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Cytomegalovirus as a primary pulmonary pathogen in AIDS
A B Waxman1, S J Goldie, H Brett-Smith
1Department of Internal Medicine, Yale University School of Medicine, New Haven, Conn 06520-8057, USA.
Chest
|January 1, 1997
Summary
Cytomegalovirus (CMV) can be a primary cause of pneumonia in patients with AIDS. Prompt anti-CMV therapy leads to significant symptom improvement and recovery in most cases.
Area of Science:
- Infectious Diseases
- Pulmonology
- Immunology
Background:
- Cytomegalovirus (CMV) isolation from respiratory secretions is common in AIDS patients, but its role as a primary pulmonary pathogen is debated.
- This study aimed to define the clinical presentation and course of CMV pneumonitis when CMV is the sole identified pulmonary pathogen in individuals with Acquired Immunodeficiency Syndrome (AIDS).
Observation:
- A retrospective review identified nine AIDS patients with CMV as the only pulmonary pathogen between 1991 and 1994.
- These patients presented with tachypnea, hypoxemia, and diffuse interstitial infiltrates on chest imaging, often with low CD4 counts and elevated lactate dehydrogenase.
- Clinical signs included increased respiratory rate, hypoxemia, and diffuse interstitial infiltrates.
Findings:
- Three untreated patients died from respiratory failure, with autopsy confirmation of CMV pneumonia.
- Five patients treated with anti-CMV therapy showed marked improvement in symptoms, oxygen saturation, and chest radiographs.
- Treated patients experienced rapid recovery, with all five being asymptomatic at 3-month follow-up, though two later died from other opportunistic infections.
Implications:
- Cytomegalovirus should be considered a primary pulmonary pathogen in immunocompromised patients, particularly those with AIDS, presenting with specific respiratory symptoms.
- Early diagnosis and treatment with anti-CMV therapy are crucial for improving patient outcomes and survival.
- This research supports the consideration of anti-CMV therapy in appropriate clinical settings for suspected CMV pneumonitis.