Diagnosing and Treating Cytomegalovirus Pneumonia in Patients with AIDS

Rodriguez‐Barradas, Maria C.; Stool, Edward W.; Musher, Daniel M.; Gathe, Joseph; Goldstein, Jane; Genta, Robert R I; Yoffe, Boris

doi:10.1093/clinids/23.1.76

Cited by 49 publications

(46 citation statements)

References 30 publications

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“…CMV pneumonia is uncommon and has been observed in only 0.24-8% of HIV-infected patients [9,10]. The diagnosis of CMV pneumonia should take into account pulmonary interstitial infiltrates, identification of multiple CMV inclusion bodies in lung tissue, and the absence of other pathogens that are more commonly associated with pneumonia occurring in this population [10].…”

Section: Discussionmentioning

confidence: 99%

“…The diagnosis of CMV pneumonia should take into account pulmonary interstitial infiltrates, identification of multiple CMV inclusion bodies in lung tissue, and the absence of other pathogens that are more commonly associated with pneumonia occurring in this population [10]. CMV hepatitis is also uncommon in HIV-infected patients, although it does occur frequently in liver transplant recipients [11].…”

Section: Discussionmentioning

confidence: 99%

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Acute cytomegalovirus pneumonia and hepatitis presenting during acute HIV retroviral syndrome

Hong

Kim

et al. 2011

Infection

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Cytomegalovirus (CMV) disease is a frequent opportunistic infection that usually occurs in the late stages of HIV infection as a result of reactivation of a latent infection. We report a case of a 23-year-old man with acute retroviral syndrome complicated by coexisting CMV pneumonia and CMV hepatitis, which were documented by histopathological examination. His CMV pneumonia and hepatitis were assumed to be primary CMV diseases owing to the absence of CMV IgG antibody. To the best of our knowledge, this is the first case of simultaneous CMV pneumonia and hepatitis occurring as primary CMV diseases during primary HIV infection. This case indicates that invasive CMV diseases such as pneumonia and hepatitis should be considered even in patients with primary HIV infection.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Acute cytomegalovirus pneumonia and hepatitis presenting during acute HIV retroviral syndrome

Hong

Kim

et al. 2011

Infection

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“…En concreto la afectación pulmonar tiene dificultades aña-didas al diagnóstico ya que el aislamiento en LBA no diferencia la infección asintomática de la neumonitis, es frecuente la coexistencia con otros patógenos y el patrón radiológico no es específico (2,5). Tampoco existe clara relación entre el cultivo de CMV en sangre y en LBA (6).…”

Section: Discussionunclassified

Infiltrado pulmonar y fiebre tras la resolución de neumonía por Pneumocystis jirovecii en un paciente con infección por el VIH

Guzmán

Márquez

Guisado

2007

An. Med. Interna (Madrid)

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INTRODUCCIÓNEl diagnóstico de enfermedad por citomegalovirus (CMV) en el paciente con infección por VIH no resulta con frecuencia fácil y suele aparecer en el contexto de inmunosupresión severa por reactivación o reinfección del virus. Además, aunque tras la introducción de terapia antirretroviral de gran actividad (TARGA) la incidencia de enfermedad por CMV ha disminuido de forma drástica, es una entidad a tener en cuenta con considerable morbimortalidad.CASO APORTADO Presentamos el caso de un varón de 23 años diagnosticado de infección por VIH cinco meses antes, vía de transmisión homosexual. Fue donante de sangre hasta un año atrás confirmándose en el archivo de donantes que la serología VIH previa era negativa. El ELISA para citomegalovirus (CMV) en el momento del diagnóstico era positivo. Un mes antes del ingreso tenía linfocitos 254 CD4/µl (19,2%) y 1420 copias/ml de carga viral. No recibía terapia antirretroviral (TAR) ni profilaxis para infecciones oportunistas.Ingresó por insuficiencia respiratoria grave diagnosticándose de neumonía por Pneumocystis jirovecii (PCP) con un cuadro clínico-radiológico compatible (Fig. 1) y el aislamiento de quistes en esputo. Se inició tratamiento con cotrimoxazol (20/100 mg/kg/día i.v.) y metilprednisolona (40 mg/12 h i.v.) y la evolución clínica fue favorable con resolución completa del infiltrado intersticial. El día 7º de ingreso se inició TAR con didanosina 400 mg/día, lamivudina 300 mg/día y saquinavir 1500 mg/día potenciado con ritonavir 100 mg/día, con buena tolerancia y sin aparición de efectos secundarios.El día 22º de ingreso, tras reducir cotrimoxazol a dosis profilácti-cas (160/600 mg/día vo), comenzó con fiebre elevada (39 ºC), dolor [0212-7199 (2007) 24: 12; pp. 588-590] ANALES DE MEDICINA INTERNA

