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High incidence of active cytomegalovirus infection among septic patients
A S Kutza1, E Muhl, H Hackstein
1Department of Surgery, University of Lübeck School of Medicine, Germany.
Abstract:
Cytomegalovirus (CMV) infection is an important cause of disease in immunocompromised patients. In a prospective longitudinal study of 34 septic patients, the incidence of active CMV infection was examined. Eleven of 34 patients (32.4%) had active CMV infection, diagnosed by immunocytochemical staining of CMV pp65 antigen in blood leukocytes and/or detection of CMV DNA by PCR. Positive results for CMV infection were obtained in a median of 4 days (by PCR) or 11 days (by staining of pp65 antigen) after onset of sepsis. Twenty patients for whom more than one sample was examined were selected for further analysis. Among the patients with active CMV infection (nine of 20) there was a trend toward higher median values of tumor necrosis factor alpha, interleukin-1 beta, alanine aminotransferase, and aspartate aminotransferase in plasma, in comparison with the values for patients without CMV infection. Sepsis in patients with CMV infection may affect outcome of the disease.
Insights
Cytomegalovirus (CMV) infection affects over 30% of septic patients, diagnosed via pp65 antigen or DNA detection. Active CMV infection during sepsis may impact patient outcomes.
Area of Science:
- Infectious Diseases
- Virology
- Critical Care Medicine
Background:
- Cytomegalovirus (CMV) infection is a significant concern for immunocompromised individuals.
- Sepsis presents a critical condition where opportunistic infections like CMV can arise.
- Understanding CMV incidence in sepsis is crucial for patient management.
Purpose of the Study:
- To determine the incidence of active Cytomegalovirus (CMV) infection in patients with sepsis.
- To investigate the timing of CMV detection relative to sepsis onset.
- To explore potential associations between CMV infection and inflammatory markers in sepsis.
Main Methods:
- Prospective longitudinal study involving 34 septic patients.
- Diagnosis of active CMV infection using immunocytochemical staining for CMV pp65 antigen and/or CMV DNA detection by PCR.
- Analysis of plasma levels of tumor necrosis factor alpha, interleukin-1 beta, alanine aminotransferase, and aspartate aminotransferase.
Main Results:
- Active CMV infection was detected in 11 out of 34 patients (32.4%).
- CMV infection was diagnosed a median of 4 days (PCR) or 11 days (pp65 staining) post-sepsis onset.
- Patients with active CMV infection showed a trend towards higher levels of TNF-alpha, IL-1 beta, ALT, and AST.
Conclusions:
- Active CMV infection is common in septic patients, with early detection possible through molecular and antigen-based methods.
- The presence of CMV infection during sepsis may correlate with elevated pro-inflammatory cytokines and liver enzymes.
- CMV coinfection in sepsis warrants further investigation regarding its impact on clinical outcomes.