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Primary or Reactivation Infection?

Calvin C. Linnemann, Jr, MD; Corwin R. Dunn, MD; M. Roy First, MD; Mariano Alvira, MD; Gilbert M. Schiff, MD

Arch Intern Med. 1978;138(8):1247-1250.

Abstract
Cytomegalovirus (CMV) infections are a recognized problem in the first six months after renal transplantation. Studies have suggested that primary infections produce symptomatic disease, whereas reactivation infections are usually asymptomatic. Two patients are described who developed fatal CMV infections in the second year after transplantation. Both patients had typical CMV disease with fever, pneumonitis, and hepatitis. Results of serologic studies in one patient were characteristic of primary infection, with seroconversion at the time of disease and appearance of specific IgM antibodies. The other patient had a similar antibody response at the time of his illness, but serial antibody tests showed that he had had a transient seroconversion earlier, in the second month after transplantation, that was not associated with clinical symptoms. These patients indicate that CMV infection must be considered in the differential diagnosis of serious febrile illnesses even in the late posttransplantation period and may occur either as the result of primary or reactivation infection. Serologic studies at the time of illness may not allow distinction between the types of infection.

(Arch Intern Med 138:1247-1250, 1978)

Author Affiliations
From the Departments of Medicine (Drs Linnemann, First, and Schiff) and Pathology (Dr Alvira), University of Cincinnati College of Medicine, and the Department of Medicine, Christ Hospital, Cincinnati (Dr Dunn).

Footnotes
Accepted for publication Oct 28, 1977.

Reprint requests to Infectious Disease Division, 7064 Medical Sciences Bldg, Cincinnati, OH 45267 (Dr Linnemann).

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