreatening infection for children with low immunity, and that ECMO can effectively improve the prognosis of children with severe respiratory distress syndrome.

Breast milk is considered ideal food for premature infants, but it can also be the main source of cytomegalovirus (CMV) infection in premature infants. CMV infection may cause serious clinical symptoms, such as sepsis-like syndrome, thrombocytopenia, neutropenia, jaundice, hepatitis, and pneumonitis. This article reviews the research advances in symptoms, treatment strategies, prognosis and the prevention of breast milk-acquired CMV infection in premature infants.

Human cytomegalovirus (HCMV) infection, a common complication, remains a major risk factor related with patient death after hematopoietic stem cell transplantation (HSCT). Cytotoxic T lymphocytes (CTL) which is crucial to control HCMV infection, can prevent or treat HCMV infection safely and effectively after adoptive infusion. Many studies have been focussed on exploring different methods for preparation of CTL. The method of using antigen presenting cells to stimulate peripheral blood mononuclear cells is simple to operate, easy to conduct large-scale clinical trials. Isolation of CTL from donor-derived PBMC by peptide-tetramer or INF-γ antibody requires a large volume of peripheral blood and high cost for preparation. Third-party CTL can provide an "off-the-shelf" product, but the problem of HLA-mismatch still would be solved. In addition, the clinical efficacy and safety of different methods also vary. This article reviews and compares the current methods to generate CTL and efficacy of the cells after infusions.

Objective: To explore the efficacy and safety of expanding cytomegalovirus specific cytotoxic T lymphocytes (CMV-CTL) in vitro on refractory cytomegalovirus (CMV) infection., Methods: A total of twenty-eight patients with refractory CMV infection following stem cell transplant (SCT) were treated with CMV-specific T cells, of which 19 cases were from hematopoietic stem cell donors and 9 from third-party donors. In the first course, CTL was infused once or twice and the efficacy and adverse effects were evaluated. If CMV infection relapsed after complete remission (CR), the second course would be given., Results: Twenty-one patients with refractory CMV viremia and seven with CMV diseases were eligible for adoptive T-cell transfer. After a median of 76 (39-321) days post-transplant, patients received a median dose of 1.0 (0.5-10.0) × 10(7) CTL infusion in the first course. All twenty-one patients with CMV viremia and four patients with CMV diseases achieved CR after using 9 (3-23) and 7 (4-18) days respecitvely. Six patients with CMV viremia and one with CMV disease received the second course after recurrence. Another four patients with viremia and one with CMV disease had reached CR again. Five patients exhibited graft-versus-host diseases (GVHD), all experiencing mild to moderate skin involvement. Six patients died of CMV infection and 2 of other transplantation-related complications., Conclusion: Our preliminary results have shown that CMV-CTL infusion is effective against refractory cytomegalovirus infection following SCT, but therapeutic schedule still needs to be improved in further study.

The aim of this study was to analyze the risk factors of cytomegalovirus (CMV) infection and CMV disease after nonmyeloablative allogeneic hematopoietic stem cell transplantation(NST) and develop a rational strategy for the diagnosis, monitoring and preemptive treatment of CMV infection. The Clinical data of 80 patients undergoing NST from November 2009 to November 2012 in the hospital 307 were retrospectively analyzed. The cytomegalovirus load in peripheral blood of patients was detected by using RT-PCR. The results indicated that the incidence of CMV infection was 77.5% (62/80), and the median time for the positive CMV-DNA firstly detected by RT-PCR was day 35 (17-133) after NST. The total of 100-day cumulative incidence of CMV disease was 11.3%(9/80) after early preemptive therapy. Both univariate and multivariate analysis showed thymoglobulin (ATG) used in preconditioning regimen, other herpesvirus infection and fungal infection in medical history before NST were the risk factors of CMV infection after NST.Univariate analysis revealed that CMV viremia and ATG used in preconditioning regimen were the risk factors for CMV disease, while the same result was not found in the multivariate analysis.The incidence of CMV infection in patients with II-IV grade of aGVHD was 91.3%,while the incidence of CMV infection in patients with 0-1 grade of aGVHD was 71.9% (P = 0.06), it seems that II-IV grade of aGVHD was not the risk factor of CMV infection for NST. It is concluded that the ATG used in preconditioning regimen may increase the incidence of both CMV infection and CMV disease after NST. CMV infection easily accompanies by other herpesvirus infection and fungal infection.Therefore other herpesvirus infection and fungal infection should be attentively monitored and prevented after trans-plantation.

Objective: Newborns have been the focus group for most studies of cytomegalovirus infection. The objective of the study is to share some preliminary analysis on clinical manifestation differences resulting from cytomegalovirus infection in children of various age groups., Methods: The clinical data of 108 children with cytomegalovirus infection were retrospectively reviewed. The children were classified into three age groups: <6 months, 6-12 months and >12 months. The differences in clinical manifestations from cytomegalovirus infection among the three age groups were identified., Results: Each age group carried distinctive differences in the occurrence of hepatic damage, jaundice, pneumonia, and hematological manifestations, as well as incidence rate of malformation (p<0.05 or 0.01). The primary clinical manifestations of group<6 months old were hepatic damage(83%), pneumonia(47%) and jaundice (43%). There was a similar proportion of anicteric-hepatitis and icteric-hepatitis; however a low incidence rate of hematological disease (6%) was found in group<6 months old. The primary clinical manifestations of group 6-12 months old were hepatic damage (86%), mostly with no presence of jaundice, pneumonia (33%), and hematological disease (20%). Hepatic damage (52%) and hematological disease (33%) were leading clinical symptoms in group>12 months old where jaundice and pneumonia were rare events., Conclusions: End-organ damage triggered by cytomegalovirus infection is related to the age of the affected children closely.

