Learn vocabulary, terms, and more with flashcards, games, and other study tools. It is related to the viruses that cause chickenpox and infectious mononucleosis mono. In immunocompetent patients, cytomegalovirus infection can be asymptomatic or result in a mononucleosislike illness. Some otherwise healthy people with cmv infection develop a mononucleosislike syndrome. Given the role of il6 in antiviral immunity, cmv reactivation in il6 blockade is not surprising 4. Cytomegalovirus infection is a topic covered in the diseases and disorders to view the entire topic, please sign in or purchase a subscription nursing central is an awardwinning, complete mobile solution for nurses and students. Treatment of cytomegalovirus pneumonia with ganciclovir. Pathogen detection and community acquired pneumonia the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Cytomegalovirus infections diagnosis difficult presence of virus or antibody to cmv does not indicate that current disease is due to cmv different strategies used in different clinical situations isolation of virus from urinecongenital cmv of birth within 30 days antigen detection in buffy coat indicates immunocompromised. Pneumonia is usually caused by infection with viruses or bacteria and less commonly by other microorganisms, certain medications.
Epidemiologic studies indicated that through 1992 nearly half of hivinfected patients eventually developed cmv endorgan disease including chorioretinitis, esophagitis, colitis, pneumonia, and central nervous system disease. In a murine model of cmv pneumonia, interstitial fibrocytes, alveolar epithelial cells, and endothelial cells were target cells of cmv infection 10. Cytomegalovirus cmv infection is a common complication of immunosuppression, and is frequently seen in transplant recipients, patients with the acquired immunodeficiency syndrome aids, and those who have received steroids. Caliendo, md, phd,3 shirish huprikar, md,4 sunwen chou, md,5 lara danzigerisakov, md, mph,6 and atul humar, md7 on behalf of the the transplantation society international cmv consensus group. Most people infected with cytomegalovirus have no symptoms. After initial infection, the virus remains in a latent state in the host and can be reactivated under a variety of conditions. Moreover, the role of viruses in hospitalacquired pneumonia. The imaging findings of viral pneumonia are diverse and overlap with those of other nonviral infectious and inflammatory conditions.
Years later, between 1956 and 1957, thomas huckle weller together with smith and rowe independently isolated the virus, known thereafter as cytomegalovirus. On the contrary, severe lifethreatening infection due to cmv, including cmv pneumonia, is rare in immunocompetent hosts. On admission, though respiratory bacteria and viruses. Frequent adverse events are upper respiratory tract infections, headache, nasopharyngitis, and gastrointestinal. Cmv infection remains amongst the most common and significant complications after hsct cumulative incidence of cmv reactivation among allohsct is around 36% and in cbt recipients could be as high as 80% cmv endorgan disease. May 05, 2018 cytomegalovirus cmv is a doublestranded dna virus and is a member of the herpesviridae family. Serologic studies identify cmvspecific igm antibodies that reflect recent seroconversion and reveal a fourfold increase in cmvspecific igg titers in paired specimens obtained at least 2 to 4 weeks apart. Cytomegalovirus is one of eight herpes viruses known to infect humans mocarski, 1993. Treatment with iv ganciclovir, or alternatively, with foscarnet, is logical ciii. Between 50 percent and 80 percent of adults in the united states have had a cmv infection by age 40. Hematologic malignanciesstem cell transplantation program. The initial choice of antibiotic is made empirically. The biological and evolutionary significance of multiple cytomegalovirus infection by andrea r.
Jun 30, 2000 human cytomegalovirus cmv, which belongs to the group of herpes viruses, is an important cause of morbidity and mortality in immunocompromised patients 112. Typically, symptoms include some combination of productive or dry cough, chest pain, fever and difficulty breathing. After kidney transplantation, active cmv infection and disease are associated with increased risk of allograft failure and death. Other members of this family include herpes simplex viruses which cause cold sores and genital herpes, varicellazoster virus which causes chickenpox and shingles, and epsteinbarr virus which causes infectious mononucleosis. Oct 02, 20 while often thought of as a pneumonitis with diffuse infiltrates, cmv can cause a lobar pneumonia in up to 30% of patients. Cytomegalovirus pronounced sitomegalovirus, or cmv, is a virus that belongs to the herpesviridae family, hence its older name, human herpes virus 5 hhv 5. Congenital cytomegalovirus infection is the most common congenital infection in neonates in the usa, affecting approximately 0. Cytomegalovirus cmv is a doublestranded dna virus and is a member of the herpesviridae family. Under the condition of weakened immune surveillance in these patients, latent cmv hidden in transplanted donor cells or in the recipients own tissues can awake to cause a destructive infection resulting in graft loss and multiple endorgan disease, of which viral pneumonia is the most feared. Multifocal nodular infiltration represents infected areas of cells with cytoplasmic cmv inclusion. Cytomegalovirus infection was demonstrated by needle aspiration cytology. Pathogen identification of bacterial pneumonia via dna detection the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. Viral pneumonia in adults could present as communityacquired pneumonia cap, ranging from mild disease to severe disease requiring hospital admission and mechanical ventilation.
