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Cytomegalovirus pneumonia.

N Salomon1, D C Perlman

  • 1Division of Infectious Diseases, Beth Israel Medical Center, Albert Einstein College of Medicine, New York, New York 10003, USA.

Seminars in Respiratory Infections
|January 19, 2000
PubMed
Summary

Cytomegalovirus (CMV) pneumonia is a significant risk for transplant patients. In human immunodeficiency virus (HIV) patients, CMV pneumonia is rare, often due to reactivation in immunocompromised individuals.

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Area of Science:

  • Infectious Diseases
  • Pulmonology
  • Transplant Medicine

Background:

  • Cytomegalovirus (CMV) pneumonia is a primary cause of illness and death in lung and bone marrow transplant recipients.
  • Its role in human immunodeficiency virus (HIV)-associated lung disease remains debated, with CMV rarely identified as the primary pathogen.

Purpose of the Study:

  • To clarify the role of Cytomegalovirus (CMV) as a causative agent of pneumonia in patients with human immunodeficiency virus (HIV).
  • To differentiate CMV pneumonia from other respiratory illnesses in immunocompromised patients.

Main Methods:

  • Clinical presentation analysis of patients with HIV-associated respiratory illness and CMV detection in lung specimens.
  • Comparison of clinical symptoms, radiographic findings, and patient history (e.g., chemotherapy, corticosteroid use) between CMV pneumonia and other pneumonias.

Main Results:

  • CMV is frequently isolated from lung tissue in HIV patients with respiratory illness but is seldom the primary cause.
  • CMV pneumonia often presents similarly to Pneumocystis carinii pneumonia, with fever, cough, hypoxemia, and diffuse opacities.
  • Extrapulmonary CMV disease and recent cytotoxic therapy suggest CMV pneumonia.

Conclusions:

  • CMV pneumonia in HIV patients is typically due to reactivation in severely immunocompromised individuals.
  • While initial response to anti-CMV therapy is observed in about 60% of cases, the condition is associated with high early mortality.
  • Severe underlying immunosuppression is likely the main factor contributing to poor outcomes in CMV pneumonia among HIV patients.

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