Primary Cytomegalovirus Pneumonia Successfully Treated with Corticosteroid Therapy and Valganciclovir.

Cytomegalovirus infection is typically asymptomatic in immunocompetent individuals. A 26-year-old woman was admitted to our hospital with a fever and breathlessness. Chest computed tomography (CT) revealed bilateral diffuse reticulation and nodules. Laboratory investigations showed atypical lymphocytosis and increased transaminases. She was treated with corticosteroid pulse therapy because of acute lung injury, and her clinical condition improved. Based on the presence of cytomegalovirus antibodies, antigen, and polymerase chain reaction findings, she was diagnosed with primary cytomegalovirus pneumonia and treated with valganciclovir. Primary cytomegalovirus pneumonia is very rare in immunocompetent individuals. The efficacy of corticosteroid and valganciclovir against cytomegalovirus pneumonia in this patient is noteworthy.

Cytomegalovirus Pneumonia in Inflammatory Bowel Disease: Literature Review and Clinical Recommendations.

Aim: The objective was to elucidate the correlation between CMVP and immunosuppressive therapy in IBD patients, we hope this review could expand on the significance of CMV as an opportunistic pathogen and the potential impact on morbidity and mortality in IBD patients. Methods: Records and clinical trajectories linked to CMVP in IBD patients were extracted from the PubMed database, irrespective of language barriers. The reference lists incorporated in these studies were manually inspected. Conclusions were generated using straightforward descriptive analysis. Results: In total, 18 IBD patients, including Crohn's disease (CD, 67%) and Ulcerative Colitis (UC, 33%), affected by CMVP were identified from 17 published articles. A minority of these patients (17%) exhibited active disease, whereas the majority (83%) presented with quiescent disease. Fever (100%) and dyspnea (44%) emerged as the most prevalent clinical symptoms. All the patients had undergone immunosuppressive therapy. A significant proportion, up to 89%, had received thiopurine treatment prior to the CMVP diagnosis. Interestingly, none of the patients were subjected to biological therapy. Half of the patients manifested with Hemophagocytic Lymphohistiocytosis (HLH). Almost all patients (94%) were administered antiviral treatment and a substantial 83% experienced full recovery. Immunosuppressive agents were either tapered or discontinued altogether. A subset of patients, 17%, suffered fatal outcomes. Conclusion: Our findings underscore the need for heightened suspicion of CMVP in IBD patients who exhibit symptoms such as fever and dyspnea. During the COVID-19 pandemic, CMVP should be considered a potential differential diagnosis. It was observed that CMVP primarily transpires during CD remission. Azathioprine emerged as the predominant immunosuppressant linked to CMV reactivation. The prompt application of effective antiviral therapy can substantially enhance patient outcomes. CMV vaccine might serve as a viable prevention strategy.

Cytomegalovirus Pneumonia in a Patient with X-Linked Agammaglobulinemia: A Case Report.

X-linked agammaglobulinemia (XLA) is a hereditary immune disorder that predisposes patients to frequent and severe bacterial infections caused by encapsulated bacteria (such as Streptococcus pneumoniae, Staphylococcus aureus, and Haemophilus influenzae). Otitis media, sinusitis, and pneumonia are common complications of XLA that require prompt diagnosis and treatment. Cytomegaloviruses (CMV) cause widespread and severe infections in immunocompromised individuals, affecting the respiratory tract, and consequently, leading to pneumonia, which is associated with a high mortality rate. However, CMV-induced pneumonia is rarely reported in patients with XLA. This case study details a 37-year-old male patient with XLA presenting with fever, productive cough, and dyspnea. The patient was diagnosed with CMV pneumonia and recovered after treatment. To the best of our knowledge, this is the first reported case of CMV pneumonia in a patient with XLA in Taiwan. This case study emphasizes that CMV pneumonia in patients with XLA is a treatable condition if diagnosed promptly, and that a shorter duration of treatment with the antiviral agent, in combination with immunoglobulin replacement therapy, can resolve symptoms.

