Chest Infections: Chest Infections II |

Cytomegalovirus Infection After Severe Pneumonia in Immunocompetent Subjects: A Two-Case Report FREE TO VIEW

Chenjuan Gu, PhD; Hong Chen, MD; Yongjie Ding, MD; Guo Chao Shi, PhD
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Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;149(4_S):A121. doi:10.1016/j.chest.2016.02.126
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SESSION TITLE: Chest Infections II

SESSION TYPE: Case Report Poster

PRESENTED ON: Sunday, April 17, 2016 at 11:45 AM - 12:45 PM

INTRODUCTION: Cytomegalovirus (CMV) is a major β herpes virus and a significant human pathogen. CMV infection has been shown to lead to significant disease in immunocompromised hosts such as those with HIV infection or transplant recipients. It has increasingly come to be recognized that critically ill patients who are traditionally considered immunocompetent may also be at risk for CMV infection.

CASE PRESENTATION: Two elderly patients were admitted to our Respiratory Intensive Care Unit for severe pneumonia and hypoxemic respiratory failure. After about 2 weeks’ treatment including invasive mechanical ventilation, broad-spectrum antibiotics and corticosteroids, their oxygenation improved with resolution of lung infiltrates on chest radiograph. On the course of recovery, their oxygenation deteriorated again and lung infiltrates extended without positive pathogenic findings of bacteria and fungi. Unexpectedly, their blood CMV DNA became positive and then they were treated with parenteral ganciclovir for more than 2 weeks. After that, their oxygenation and chest radiograph returned to normal.

DISCUSSION: Invasive mechanical ventilation and use of corticosteroids could be the risk factors of immunocompetent subjects to develop CMV infection after severe pneumonia. The clinical characteristics include deterioration of oxygenation and extensive lung infiltrates without positive pathogenic findings of bacteria and fungi. Quantitive nucleic acid amplification tests for blood CMV DNA, CMV pp65 antigenemia test and histology/immunohistochemistry are recommended diagnostic tools. Valganciclovir or intravenous ganciclovir are recommended as first-line treatment for at least 2 weeks.

CONCLUSIONS: CMV infection occurs frequently in immunocompetent subjects with critical illness. CMV pneumonia should especially be considered in patients with severe pneumonia, receiving mechanical ventilation and steroids. Early diagnosis and treatment may help improve the prognosis of these patients.

Reference #1: Kalil AC, Florescu DF. Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit. Crit Care Med,2009,37:2350-2358

Reference #2: Jain M, Duggal S, Chugh TD. Cytomegalovirus infection in nonimmunosuppressed critically ill patients. J Infect Dev Ctries,2011,5:571-579.

Reference #3: Limaye AP, Kirby KA, Rubenfeld GD, et al. Cytomegalovirus Reactivation in Critically-Ill Immunocompetent Patients. JAMA,2008,300:413-422.

DISCLOSURE: The following authors have nothing to disclose: Chenjuan Gu, Hong Chen, Yongjie Ding, Guo Chao Shi

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