Autopsy studies are the most abundant source of evidence for cmv as a cause of pulmonary disease in hivinfected patients. Rearrange individual pages or entire files in the desired order. Infant primary infection and maternal nonprimary infection were defined by the onset of persistent highlevel oral cmv. Once infected, your body retains the virus for life. Jun 15, 2017 even in the era of highly active antiretroviral therapy, the most common etiologies of pneumonia in this setting are still pneumocystis jirovecii. Peckham1 1mrc centre of epidemiology for child health, ucl institute of child health, university college london, united kingdom. Nonprimary maternal cytomegalovirus infection after viral.
Although the development of effective cytomegalovirus cmv prevention strategies has significantly reduced the need to treat established cmv disease after hematopoietic cell transplantation hct, the management of cmv pneumonia remains a formidable challenge. Pneumocystis jiroveci pneumonia pcp and cytomegalovirus cmv are opportunistic infection seen in patients with advanced immunocompromised states, such as hiv infection. A read is counted each time someone views a publication summary such as the title, abstract, and list of authors, clicks on a figure, or views or downloads the fulltext. Mar 12, 2020 cytomegalovirus cmv is a virus found around the world. The patients symptoms and radiographic abnormalities resolved completely on ganciclovir therapy. We enrolled patients with cmv associated severe pneumonia admitted to the vietnam national hospital of pediatrics, hanoi, vietnam, from january 2010 to december 2011. Cytomegalovirus can be transmitted from mother to fetus even if the mother was infected years before conception.
Viruses are the most common causes of acute respiratory infections, and causative agents of lower respiratory tract infection vary according to patient age and immunity. The objective was to compare the use of the polymerase chain reaction pcr, virus culture, and immunostaining of alveolar cells used alone and in combination as diagnostic methods for the rapid diagnosis of cytomegalovirus cmv pneumonia in marrow transplant recipients. The eight species in this genus include the type species, human betaherpesvirus 5 hcmv, human cytomegalovirus, hhv5, which is the species that infects humans. Most people dont know they have cmv because it rarely causes problems in healthy people if youre pregnant or if your immune system is weakened, cmv is cause for concern. Pneumonia can be a complication of another illness, such as the flu, when your body is already in a weakened state. Cytomegalovirus pulmonary infection radiology reference. Cmv is a widespread and common virus that can infect almost anyone. It can cause pneumonia, while at the same time infecting other body organs too.
Diagnosing and treating cytomegalovirus pneumonia in. In studies of septic patients, about onethird of the patients developed cmv reactivation 2,3. Experience treating welldocumented cmv pneumonia in patients with hiv infection is limited and anecdotal. Presence of human cytomegalovirus dna in blood of patients. Cytomegalovirus pneumonia in a patient with interstitial.
Disease bioinformatics research of cytomegalovirus infections has been linked to infective disorder, virus diseases, acquired immunodeficiency syndrome, hiv infections, immunologic deficiency syndromes. The clinical presentations of these patients were nonspecific, including fever 100% of patients, shortness of breath 71%, cough 76%, and pao 2 of cytomegalovirus pneumonia is a type of viral pneumonitis and occurs due infection with cytomegalovirus cmv, which is a member of the herpetoviridae family. Cytomegalovirus cmv pneumonia is a major cause of morbidity and mortality in allogeneic bone marrow transplant and lung transplant recipients. Cytomegalovirus pneumonia after complicated cardiothoracic. Cytomegalovirus cmv from the greek cyto, cell, and megalo, large is a genus of viruses in the order herpesvirales, in the family herpesviridae, in the subfamily betaherpesvirinae. Community acquired pneumonia boston health care for the. A patient with aids and a history of nonhodgkins lymphoma developed a generalized illness associated with the appearance of multiple pulmonary nodules on a chest radiograph. Cytomegalovirus cmv is a common virus that asymptomatically infects the majority of the population by early adulthood. Cmv pneumonia is caused by a member of a group of herpestype viruses.
When cmv is active, symptoms can range from feeling like you have the flu to a lifethreatening illness. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with hiv k2 cmv pneumonitis is extremely uncommon. This study aimed to evaluate the effectiveness of gancyclovir gcv treatment for severe cytomegalovirus cmv associated pneumonia in immunocompetent children. Bmt 2007 australia organ insufficiency invasive fungal infection cmv reactivation agarwal i wsp, intern med. Cmv pneumonia is a rare finding in immunologically normal persons. The radiographic findings of cmv pneumonia are variable and include diffuse reticulonodular densities 2, 3, 7, 8, diffuse haze, and dense areas of consolidation 15. Cytomegalovirus cmv is related to the herpes virus that gives you cold sores. The recent development of antiviral agents with activity against cmv has led to a needfor rapid and reliable diagnostic tests.