Clinical characteristics of human cytomegalovirus pneumonia in children and the diagnosis value of detecting human cytomegalovirus DNA in bronchoalveolar lavage fluid / 中国小儿急救医学

Objective:To investigate the clinical features, therapy and prognosis of human cytomegalovirus(HCMV)pneumonia in pediatric patients, and to analyze the diagnosis value of detecting HCMV DNA in bronchoalveolar lavage fluid(BALF)by real-time PCR.Methods:The clinical characteristics of 58 pediatric inpatients who were HCMV DNA positive in BALF were retrospectively reviewed.All the patients were from Shengjing Hospital of China Medical University from January 2015 to December 2019.Clinical, radiologic, laboratory and microbiologic data was collected for each patient.The study cohort was divided into HCMV productive infection and latent infection consisting of 22 and 36 patients respectively, based on the HCMV active infection in lung or not.Receiver operating characteristic(ROC)curve was used to assess utility of detecting HCMV DNA in BALF and establish a threshold for diagnosis.Results:(1)Compared with patients in latent infection group, the children in productive infection group had a lower age of onset( P<0.05), a higher proportion of male( P<0.05), and more prolonged hospitalization stay( P<0.05). Pulmonary rales, hypoxemia and higher AST, CK, LDH in serum were easier to detect in productive infection group( P<0.05). Higher HCMV DNA copies in BALF was also detected( P<0.01). Patients in productive infection group had significantly more exposure to additional oxygen treatment or mechanical ventilation and systemic hormone therapy( P<0.05), while with poorer outcomes( P<0.05). (2) ROC curve analysis showed that the AUC for HCMV DNA in BALF in diagnosis of HCMV pneumonia was 0.708 with a threshold of 8.83×10 3 copies/mL, a sensitivity of 77.27%, and a specificity of 58.33%. Conclusion:Those who are diagnosed HCMV pneumonia have a lower age of onset with higher male proportion.These children suffered severer clinical signs.The patients with HCMV DNA copies higher than 8.83×10 3 copies/mL in BALF would be more likely to be diagnosed as HCMV pneumonia.

Fatal cytomegalovirus pneumonia in a critically ill patient with COVID-19.

Coronavirus disease 2019 (COVID-19) can cause severe lymphopenia and respiratory failure requiring prolonged invasive mechanical ventilation (MV). COVID-19 patients with severe lymphopenia or respiratory failure are at risk of developing secondary infections. Here, we present the needle autopsy findings of a critically ill patient with COVID-19 who required reintubation and prolonged MV, and eventually died of secondary cytomegalovirus (CMV) pneumonia. This case highlights the potential risk of long-term steroid use and the need for routine monitoring for CMV infection in critically ill patients with COVID-19.

Cytomegalovirus pneumonia complicating immune checkpoint inhibitors-induced pneumonitis: A case report.

A 63-year-old man was hospitalized for immune check-point inhibitors (ICIs) medicated pneumonitis, secondary to treatment with pembrolizumab for non-small cell lung cancer. He was treated with high dose steroids, mycophenolate mofetil, empiric broad spectrum antibiotics and empiric trimethoprim-sulfamethoxazole and intravenous immunoglobulin. Despite the aforementioned treatment, his condition continued to deteriorate. The patient was admitted to the intensive care unit. While intubated, he underwent bronchoscopy and lavage, which was analyzed for potential infectious agents. Cytomegalovirus (CMV) pneumonia was diagnosed and treated. He passed away despite antiviral treatment and maximal supportive care. CMV infection should be suspected in patients failing to recover from toxicities of ICIs with appropriate immunosuppression.

[Clinical study of 34 patients with cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation].

