Cytomegalovirus Infection after Severe Pneumonia in Immunocompetent Subjects: A Two-case Report and Literature Review_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

GuChenjuan ,  ChenHong , DingYongjie , ShiGuochao

Department of Respiratory Medicine, Shanghai Ruijin Hospital, Medical School of Shanghai Jiaotong University, Shanghai, 200025, China;

Corresponding author：

ChenHong, Email: chenjiangjenny@sina.com

Keywords：

Immunocompetent subjects; Severe pneumonia; Cytomegalovirus infection

DOI：

10.7507/1671-6205.2015113

Video：

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Objective To summarize the clinical features of cytomegalovirus infection after severe pneumonia in immunocompetent subjects. Methods Two cases of cytomegalovirus infection after severe pneumonia in immunocompetent subjects were reported and the literatures were reviewed. Results Two elderly patients were admitted to our Respiratory Intensive Care Unit for severe pneumonia and typeⅠrespiratory failure. After treatment of invasive mechanical ventilation, broad-spectrum antibiotics and steroids, their body temperature became normal with improvement of oxygenation and lung infiltrates on chest radiograph. After extubation, their oxygenation deteriorated, with extensive lung infiltrates on chest X ray. Coincidently, their blood cytomegalovirus 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. Combined with the results of the related literature, invasive mechanical ventilation and use of corticosteroids could be the risk factors of immunocompetent subjects to develop cytomegalovirus 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 cytomegalovirus DNA, cytomegalovirus 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 Cytomegalovirus infection occurs frequently in immunocompe-tent subjects with critical illness. Cytomegalovirus 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.

Citation： GuChenjuan, ChenHong, DingYongjie, ShiGuochao. Cytomegalovirus Infection after Severe Pneumonia in Immunocompetent Subjects: A Two-case Report and Literature Review. Chinese Journal of Respiratory and Critical Care Medicine, 2015, 14(5): 462-467. doi: 10.7507/1671-6205.2015113 Copy

1.	Stanberry LR, Rosenthal SL, Mills L, et al. Longitudinal risk of herpes simplex virus (HSV) type 1, HSV type 2, and cytomegalovirus infections among young adolescent girls. Clin Infect Dis, 2004, 39:1433-1438.
2.	Gandhi MK, Khanna R. Human cytomegalovirus:clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis, 2004, 4:725-738.
3.	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.
4.	Jain M, Duggal S, Chugh TD. Cytomegalovirus infection in non-immunosuppressed critically ill patients. J Infect Dev Ctries, 2011, 5:571-579.
5.	Limaye AP, Kirby KA, Rubenfeld GD, et al. Cytomegalovirus reactivation in critically-ill immunocompetent patients. JAMA, 2008, 300:413-422.
6.	Osawa R, Singh N. Cytomegalovirus infection in critically ill patients:a systematic review. Critical Care, 2009, 13:R68.
7.	Ziemann M, Sedemund-Adib B, Reiland P, et al. Increased mortality in long-term intensive care patients with active cytomegalovirus infection. Crit Care Med, 2008, 36:3145-3150.
8.	Kotton CN, Kumar D, Caliendo AM, et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation, 2013, 96:333-360.
9.	Papazian L, Fraisse A, Garbe L, et al. Cytomegalovirus. An unexpected cause of ventilator-associated pneumonia. Anesthesiology, 1996, 84:280-287.
10.	Chiche L, Forel JM, Roch A, et al. Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients. Crit Care Med, 2009, 37:1850-1857.
11.	Ong DS, Klein Klouwenberg PM, VerduynLunel FM, et al. Cytomegalovirus seroprevalence as a risk factor for poor outcome in acute respiratory distress syndrome. Crit Care Med, 2015, 43:394-400.
12.	Balthesen M, Messerle M, Reddehase MJ. Lungs are a major organ site of cytomegalovirus latency and recurrence. J Virol, 1993, 67:5360-5366.
13.	Chen K, Kolls JK. T cell-mediated host immune defenses in the lung. Annu Rev Immunol, 2013, 31:605-633.

1. Stanberry LR, Rosenthal SL, Mills L, et al. Longitudinal risk of herpes simplex virus (HSV) type 1, HSV type 2, and cytomegalovirus infections among young adolescent girls. Clin Infect Dis, 2004, 39:1433-1438.
2. Gandhi MK, Khanna R. Human cytomegalovirus:clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis, 2004, 4:725-738.
3. 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.
4. Jain M, Duggal S, Chugh TD. Cytomegalovirus infection in non-immunosuppressed critically ill patients. J Infect Dev Ctries, 2011, 5:571-579.
5. Limaye AP, Kirby KA, Rubenfeld GD, et al. Cytomegalovirus reactivation in critically-ill immunocompetent patients. JAMA, 2008, 300:413-422.
6. Osawa R, Singh N. Cytomegalovirus infection in critically ill patients:a systematic review. Critical Care, 2009, 13:R68.
7. Ziemann M, Sedemund-Adib B, Reiland P, et al. Increased mortality in long-term intensive care patients with active cytomegalovirus infection. Crit Care Med, 2008, 36:3145-3150.
8. Kotton CN, Kumar D, Caliendo AM, et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation, 2013, 96:333-360.
9. Papazian L, Fraisse A, Garbe L, et al. Cytomegalovirus. An unexpected cause of ventilator-associated pneumonia. Anesthesiology, 1996, 84:280-287.
10. Chiche L, Forel JM, Roch A, et al. Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients. Crit Care Med, 2009, 37:1850-1857.
11. Ong DS, Klein Klouwenberg PM, VerduynLunel FM, et al. Cytomegalovirus seroprevalence as a risk factor for poor outcome in acute respiratory distress syndrome. Crit Care Med, 2015, 43:394-400.
12. Balthesen M, Messerle M, Reddehase MJ. Lungs are a major organ site of cytomegalovirus latency and recurrence. J Virol, 1993, 67:5360-5366.
13. Chen K, Kolls JK. T cell-mediated host immune defenses in the lung. Annu Rev Immunol, 2013, 31:605-633.

Chinese Journal of Respiratory and Critical Care Medicine

Cytomegalovirus Infection after Severe Pneumonia in Immunocompetent Subjects: A Two-case Report and Literature Review

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