Objective: To explore the etiopathogenesis, therapy and incidence of pulmonary infection in kidney transplantation recipients taking new immunosuppressant., Methods: The clinical data from 752 kidney transplant recipients were retrospectively analyzed, who were divided into 3 groups according to the immunosuppressants administered, namely group A (CsA+MMF+Pred, n=226), group B (FK506+MMF+Pred, n=386) and group C (FK506+Rap+Pred, n=140). The incidence and mortality of pulmonary infection were recorded and the analysis of etiopathogenesis, diagnosis and therapy of pulmonary infection were carried out in the 3 groups., Results: Fifty-three patients acquired post-transplant pulmonary infection. The incidence of pulmonary infection was 7.08% (16/226) in group A, 7.25% (28/386) in group B and 6.43% (9/140) in group C. One patient died in group A and 2 in group B. Among the 53 patients, 24 had simple bacterial infection, 9 had cytomegalovirus infection, 1 had mycotic infection, 17 had combined infection, and 2 had unidentified pathogen infection. Of the pathogenic bacteria detected, 68.35% were Gram-negative., Conclusion: Gram-negative bacteria are most likely responsible for pulmonary infection after kidney transplantation, which most possibly occurs within 6 months after kidney transplantation. Early diagnosis and early treatment are critical for decreasing the mortality of severe pneumonia and for improving the survival rate of the patients and grafts.

Objectives: To investigate the diagnosis and treatment of cytomegalovirus (CMV) pneumonia after liver transplantation., Methods: Five cases of CMV pneumonia after liver transplantation were analyzed retrospectively. CMV pneumonia was diagnosed according to its clinical manifestation, chest X-ray, and etiologic test. All 5 patients received comprehensive therapy based on anti-virus treatment and immunologic adjustment., Results: The clinical manifestation of CMV pneumonia after liver transplantation was nonspecific. Its main symptoms included fever, cough, dyspnea, tachycardia, fatigue, hypoxemia and neutropenia. The chest X-ray showed interstitial pneumonia. Sera CMV antigens or antibodies could be detected in the patients. Four patients were cured and 1 patient died., Conclusions: The clinical manifestation of CMV pneumonia was nonspecific. CMV pneumonia could be diagnosed according to its manifestations, chest X-ray and etiologic test. The comprehensive therapy based on anti-virus treatment and immunologic adjustment was effective for the disease.

Objective: To report 6 cases of cytomeganlovirus (CMV) enteritis in allogeneic bone marrow transplantation (allo-BMT) or peripheral blood stem cell transplantation(PBSCT) recipients and the outcome after treatment., Methods: The 6 patients suffered from leukemia and received allo-BMT or allo-PBSCT., Results: Five of the 6 patients had acute GVHD II-III at 42, 26, 66, 45 and 57 days after transplantation respectively and they recovered after proper treatment. However they soon had severe diarrhea, abdominal pain or/and gastrointestinal bleeding, 5 of the 6 patients received endoscopic examination with biopsy at 50, 57, 80, 65, 35 days after transplantation respectively. They were all diagnosed as having CMV enteritis based on the presence of cytomegalic cells on mucosal biopsy specimens stained with hematoxylin and eosin. Meanwhile the immunoperoxidase stain of histologic specimens for CMV antigen or in situ hybridization by CMV DNA probe was positive. One patient was diagnosed CMV enteritis at 138 days after transplantation based on the clinic and response to therapy. They received antiviral treatment with ganciclovir (DHPG) 500 mg/d for 4 to 21 days, foscarnet 2.4 g q8 h or 4.8 g q12 h for 21 to 90 days, garlic extract 60-120 mg/d, globulin and other supportive measures. All the 6 cases had complete clinical response., Conclusion: CMV enteritis should be diagnosed as soon as possible with histopathologic examination and early proper treatment may lead to good clinical response.

Fifty-seven patients with CMV hepatitis, who were within 3 months of age, were treated with interferon from August 1992 to April 1993. They were randomized to be assigned to two groups. There were 30 patients in the therapeutic group, who were given daily interferon 1,000,000 u intramuscularly for 10 days and 27 patients in the control group, who were put on daily vitamin C and inosine therapy intravenously for 10 days. The results showed that there was a significant difference in the aspects of jaundice disappearance, liver and serum SGPT recovery time between the two groups. In the therapeutic group, the average alleviating time of jaundice, hepatomegaly and serum SGPT level after treatment with interferon were 15.26, 29.89 and 14.26 days ahead of those in the control group, respectively. The cure rate at one month and two months after treatment was 43.0% and 90.0% in the therapeutic group, respectively; 18.5% and 48.0% in the control group, respectively.