Objective: To analyze the clinical features and prognosis of cytomegalovirus pneumonia after allogeneic hematopoietic stem cell transplantation(allo-HSCT). Methods: We reviewed the clinical features and laboratory data of cytomegalovirus pneumonia patients after allogeneic peripheral blood HSCT from March 1, 2016 to June 30, 2019 at the hematology department of the Shanghai general hospital and analyze the prognostic factors. Results: Of the 411 allo-HSCT patients, 34(8.3%)developed CMV pneumonia after transplantation, including 18 men and 16 women, with a median age of 32(8-62)y. Total 14 patients had acute myeloid leukemia, 10 had acute lymphoblastic leukemia, 5 had myelodysplastic syndrome, 3 had non-Hodgkin's lymphoma, and 2 had aplastic anemia. The median onset time for CMV pneumonia was 53(36-506)d after transplantation. The main symptoms were cough(26 cases, 76.5%), fever(23 cases, 67.6%), and shortness of breath(14 cases, 41.2%). Only 17.6%(6/34)patients had expectoration, and 2 cases(5.9%)had no obvious symptoms in the early stage, but were diagnosed on routine chest CT examination. Twenty-eight(82.4%)patients showed signs of typical interstitial pneumonia, such as lobular central nodule and diffuse ground glass opacity; 6(17.6%)patients showed atypical imaging changes of patch, nodule, and consolidation. Further, 26 patients(76.5%)were positive for CMV-DNA, and the copy number was lower than that of BALF[1.70×10(7)(5.44×10(5)-4.45×10(9))copies/L vs 1.45×10(8)(1.10×10(7)-1.10×10(11))copies/L, P=0.004]. Thirteen(38.24%)patients with CMV pneumonia had mixed infection with other lower respiratory tract pathogens(10 strains of fungi, 6 strains of bacteria, and 1 of adenoviruses). The median follow-up duration was 12.8(0.4-46.5)months. The OS rate was 58.82%. Age ≥ 40 y and high flow ventilation were independent risk factors for poor prognosis in CMV pneumonia patients(P=0.049, P=0.009). Conclusion: Bronchoscopic bronchoalveolar lavage fluid detection helps in improving the accuracy of the etiological diagnosis of CMV pneumonia after allo-HSCT. Age ≥ 40 y and high flow ventilation were independent risk factors for poor prognosis in patients with CMV pneumonia.

Differences and similarities of high-resolution computed tomography features between pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients.

BACKGROUND: Accurately differentiating pneumocystis from cytomegalovirus pneumonia is crucial for correct therapy selection in AIDS patients. Hence, the goal of this study was to compare the computerized tomography (CT) features of pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients and identify clinical hallmarks to accurately distinguish these two pathologies. METHODS: A total of 112 AIDS patients (78 with pneumocystis pneumonia and 34 cytomegalovirus pneumonia) at Beijing Ditan Hospital from January 2017 to May 2019 were included in this study. Two experienced chest radiologists retrospectively reviewed CT images for 17 features including ground-glass opacity, consolidation, nodules, and halo sign. Binary logistic regression analyses were conducted to identify the significant parameters that distinguished pneumocystis pneumonia from cytomegalovirus pneumonia. Correlations were analyzed by Pearson or Spearman correlation analyses. Result were considered significant if P < 0.05. RESULTS: The presence of consolidation, halo signs, and nodules (all P < 0.05) were significantly more frequent in patients with cytomegalovirus pneumonia than in those with pneumocystis pneumonia. Small nodules (32.5% in cytomegalovirus pneumonia, 6.41% in pneumocystis pneumonia, P < 0.001) without perilymphatic distribution were particularly common in patients with cytomegalovirus pneumonia. Large nodules were not found in any of patients with cytomegalovirus pneumonia. The presence of ground-glass opacity, reticulation, and bronchial wall thickening (all P > 0.05) were common in both groups. CONCLUSIONS: Analysis of consolidation, nodules, and halo signs may contribute to the differential diagnosis of pneumocystis pneumonia or cytomegalovirus pneumonia. However, some CT features considered typical in one or other diseases appear with similar frequency in both cohorts of AIDS patients. CT features are potentially useful for the differential diagnosis of pneumocystis pneumonia and cytomegalovirus pneumonia in AIDS patients.