Pdf differences and similarities of cytomegalovirus and. Clinical manifestations, diagnosis, and treatment of cytomegalovirus infection in lung transplant recipients formulary drug information for this topic no drug references linked in this topic. Cmv exhibits acute interstitial pneumonia with diffuse alveolar edema with fibrinous exudate. Cytomegalovirus pneumonia after bone marrow transplantation successfully treated with the combination of ganciclovir and highdose intravenous immune globulin. The majority of persons with acute cmv will experience an inapparent infection. Cytomegalovirus cmv pneumonia is a lung infection caused by the virus cytomegalovirus, leading to inflammation in the lung tissues in patients with poor immune system. The third international consensus guidelines on the. Other rare complications for healthy adults include problems with the digestive system, liver, brain and nervous system. This causes respiratory symptoms and rapid deterioration in clinical condition. Oct 28, 2014 after a primary infection, human cytomegalovirus hcmv remains latent in certain human cells. Pneumonia is an inflammatory condition of the lung affecting primarily the small air sacs known as alveoli. Most people come into contact with cmv in their lifetime. Cytomegalovirus was first observed by german pathologist hugo ribbert in 1881 when he noticed enlarged cells with enlarged nuclei present in the cells of an infant. Hematologic malignanciesstem cell transplantation program diagnosis and management of interstitial pneumonia 2 pentamidine aerosolized 300 mg, or 4 mgkg iv, monthly for prevention of pneumocystis carinii pneumonia.
Cytomegalovirus cmv has rarely been implicated as the cause of sids. J, 2012 taiwan pneumonia bacterial pneumonia cmv invasive fungal infection sepsis yang i wsp, j formos med. To our knowledge, this is the first case report on the occurrence of combined primary cytomegalovirus and pneumocystis jiroveci infection in a patient with vasculitis. Survival of 52% of 25 patients from the initial episode of cytomegalovirus pneumonia with the regimen of ganciclovir and cytomegalovirus immunoglobulin is significantly better p cytomegalovirus pulmonary infection dr mostafa elfeky and dr yuranga weerakkody et al. A cohort of ugandan newborns and their mothers were tested weekly for cmv by quantitative polymerase chain reaction of oral swabs. In treating cytomegalovirus cmv infection, it is crucial to decide whether one is treating preemptively or if one is treating established disease. Pathogen detection and community acquired pneumonia full. Many germs, such as bacteria, viruses, and fungi, can cause pneumonia. In the last decade, the role of the reactivation in immunocompetent patients with serious illness has been intensely studied. Viral pathogens are increasingly recognized as a cause of pneumonia, in immunocompetent patients and more commonly among immunocompromised.
Cytomegalovirus cmv pneumonia is a type of viral pneumonitis and occurs due to infection with cytomegalovirus cmv, which is a member of the herpetoviridae family. Clinical manifestations, diagnosis, and treatment of. Cytomegalovirus pneumonia in patients with lymphoma request pdf. Cytomegalovirus pneumonia in sudden infant death syndrome. Generally, mild disease in immunosuppressed patients may be treated with oral valganciclovir. You can also get pneumonia by inhaling a liquid or chemical. Rarely, cmv causes a healthy adult to develop mononucleosis.
There are a number of indicators for identifying viral. Cytomegalovirus pneumonia definition of cytomegalovirus. Cmv pneumonia ranges from 10% to 30% in allosct recipients. Cmv pneumonia was defined as clinical and radiographic evidence of pneumonia in association with the isolation of cmv in viral cultures of bronchoalveolar lavage or lung tissue specimens, or with. Ventilatorassociated cytomegalovirus organizing pneumonia in an immunocompetent critically ill patient dear editor, organizing pneumonia is characterized by. Listing a study does not mean it has been evaluated by the u. Cytomegalovirus pneumonia in sudden infant death syndrome to the editor. Cytomegalovirus pneumonia is a type of viral pneumonitis and occurs due infection with cytomegalovirus cmv, which is a member of the herpetoviridae family.
Townsend, 1marianne forsgren,2 karin ahlfors, 3stenanders ivarsson, pat a. Merge pdf files combine pdfs in the order you want with the easiest pdf merger available. Women who develop an active cmv infection during pregnancy can pass the virus to their babies, who might then. Thinsection ct findings in 32 immunocompromised patients. Furthermore, late cmv disease may occur after both myeloablative and nonmyeloablative hct. The other family members include herpes simplex virus type 1 hsv1 or hhv1 and herpes simplex virus type 2 hsv2 or hhv2, varicella zoster virus vzv, human herpes virus hhv6, hhv7, and hhv8. Prophylaxis is effective, but cases can occur despite a preemptive strategy. However, its role as a cause of lung disease in patients with the human immunodeficiency virus hiv is controversial. Healthcare providers, see the clinical overview and laboratory testing guidelines for cytomegalovirus cmv, as well as information on congential cmv infection. But usually, its people with a weakened immune system, such as those with hivaids, who become ill from cmv infection. Most people are exposed to cmv in their lifetime, but typically only those with weakened immune systems become ill from cmv infection.
