CMV pneumonitis: Difference between revisions
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==Treatment== | ==Treatment== | ||
[[CMV pneumonitis medical therapy|Medical therapy]] | [[CMV pneumonitis surgery|Surgical options]] | [[CMV pneumonitis primary prevention|Primary prevention]] | [[CMV pneumonitis secondary prevention|Secondary prevention]] | [[CMV pneumonitis cost-effectiveness of therapy|Financial costs]] | [[CMV pneumonitis future or investigational therapies|Future therapies]] | [[CMV pneumonitis medical therapy|Medical therapy]] | [[CMV pneumonitis surgery|Surgical options]] | [[CMV pneumonitis primary prevention|Primary prevention]] | [[CMV pneumonitis secondary prevention|Secondary prevention]] | [[CMV pneumonitis cost-effectiveness of therapy|Financial costs]] | [[CMV pneumonitis future or investigational therapies|Future therapies]] | ||
=== History and Symptoms === | === History and Symptoms === | ||
Revision as of 14:13, 1 February 2012
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For the WikiPatient page for this topic, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes
Differentiating CMV pneumonitis
Complications & Prognosis
Diagnosis
History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics
Treatment
Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies
History and Symptoms
- 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.
Laboratory Findings
Electrolyte and Biomarker Studies
- LDH elevation in 94% – mean 450 IU/l
- pO2 reduced in most – severity is predictive of mortality
- Microangiopathic hemolytic anemia develops in some patients
Chest X Ray
- Chest x-ray (CXR) – findings present in most patients. Usually bilateral.
- Interstitial changes are most common
- Alveolar consolidation in ~25%
- Ground glass appearance may be present in some
- Nodular opacities in ~10%
- Pleural effusion in ~30%
- Adenopathy in ~10%
- Most patients with normal CXR will have findings on CT scan and gallium scan.
Differential Diagnosis
- Pneumonia due to bacteria
- Fungal infection
- Mycobacteria
- PCP (Pneumocystis carinii)
Risk Stratification and Prognosis
- Prognosis is poor. Particularly in significantly immunocompromised hosts, mortality from significant CMV pneumonitis may be greater than 50%.
Treatment
Pharmacotherapy
- Treatment is most commonly with ganciclovir 5 mg/kg q12h, though results are disappointing. BMT patients characteristically respond, but clinical response is quite variable in AIDS patients, inconsistently showing a significant benefit in different studies.
Transplantation
- Prophylaxis is now being used at some transplant centers. Options include CMV hyperimmune globulin or antiviral treatment such as ganciclovir.
Future or Investigational Therapies
- Trials of ganciclovir with CMV IgG have not shown a consistent benefit in all studies.
- Foscarnet is an alternative agent but data on its efficacy is lacking