[Impact of poor graft function on cytomegalovirus pneumonia in patients who have undergone haploidentical stem cell transplantation].

Objective: To retrospectively analyze the impact of primary PGF on CMV pneumonia in patients who have undergone haplo-HSCT. Methods: The clinical data of 122 patients who underwent haplo-HSCT at the Peking University Institute of Hematology from 2011-2012 were retrospectively reviewed. The incidence rate of CMV pneumonia between PGF and good graft function (GGF) was compared, and the factors were analyzed. In addition, outcomes in PGF patients with CMV pneumonia have been described. Results: Total 122 patients were retrospectively reviewed, and of these, 26 (21.3% ) had PGF, while 96 (78.7% ) had GGF. In addition, 15 patients had CMV pneumonia, and the median time to the development of CMV pneumonia was 103 (31-262) days; the 1-year cumulative incidence of CMV pneumonia was 12.3% (95% CI 6.2% -18.4% ) . In patients with primary PGF and GGF after Haplo-HSCT, the incidence of CMV pneumonia was 30.8% (8/26) and 7.3% (7/96) , respectively (P=0.002) . Moreover, 24 patients had CMV viremia (92.3% ) , while of the 96 GGF patients, 79 (82.3% ) had CMV viremia (P=0.212) . In multivariate analysis, the results showed that primary PGF had a significant influence on CMV pneumonia (P=0.005) . Compared with those without CMV pneumonia, patients with CMV pneumonia had poorer overall survival 37.3% (95% CI 11.2% -63.4% ) vs. 78.9% (95% CI 72.0% -87.6% ) (χ(2)=16.361, P<0.001) . The 1-year overall survival (OS) was 25.0% (95% CI 0% -55.0% ) and 50.0% (95% CI 26.9% -73.1% ) (χ(2)=4.656, P=0.031) in PGF patients with (8/26) and without (18/26) CMV pneumonia. Conclusion: The incidence of cytomegalovirus pneumonia in patients with primary poor graft function increases and the survival rate decreases.

Guidelines for organ donation and transplantation in China during novel coronavirus pneumonia epidemic / 器官移植

In December 2019, a novel coronavirus pneumonia outbreak in Hubei Province spread rapidly to many provinces and cities. As organ transplantation is in the stage of high-quality development in China, how to carry out organ donation and transplantation in a scientific and orderly manner during the severe epidemic, summarize and analyze the clinical characteristics of COVID-19 on organ transplant recipients, and optimize the prevention, early diagnosis and treatment strategies of COVID-19 to ensure medical safety is essential to the development of organ transplantation and the treatment of the patients with end-stage organ failure as well as the overall situation of the prevention and control of COVID-19 epidemic. Thus, based on the instructions of the National Health Committee, the guidelines are issued by several experts organized by Branch of Organ Transplantation of Chinese Medical Association, providing help to the workers and managers of organ donation and transplantation in China. Approved by the Standing Committee of Branch of Organ Transplantation of Chinese Medical Association, the guidelines adopt the 'expert advice', 'prevention and control strategies' and 'guidance' published in China for reference, and will be revised upon changes of the further understanding of COVID-19 and epidemic control situation.

The experience of extracorporeal membrane oxygenator combined with plasma exchange in treatment of a patient with severe cytomegalovirus pneumonia / 中国中西医结合急救杂志

In recent years, with the development of bone marrow and organ transplantation, cytomegalovirus (CMV) has become a common pathogen threatening patients having undergone organ transplantation. CMV may cause severe pulmonary infection and respiratory failure, leading to the death of patient with CMV pneumonia. CMV infectious pneumonia is characterized by the formation of huge type A eosinophil inclusion bodies in the nucleus and cytoplasm of the infected cells. The susceptible population is often associated with low immune function, and to promote the recovery of autoimmune function is the key point for treatment of CMV pneumonia, and the plasma exchange therapy can reconstruct the autoimmune function and improve the prognosis of patients with CMV pneumonia to a certain extent. Now the experience of 1 patient of severe CMV pneumonia treated by ECMO combined with plasmapheresis is reported.

