PMC4719720_01
Monitoring of relevant blood tests in the course of infection. The arrow indicates the duration of valganciclovir therapy. Both diagrams show a return to normalcy of all parameters after brief antiviral therapy
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Fig1
WBC and thrombocytes decreased further (Fig. 1). We therefore started valganciclovir treatment, with oral administration of 900 mg doses twice a day, due to the patient's severe clinical conditions, in particular the worsened coagulopathy (Fig. 1). After administration of four valganciclovir doses, CRP and D-dimers decreased strongly, leukocyte and thrombocyte counts increased, and fever and chills disappeared (Fig. 1). IgM reactivity (IgM index <1,0), a steep increase in CMV IgG (about 4-fold), and the emergence of gB2-IgG, which indicates CMV neutralising antibodies (Table 1, Fig. 2, Additional file 1). Interestingly, the CMV specific antibody pattern had already been present with high titers at the very onset of symptoms, while gB1 and gB2 reactivity only developed slowly (Fig. 2, Additional file 1).
Epithelial cell-specific (ARPE-19) plaque reduction neutralisation capacity of the sera 1-4. Reference sera include a negative pool (N = 100 sera from seronegative women at birth), and a pool of latently CMV-infected women at birth (IgG positive, IgM negative, high IgG avidity) as well as the hyperimmunoglobulin preparation Cytotect (Biotest, Germany). The shaded columns show the mean number (N = 3 replica) of CMV IE1-stained plaques (NIEA plaques) in the absence of CMV-specific antibodies after 5 days of incubation. Black columns show the percentage of neutralisation via plaque reduction of each serum panel. Gray columns show CMV IgG avidity (AI ECLIA, %). Specific NT capacity is not present in early sera of the patient (within one week of admission). However, after 5 weeks, NT50 values are reached
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Fig2
IgM reactivity (IgM index <1,0), a steep increase in CMV IgG (about 4-fold), and the emergence of gB2-IgG, which indicates CMV neutralising antibodies (Table 1, Fig. 2, Additional file 1). Interestingly, the CMV specific antibody pattern had already been present with high titers at the very onset of symptoms, while gB1 and gB2 reactivity only developed slowly (Fig. 2, Additional file 1). However, the neutralising capacity was not fully developed five weeks after onset of symptomatic infection (Fig. 2).