Nihon Kyukyu Igakukai Zasshi
Online ISSN : 1883-3772
Print ISSN : 0915-924X
ISSN-L : 0915-924X
Original Article
Active cytomegalovirus infection and cytomegalovirus pneumonia in patients with acute respiratory failure in a general ICU
Yoshiki TohmaShigeru SanoShigeru ShionoHisayuki Tabuse
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JOURNAL FREE ACCESS

2012 Volume 23 Issue 5 Pages 183-191

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Abstract

Context: Cytomegalovirus (CMV) has long been recognized as a lethal viral pathogen in immunocompromised hosts, but it has recently also become known as a pathogen of emerging importance for immunocompetent patients with septic shock, acute respiratory failure (ARF), or severe trauma.
Objective: To define the frequency and clinical characteristics of active CMV infection and CMV pneumonia in patients with ARF treated in a general intensive care unit (ICU).
Design: A retrospective clinical study.
Patients: Thirty-five ARF patients were divided into 2 groups based on the presence or absence of CMV pneumonia. CMV pneumonia was defined as 1) clinical findings of pneumonia, 2) positive pp65 antigenemia (active CMV infection), and 3) positive PCR assay of bronchoalveolar lavage fluid (BALF) or transtracheal aspiration (TTA).
Results: The incidences of active CMV infection and CMV pneumonia in the 35 ARF patients were 7/35 (20.0%) and 6/35 (17.1%), respectively. There were no significant differences between the 2 groups in terms of age, sex, mortality rate, lung injury score, or sepsis-related organ failure assessment score. Septic acute respiratory distress syndrome (septic ARDS) patients who received methylprednisolone (MPS) therapy was major risk factors for the onset of CMV pneumonia (p = 0.0073, Odds ratio=90.9). The change in the cell component of BALF (from neutrophil-dominant to lymphocyte-dominant) was helpful in predicting the onset of CMV pneumonia. Ganciclovir and immunoglobulin were effective in treating CMV pneumonia. The mortality rate of CMV pneumonia patients was 16.6% (1/6) in our study.
Conclusion: Active CMV infection and CMV pneumonia are not uncommon among ARF patients in a general ICU. Longitudinal examination of pp65 antigenemia and PCR assay of BALF or TTA are crucial in determining active CMV infection or CMV pneumonia in these patients, particularly in septic ARDS patients who receive MPS therapy. Ganciclovir and immunoglobulin are effective treatment modalities in these patients.

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© 2012 Japanese Association for Acute Medicine
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