Cytomegalovirus cmv pneumonitis is a wellrecognized cause of serious morbidity and mortality in immunocompromised hosts. Early in the aids epidemic, cytomegalovirus cmv was a major cause of morbidity and mortality in patients with aids in the united states. The biological and evolutionary significance of multiple. Cytomegalovirus is a common herpesvirus that causes serious peripheral nervous system syndromes in immunosuppressed patients, such as organ transplant recipients or patients with advanced hiv infection. Cytomegalovirus pneumonia in nonimmune compromised icu patients is a largely unexpected and probably underestimated diagnosis. May 07, 2018 what are the causes of cytomegalovirus pneumonia. The optimal duration of therapy and the role of oral valganciclovir have not been established. Viral pneumonia1 viruses are the most common causes of respiratory infection. As in this patient, the effect of steroids on risk for infection often cannot be determined.
Cmv pneumonia, which is a common manifestation of the infection. Department of health and human services centers for disease control and prevention diagnose, treat, and monitor children with congenital cytomegalovirus cmv to help improve their health outcomes. Reduced mortality of cytomegalovirus pneumonia after. However, identification of the underlying viral pathogens may not always be easy. Recently, we saw a patient with sids from whom interstitial pneumonitis caused by cmv was demonstrated. Cmv pneumonia is a common lifethreatening complication seen in immunocompromised patients, such as the patient presented in this report.
Apr 15, 2010 the patient was shown to have coexistent pneumocystis jiroveci pneumonia and primary cytomegalovirus cmv infection with presumed cmv pneumonitis and colitis. Skip directly to site content skip directly to page options skip directly to az link. Complement fixation studies, hemagglutination inhibition antibody tests for cmv isolate the virus or demonstrate increasing serologic titers. We present a patient with orai1 deficiency and normal trec numbers observed after diagnosis at the age of 14 months who suffered from disseminated fatal cytomegalovirus and pneumocystis jirovecii infection, demonstrating a potential pitfall of the current nbs program. In one study 25 of 86 patients who had a prolonged stay in icu had cmv pneumonia 1,2. There are many different types of pneumonia, most are caused by a bacteria, virus, or fungus. Longterm outcomes of congenital cytomegalovirus infection in sweden and the united kingdom claire l. Computed tomographic ct findings of viral pneumonia are diverse and may be affected by the immune status of the host and the underlying pathophysiology of the viral pathogen. We present a case of pcpcmv coinfection in a patient with newly diagnosed hiv disease. Atif ali bashir assistant professor of pathology college of medicine majmaah university introduction. Cytomegalovirus pulmonary infection dr mostafa elfeky and dr yuranga weerakkody et al. Primary cytomegalovirus infection with accompanying. Pneumonia is an infection in one or both of the lungs. Pneumonia is an inflammation of your lungs, usually caused by an infection.
Diagnosis and management of cytomegalovirus cmv infection and disease. Complications of cmv infection vary, depending on your overall health and when you were infected. Lung biopsy gold standard pp65 sensitivity and specificity 73% and 50% vl hsiao et al significantly higher cmv viral load in infants with probable. Longterm outcomes of congenital cytomegalovirus infection in. Different stimuli, including immune deficiency and severe infection, can trigger the reactivation of latent hcmv infection. It can cause blindness and other serious problems if youre hivpositive. In a 22month period, cmv pneumonia was diagnosed in 17 8% of 210 hivinfected patients who underwent lung biopsy on the basis of microbiological and histologic criteria. Etiology cytomegalovirus pneumonia is a viral infectious disease which occurs in patients with poor immune system, and sometimes in healthy people as well. Pathogen identification of bacterial pneumonia via dna. Rapid diagnosis of cytomegalovirus pneumonia in marrow. Disease may be further divided into viral syndrome and tissueinvasive disease. Differences and similarities of cytomegalovirus and pneumocystis pneumonia in hivnegative immunocompromised patients thin section ct morphology in the early phase of the disease. Ct findings are nonspecific and diverse and have been described without distinction between aids and nonaids patients.
90 1347 1446 1392 1021 1394 386 550 123 369 40 524 66 710 762 911 1191 1182 247 1627 1233 1384 1437 346 1312 1237 756 298 440 1465 893 916 883 1609 939 150 503 1309 184 1265 491 839 675 155 576 117 1162