Local presence of cytomegalovirus and Candida species vs oral lesions in liver and kidney transplant recipients
Dorota Olczak-Kowalczyk, Joanna Pawłowska, Bożena Cukrowska, Przemysław Kluge, Ewa Witkowska-Vogtt, Katarzyna Dzierżanowska-Fangrat, Danuta Wrześniewska, Ewa Śmirska, Ryszard Grenda
Ann Transplant 2008; 13(4): 28-33
Background: Anti-CMV prophylaxis is currently a routine management in patients after organ transplantation. One of the clinical symptoms of CMV infection may be lesions in the oral cavity.The aim of this study was to determine the relationship between CMV infection, occurrence of Candida species and presence of oral mucosal ulceration in transplant recipients.
Material/Methods: Twenty five patients after kidney or liver transplantation (mean age 13 years ±4 years), receiving immunosuppression (tacrolimus, cyclosporine or sirolimus), who presented minor and major recurrent aphtous stomatitis (RAS), atypical ulcerations or focal necrosis in the oral cavity were enrolled into the study. Mean duration of post-transplant follow-up was 4 years and 3 months (±3 years and 5 months). Clinical dental examination (Pl I, GI), mycological tests and blood tests for CMV infection (specific IgM antibodies and/or pp65 antygenemia) were performed in all patients. Eighteen specimens of oral mucosa were evaluated for CMV presence in situ.
Results: CMV infection was confirmed in 13 patients with oral mucosal ulceration (46.43%); which were accompanied by gingivitis (average GI=1.34); in two cases Candida albicans was identified. DNA of HCMV was found in-situ in 5.5% of all biopsies, and in 9% of biopsies of patients with clinical CMV infection; changes did not show the presence of Candida spp.
Conclusions: There is a significant correlation between CMV infection and oral lesions; in some cases, CMV may be a direct cause.
Keywords: Organ Transplantation, Immunosuppression, Cytomegalovirus, vascular cognitive impairment, Morphine-6-glucuronide