Multiple nodular lesions following Pneumocystis pneumonia in a non-HIV immunocompromised patient.

Cytomegalovirus superinfection is associated with a poor prognosis in non-HIV Pneumocystis pneumonia (PCP) and can cause deterioration of PCP not only simultaneously but also after initiating PCP treatment. Cytomegalovirus pneumonia should be considered in cases with deterioration after initiating PCP treatment; multiple nodular lesions are useful findings for the diagnosis.

Levels and clinical significance of serum SP-D and MBL in infants with cytomegalovirus pneumonia / 国际儿科学杂志

Objective To investigate the levels of serum surfactant protein D (SP-D) and mannosebinding lectin (MBL) in infants with cytomegalovirus (CMV) pneumonia with the severity of disease.Methods A total of 101 hospitalized infants with CMV pneumonia were enrolled from January 2011 to December 2012.These patients were divided as the severe pneumonia group (n =48) and the mild pneumonia group (n =53) according to physical sign of lung and complication.Another 55 infants who were hospitalized in the same period with non-infectious diseases were used as the control group.Serum levels of SP-D and MBL were detected by enzyme-linked immunosorbent assay.Blood gas analyzer was used to measure arterial partial pressure of oxygen (PaO2) of the blood in severe patients.Results The mean serum SP-D levels in the severe pneumonia group [(150.08 ±52.59)ng/ml] and the mild pneumonia group [(109.67 ±31.39)ng/ml] were significantly higher than those in control group [(41.33 ± 16.42) ng/ml] (P ＜ 0.01), and higher in the severe pneumonia group than in the mild pneumonia group (P ＜ 0.01).However, there was no significant difference in serum MBL between all groups (P ＞ 0.05).In severe patients, serum SP-D levels were negatively correlated with PaO2 (r =-0.565, P ＜ 0.01).Conclusion Serum SP-D is associated with the severity of CMV pneumonia, but MBL shows no relation.The serum SP-D levels has an important clinical significance in judgment the sererity of infants with CMV pneumonia.

Pharmaceutical Care for a Patient with Multiple Pulmonary Infection after Renal Transplantation / 中国药房

OBJECTIVE:To investigate the role of clinical pharmacists in the therapy for patient with multiple pulmonary in-fection after renal transplantation. METHODS:Clinical pharmacists participated in drug therapy for a patient with multiple pulmo-nary infection after renal transplantation,and assisted physicians to formulate primary therapy plan:ganciclovir 250 mg,ivgtt,q12 h+ Cefoperazone sodium and sulbactam sodium 3 g,ivgtt,bid+ methylprednisolone 80 mg,ivgtt,qd+ Compound sulfamethoxazole tablet,2 piece,po,qd+Ciclosporin soft capsule 75 mg,po,q12 h+Sodium bicarbonate tablet 1 g,po,qd+Nifedipine controlled release tablet 30 mg,po,qd+Famotidine tablet 20 mg,po,bid. The dose of ganciclovir was adjusted twice because of complica-tion cytomegaloviral pneumonia;the dose of ganciclovir was adjusted twice because of complication pneumocystis pneumonia. Pre-vention and disposal of ADR,patient education were also conducted. RESULTS:Physicians adopted the suggestion of clinical phar-macists;the pulmonary infection had been controlled,and the patient was discharged from hospital. CONCLUSIONS:Clinical pharmacists identify the breakthrough point to promote rational drug use,indicating the value of pharmaceutical care in the clinical treatment.

A retrospective study of cytomegalovirus pneumonia in renal transplant patients.

