Cytomegalovirus in the Lungs of Patients with AIDS: Respiratory Pathogen or Passenger?

Millar, Ann; Patou, Gary; Miller, R F; Grundy, Jane E.; Katz, David R.; Weller, I. V. D.; Semple, S. J. G.

doi:10.1164/ajrccm/141.6.1474

Cited by 118 publications

(50 citation statements)

References 6 publications

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“…Disseminated Mycobacterium avium complex infection was defined by staining and culture of the organism from BAL fluid and blood and/or bone marrow. Cytomegalovirus (CMV) pneumonitis was defined by identification in BAL fluid of typical intranuclear and intracytoplasmic inclusions and by a positive result of testing for CMV (detection of early antigen by fluorescent foci) [13]. Pulmonary Kaposi sarcoma was defined by visualization during bronchoscopy of multiple violaceous lesions [14] and identification of multiple skin lesions.…”

Section: Samplesmentioning

confidence: 99%

Limited Asymptomatic Carriage ofPneumocystis jiroveciin Human Immunodeficiency Virus–Infected Patients

et al. 2003

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Forty-seven bronchoalveolar lavage fluid samples from 16 human immunodeficiency virus (HIV)-infectedpatients were used to test the latency model of Pneumocystis infection in the human host. Identification of DNA sequence polymorphisms at 4 independent loci were used to genotype Pneumocystis jiroveci from the 35 samples that contained detectable P. jiroveci DNA. Eighteen of those 35 samples came from patients who did not have Pneumocystis pneumonia (PCP) and had confirmed alternative diagnoses. Seven patients had asymptomatic carriage of P. jiroveci over periods of р9.5 months after an episode of PCP, and in all 7 cases, a change in genotype from that in the original episode of PCP was observed. The absence of P. jiroveci DNA in one-fourth of the 47 samples and the observed changes in genotype during asymptomatic carriage do not support the latency model of infection. Asymptomatic carriage in HIV-infected patients may play a role in transmission of P. jiroveci and may even supply a reservoir for future infections.The route of transmission of human Pneumocystis infection is still not understood. It was long thought that Pneumocystis jiroveci organisms were acquired during childhood and persisted throughout life in the lungs in a dormant phase [1,2]. Subsequent immunosuppression of the host, resulting from a variety of causes, permitted the fungus to propagate and to cause disease. According to this theory of transmission, there was little reason to protect immunosuppressed adults from possible exposure to Pneumocystis; acquisition of the infection was thought to take place early in life and not at the time of immunosuppression. The latency hypothesis, however, has recently been challenged. Several studies have suggested that, in the immunocompetent human host, Pneumocystis organisms are frequently acquired and cleared by the immune system, rather than being acquired during childhood and persisting for a lifetime. This reinfection hypothesis has important public health implications, because it suggests that susceptible individuals could be protected from Pneumocystis infection.Data refuting the latency hypothesis come from animal studies. It has been shown in a rat model that Pneumocystis organisms were eliminated from the lungs after Pneumocystis pneumonia (PCP) and that persistence of latent organisms was limited [3]. Similar results have been obtained using the severe combined immunodeficiency (SCID) mouse model [4]. In addition, some studies of human infection have indicated the

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Section: Samplesmentioning

confidence: 99%

Limited Asymptomatic Carriage ofPneumocystis jiroveciin Human Immunodeficiency Virus–Infected Patients

et al. 2003

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“…Such an association in an immunocompromised transplant recipient emphasizes the issue of whether a ubiquitous herpes virus like EBV represents "a passenger or a pathogen" when localized in lung tissue. Further examples of this controversy are with cytomegalovirus (CMV) in acquired immune deficiency syndrome (AIDS) patients and human herpes virus 6 in bone marrow transplant recipients [36,37]. In the study by KUWANO et al [7], an increased incidence of adenovirus seen in patients receiving corticosteroid therapy is a further example of this controversy.…”

