Cytomegalovirus (CMV) is a member of a group of herpes-type viruses that can cause an infection of the lungs in immune-suppressed persons. This infection is particularly common in solid organ transplant and bone marrow transplant recipients.
Alternative Names
Pneumonia - cytomegalovirus; Cytomegalovirus pneumonia; Troll of transplantation
Causes, incidence, and risk factors
Infection with CMV is very common. The majority of healthy adults have antibodies (an indication of previous infection) to CMV in their blood. Usually CMV produces no symptoms, but serious CMV infections can occur in people with impaired immunity , such as those with AIDS , organ transplant and bone marrow transplant recipients, and people receiving chemotherapy or other immunosuppressive treatments. CMV disease is a common complication of organ transplantation. CMV pneumonia occurs in 20% of bone marrow transplant recipients. Risk of infection is greatest between 5 to 13 weeks after transplantation. Complications of CMV infection in individuals with AIDS include: an infectious mononucleosis-like illness (CMV mononucleosis ), CMV pneumonia, inflammation of the retina ( CMV retinitis ), and intestinal disease. In addition, CMV may increase the replication of HIV in infected individuals. CMV pneumonia is associated with fever , a non-productive cough and shortness of breath ( dyspnea ). CMV pneumonia is often present simultaneously with pneumocystis pneumonia . Decreased oxygen levels in the blood (hypoxemia) in association with CMV pneumonia often predicts a fatal outcome.
Signs and tests
urine culture (clean catch)blood culture CMV serology by IFA
bronchoscopy with biopsy , stains, and culture for CMV
chest X-rayarterial blood gas
Expectations (prognosis)
Antiviral medications stop the replication of the virus, but do not destroy it. CMV is, in itself, immunosuppressive and may increase the risk of other infections due to the additive immunosuppression .
Complications
relapse of infection overwhelming infection not responsive to treatment low white blood cell count with use of ganciclovir
kidney impairment with use of foscarnet
Calling your health care provider
Call your health care provider if symptoms of CMV pneumonia occur.
Prevention
Use of CMV-negative donors for seronegative recipients of organ transplants, use of CMV-negative blood products for transfusion, and CMV-immune globulin in certain patients has shown some preventive effects. Prevention of AIDS avoids opportunistic diseases, including CMV, associated with a damaged or incompetent immune system.