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Severe cytomegalovirus infection in multiply transfused, splenectomized, trauma patients
Abstract:
During a 2-year period 5 previously healthy young men who had undergone splenectomy and received multiple transfusions for trauma had severe cytomegalovirus (CMV) infection. Their illness was characterised by a long period of high fever, severe interstitial pneumonitis with dyspnoea and hypoxaemia, and an unusually high lymphocytosis (12 000-26 000 cells/microliter) with numerous atypical forms. The presumptive diagnosis was based on the patients' seroconversion and viral excretion, on the clinical and haematological findings which were typical of severe CMV infection, and on the absence of other infective organisms. In 1 case widespread CMV pneumonitis was confirmed at necropsy. These observations raise the possibility that splenectomy increases the severity and modifies the pattern of CMV infection, since during the same period no other case of severe CMV infection was observed among a large number of patients who had received multiple transfusions but had not undergone splenectomy.
Insights
Splenectomy may worsen cytomegalovirus (CMV) infection severity in trauma patients receiving transfusions. This study observed severe CMV illness, including pneumonitis and high lymphocytosis, in five post-splenectomy men.
Area of Science:
- Infectious Diseases
- Hematology
- Immunology
Background:
- Cytomegalovirus (CMV) is a common virus that can cause serious illness in immunocompromised individuals.
- Splenectomy, the surgical removal of the spleen, can impact immune function.
- Multiple blood transfusions are sometimes necessary for trauma patients.
Purpose of the Study:
- To investigate the potential link between splenectomy, multiple transfusions, and severe cytomegalovirus (CMV) infection.
- To describe the clinical and hematological characteristics of severe CMV infection in post-splenectomy patients.
Main Methods:
- Observational study over a 2-year period.
- Clinical case review of five previously healthy young men.
- Diagnosis based on seroconversion, viral excretion, clinical presentation, hematological findings, and exclusion of other infections.
- Confirmation of CMV pneumonitis in one case via necropsy.
Main Results:
- Five splenectomized trauma patients receiving multiple transfusions developed severe CMV infections.
- Illness characterized by prolonged high fever, severe interstitial pneumonitis, dyspnea, hypoxemia, and marked lymphocytosis with atypical forms.
- No severe CMV cases observed in a large cohort of transfusion recipients without splenectomy during the same period.
Conclusions:
- Splenectomy may increase the severity and alter the presentation of cytomegalovirus (CMV) infection.
- This finding suggests a potential role for the spleen in controlling CMV infection, particularly in transfusion-dependent patients.