Section: Epstein-barr Virusmentioning

confidence: 99%

Viruses and idiopathic pulmonary fibrosis

Egan¹,

Woodcock²,

Stewart³

1997

Eur Respir J

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“…In this setting, there is doubt regarding to what extent CMV is acting as a pathogen. 3 The diagnosis of CMV pneumonitis is therefore often based on typical symptoms of fever, shortness of breath, hypoxaemia and diffuse infiltrates on the CXR in combination with detection of the virus in BAL fluid and the absence of other pathogens. 4 However, because of the high rates of co-infection, a definitive diagnosis of CMV requires identification of CMV intranuclear or cytoplasmic inclusion bodies in transbronchial biopsy specimens (used in our patients) or open lung biopsy specimens.…”

Section: Discussionmentioning

confidence: 99%

Nonspecific radiographic manifestations of cytomegalovirus infection in 4 HIV-positive adults – diagnosis through transbronchial biopsy

Goodier¹,

Rubin²

2011

South. Afr. j. HIV med.

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A 45-year-old man with a history of previous tuberculosis (TB) infection presented with a cough and chest pain. Sputum results and blood cultures were negative. The chest radiograph (CXR) demonstrated bilateral multifocal areas of patchy airspace disease, as well as a dominant focal area of density in the right upper lobe (Fig. 1). No effusions were noted. A presumed diagnosis of PJP was made, but the patient did not respond to treatment. Bronchoscopic biopsy confirmed CMV infection. CASE 2A 43-year-old woman with no history of TB or TB contacts presented with a cough and haemoptysis, loss of weight, low fever and rigors. The white cell count (WCC) was 6.4×10 9 /l, and sputum results and blood cultures were negative. The CXR revealed bilateral reticular-nodular and ground-glass opacities without any effusions ( Fig. 2, a). The differential diagnosis included TB and PJP. Bronchoscopic biopsy confirmed the diagnosis of both CMV and PJP infections. CASE 3A 30-year-old woman presented with shortness of breath, a dry cough, loss of weight and fever. The WCC was 13×10 9 /l and the CD4 count 481 cells/µl. The CXR demonstrated bilateral reticular and ground-glass opacities (Fig. 2, b). Treatment for TB and PJP was started, but the patient showed no clinical improvement. Bronchoscopic biopsy confirmed both CMV and pneumocystis pneumonia (PCP). CASE 4A 29-year-old woman presented with a cough, chest pain, loss of weight and shortness of breath. The WCC was 9.1×10 9 /l and the CD4 count 14 cells/µl. On the CXR there were bilateral, diffuse, reticular and airspace shadows with no effusions (Fig. 2, c). Both TB and PJP were considered in the differential diagnosis. Transbronchial biopsy revealed CMV and PJP infections.Transbronchial biopsy in all patients demonstrated alveolar tissue containing CMV with nuclear and cytoplasmic inclusions (Fig. 3). This was accompanied by alveolitis and an associated inflammatory cell infiltrate NONSPECIFIC RADIOGRAPHIC MANIFESTATIONS OF CYTOMEGALOVIRUS INFECTION IN 4 HIV-POSITIVE ADULTS -DIAGNOSIS THROUGH TRANS-BRONCHIAL BIOPSY Matthew Goodier, MB ChBGrace Rubin, MB BCh, DA (SA), FCRad (Diag) (SA) Department of Radiology, University of the Witwatersrand, JohannesburgWe report on 4 HIV-positive adult patients who presented (over a 2-year period) with clinically significant cytomegalovirus (CMV) pneumonia requiring transbronchial biopsy for diagnosis. The patients were not on antiretroviral therapy. Clinical findings were nonspecific, sputum samples were negative, blood test results were non-contributory, and empirical treatment had failed. Radiological findings were extensive but nonspecific. Three of the 4 patients were co-infected with Pneumocystis jirovecii (PJP) pneumonia, further confounding the radiological diagnosis.

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Cytomegalovirus in the Lungs of Patients with AIDS: Respiratory Pathogen or Passenger?

Cited by 118 publications

References 6 publications

Limited Asymptomatic Carriage ofPneumocystis jiroveciin Human Immunodeficiency Virus–Infected Patients

Limited Asymptomatic Carriage ofPneumocystis jiroveciin Human Immunodeficiency Virus–Infected Patients

Viruses and idiopathic pulmonary fibrosis

Nonspecific radiographic manifestations of cytomegalovirus infection in 4 HIV-positive adults – diagnosis through transbronchial biopsy

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