CMV pneumonitis history and symptoms
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
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Overview
History and Symptoms
- CMV is usually asymptomatic in immunocompetent hosts.
- Infected cells characteristically show large intranuclear inclusions with surrounding clearing, smaller cytoplasmic inclusions, and increased cell size.
- CMV causes significant morbidity and mortality in transplant patients, and is the most common infection in lung transplant patients after bacterial pneumonia. CMV negative transplant patients who receive transplants from CMV negative donors usually are unaffected, but CMV positive or negative transplant patients who receive CMV positive or negative kidneys are at significant risk for CMV disease, and prophylaxis is now commonly given with CMV immune globulin or antivirals. Peak onset is 1-4 months post transplant.
- Involvement of most organ systems have been described, but the most common include pneumonitis, colitis, retinitis, hepatitis, pancreatitis, and meningoencephalitis.
- Patients will often present with a mononucleosis-like syndrome with fever/cough, myalgias, fatigue, headache, splenomegaly, and atypical lymphocytosis. Pharyngitis and cervical lymphadenopathy are less common.
- Symptoms may be present for 1-4 weeks before presentation; usually <2 weeks.
- The clinical presentation is variable depending on the severity of the illness, and ranges from a self-limited upper respiratory infection to progressive fatal pneumonia. CMV inclusions may be found at autopsy in up to half of patients who die of HIV, of which half were probably not clinically significant.
- Fever (89-100%)
- Cough (76-94%) – often nonproductive
- Dyspnea (71-94%)
- Patients with CMV pneumonitis are likely to suffer from extrapulmonary CMV.
- Infected individuals are also at risk for coinfection with other pulmonary pathogens, such as PCP.
- Advanced AIDS is major risk factor for disease and mortality.
- CMV pneumonia may be seen following immunosuppression, such as with chemotherapy.