The aim of the present study was to investigate an optimal prophylaxis of cytomegalovirus (CMV) pneumonia in renal transplant recipients. A total of 83 kidney transplant recipients who had been diagnosed with CMV pneumonia between January 2008 and December 2011 were enrolled in the study. Patients were assigned to a standard or improved group based on the prophylaxis administered. The retrospective study was undertaken to compare the incidence of CMV pneumonia, cure rate or recovery rate and mortality between the two groups. The results indicated that a longer duration of prophylaxis with oral ganciclovir effectively reduced the risk of CMV pneumonia in kidney transplant recipients. Treatments, including early withdrawal of immunosuppressants, regular use of glucocorticosteroids and careful supportive therapy, were beneficial in controlling CMV pneumonia. Furthermore, antibody induction therapy may not increase the risk of CMV pneumonia in kidney recipients administered proper prophylaxis [3-month course of oral ganciclovir and trimethoprim-sulfamethoxazole (SMZ-TMP)]. Therefore, the present study demonstrated that a longer duration of prophylaxis with oral ganciclovir, withdrawal of immunosuppressants and regular use of glucocorticosteroids may be improved treatments for CMV pneumonia.

Application of discriminant analysis in the screening of cytomegalovirus pneumonia / 国际儿科学杂志

Objective To look for a reliable and convenient judgement criteria for the screening of cytomegalovirus pneumonia in order to reduce misdiagnosis and resulted mistherapy.Methods Process collected data on fifty-six cytomegalovirus pneumonia and forty-two common viruses induced asthmatic bronchitis cases by use of discriminant analysis to construct prediction model of diagnosis result.Results Only three indexes including age,lymph count and platelet count were selected into the model via sift.The performance of the established screening model showed as follows:sensitivity was 80.36％,specificity was 80.95％,misdiagnosis rate was 19.05％,false negative rate was 19.64％,diagnostic accordance rate was 80.61％.Conclusion Being concise and of strong maneuverability and high accuracy in prediction,cytomegalovirus pneumonia diagnosis model constructed through discriminant analysis can provide powerful screening means for medical staff.

Human Cytomegalovirus Pneumonia and Pulmonary Aspergillosis in a Patient with Acute Myelogenous Leukemia following Chemotherapy / 감염

Cytomegalovirus (CMV) pneumonia is one of the major causes of morbidity and mortality in immunocompromised patients such as transplant recipients. But CMV pneumonia is unusually reported among adults with leukemia who have not undergone transplantation. Because it is a cause of life-threatening pneumonia in adults with leukemia receiving potent immunosuppressive therapies, CMV has emerged as an important pathogen. We report a case of CMV pneumonia and invasive pulmonary aspergillosis in a patient with acute leukemia who have not undergone transplantation. A 31-year-old man with acute myelogenous leukemia developed high fever on day 9 of second consolidation chemotherapy. Six days later, chest radiography showed patchy consolidation with central cavity on right upper lung. Considering fungal pneumonia, amphoterin B was started, then fever was subsided. Chest CT showed necrotizing pneumonia with cavity formation in posterior segment of right upper lobe. Because of several episodes of hemoptysis, lobectomy was performed. Grossly, the area of focal necrosis with central cavity formation and multiple small interstitial nodules were observed. In the area of interstitial nodules, giant cells with intranuclear inclusion and perinuclear halo were found. In the area of focal necrosis, fungal hyphae with acute branching and septation were found. Ganciclovir and immunoglobulin were administered for CMV pneumonia. On day 62 of the chemotherapy, the patient discharged with improved symptoms. After several weeks, unrelated HLA-matched allogeneic stem cell transplantation was performed. On day 14 of transplantation, the patient died due to septic shock of unknown cause.

Thirty six-year-old man presenting acute respiratory failure / 결핵

We report a case of pneumonia in 36 year-old male patient who presented acute respiratory failure and associated radiologic findings of bilateral ground-glass opacity with focal cystic changes, showing rapidly aggravating course and was diagnosed as concomitant Pneumocystis carinii and Cytomegalovirus pneumonia accompanied by acquired immunodeficiency syndrome through antemortem open lung biopsy.