Cytomegalovirus pneumonia

Alternative names
Pneumonia - cytomegalovirus; CMV - pneumonia; Troll of transplantation

Definition
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.

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 from 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.

Symptoms

     
  • cough  
  • shortness of breath  
  • shortness of breath on exertion  
  • fever  
  • general discomfort, uneasiness, or ill feeling (malaise)  
  • loss of appetite  
  • fatigue  
  • sweating, excessive (night sweats)  
  • muscle aches or joint pains

Signs and tests

     
  • urine culture (clean catch)  
  • blood culture  
  • CMV serology by IFA  
  • bronchoscopy with biopsy, stains, and culture for CMV  
  • chest X-ray  
  • arterial blood gas

Treatment

The objective of treatment is to stop the replication of the virus within the body through the use of antiviral agents, such as ganciclovir or foscarnet. Oxygen therapy and ventilatory support may initially be necessary to maintain oxygenation until the infection is brought under control.

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.

Johns Hopkins patient information

Last revised: December 7, 2012
by Sharon M. Smith, M.D.

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