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Severe cytomegalovirus infection in immunocompetent patients
M Eddleston1, S Peacock, M Juniper
1Nuffield Department of Clinical Medicine, University of Oxford, John Radcliffe Hospital, United Kingdom.
Abstract:
Severe cytomegalovirus (CMV) infection is rare in previously healthy immunocompetent individuals; to our knowledge, only thirty-four such cases have been reported in the worldwide literature. Multiorgan involvement was associated with a high mortality rate among these patients. Disease that clinically involves only the liver or lungs could be fatal; in contrast, none of the patients with isolated central nervous system infection died. Although few patients were treated with specific antiviral therapy, five of six patients with severe infection recovered after receiving therapy with ganciclovir or foscarnet. The rarity of severe CMV disease in immunocompetent patients probably precludes the performance of a clinical trial to evaluate the efficacy of specific antiviral therapy. However, the historically poor prognosis in the absence of such therapy suggests that rapid diagnosis of CMV disease and early instigation of specific treatment may be important.
Insights
Severe cytomegalovirus (CMV) infection is rare in healthy individuals but can be fatal if it affects multiple organs. Early diagnosis and antiviral treatment, such as ganciclovir, may improve outcomes.
Area of Science:
- Virology
- Immunology
- Infectious Diseases
Background:
- Severe cytomegalovirus (CMV) infection is uncommon in immunocompetent individuals, with limited documented cases.
- Previous reports highlight a high mortality rate associated with multiorgan involvement in severe CMV disease.
Observation:
- Isolated central nervous system CMV infection in immunocompetent patients had a favorable prognosis, with no reported deaths.
- Conversely, CMV disease affecting the liver or lungs presented a fatal risk.
Findings:
- Antiviral therapy with ganciclovir or foscarnet was administered to a small number of patients.
- Five out of six patients with severe CMV infection who received antiviral treatment showed recovery.
Implications:
- The rarity of severe CMV disease in immunocompetent hosts impedes clinical trials for antiviral efficacy.
- Prompt diagnosis and early initiation of antiviral therapy are crucial for improving the prognosis of severe CMV infections in this population.