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“…The most common manifestations of PCP are subacute onset of progressive dyspnea, fever, non-productive cough, chest discomfort and respiratory failure (1). While cytomegalovirus (CMV) infections with retinitis and gastrointestinal disease were most often observed in patients with HIV, CMV pneumonitis was rarely emphasized (2,3). Negligence of CMV pneumonia could lead to serious consequences (4).…”

Section: Dear Editormentioning

confidence: 99%

The Second Hit of Fatal Pneumonia by Cytomegalovirus in a Patient With Human Immunodeficiency Virus Infection

Tang

Chao

2016

Int J Infect

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Pneumocystis pneumonia (PCP) is the most common opportunistic infection in patients with the human immunodeficiency virus (HIV). The most common manifestations of PCP are subacute onset of progressive dyspnea, fever, non-productive cough, chest discomfort and respiratory failure (1). While cytomegalovirus (CMV) infections with retinitis and gastrointestinal disease were most often observed in patients with HIV, CMV pneumonitis was rarely emphasized (2, 3). Negligence of CMV pneumonia could lead to serious consequences (4). Herein is reported an HIV+ case with second hit of fatal pneumonia to alert clinicians to the potentially high mortality of CMV pneumonitis in the patients with HIV.A 27-year-old young male with severe kyphoscoliosis had cough and fever for two weeks. Hence, he was brought to the hospital, where chest x-ray (CXR) film showed mixed alveolar and interstitial infiltration predominantly over left lung field, probably pneumonia ( Figure 1A). Rotatory scoliosis of thoracic spine with convexity to right side was noticed. He had no other systemic diseases. He was intubated due to acute respiratory failure. Laboratory data included a white blood cell (WBC) count of 5,200/µL; monocyte, 4.8%; hemoglobin, 9.2 g/dL; platelet count, 180,000/µL; C-reactive protein (CRP), 80.1 mg/L; procalcitonin, 3.52 ng/mL and albumin, 1.7 g/dL. An anti-HIV antibody was positive and CD4+ lymphocyte count was 12 /µL with a CD4+/CD8+ ratio of 0.18. The HIV viral load was 66,321 copies/mL. The patient was admitted to the intensive care unit (ICU) with antibiotic therapy including intravenous levofloxacin (750 mg, on prescription), tigecycline (50 mg, every 12 hours) and trimethoprim/sulfamethoxazole (1200/240 mg, every six hours). The sputum, urine and blood cultures showed no bacterial growth. The clinical condition greatly improved and CXR film showed nearly complete resolution of the lung infiltration after one week of therapy ( Figure 1B). The procalcitonin level dropped to 0.48 ng/mL. However, the second hit of pneumonia accompanied by septic shock developed on the day 11 of the hospitalization, followed by rapid clinical deterioration without response to the same antibiotic regimen. Follow-up CXR film showed worsening infiltrates over left lung field (Figure 1C). The WBC count was 3,000/µL; band, 13.0 %; monocyte, 13.0 %; platelet count, 21,000/uL; CRP, 130.0 mg/L and procalcitonin, 48.21 ng/mL. An arterial blood gas showed hypoxemia with pH, 7.319; PCO2, 33.0 mmHg; PO2, 67.9 mmHg; base excess, -7.5 mM/L and PaO 2 /FiO 2 ratio, 150.9 mmHg (FiO 2 , 45%). Meanwhile, hemodynamic support could not rescue the patient. The family decided to have palliative therapy and the patient died on the day 13 of the hospitalization. The results of CMV-polymerase chain reaction for sputum and blood samples obtained on day 12 were both positive. Parental ganciclovir was not given in time.In this HIV case, empirical therapy against initial pneumonia suspicion for PCP and usual bacterial pathogens achieved a good therapeutic response. Howeve...

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Diagnosing and Treating Cytomegalovirus Pneumonia in Patients with AIDS

Cited by 49 publications

References 30 publications

Acute cytomegalovirus pneumonia and hepatitis presenting during acute HIV retroviral syndrome

Acute cytomegalovirus pneumonia and hepatitis presenting during acute HIV retroviral syndrome

Infiltrado pulmonar y fiebre tras la resolución de neumonía por Pneumocystis jirovecii en un paciente con infección por el VIH

The Second Hit of Fatal Pneumonia by Cytomegalovirus in a Patient With Human Immunodeficiency Virus Infection

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