Cytomegalovirus Reactivation in Critically ill Patient
Main Article Content
Abstract
Introduction:
The role of cytomegalovirus infection in contributing to outcomes In critically ill immunocompetent patient has not been fully Defined. More studies are needed to identify factors that could predict the risk of developing a CMV reactivation ,mechanism causing CMV pathogenicity and predisposing immunologic conditions associated with the development of CMV reactivation. Clinically significant CMV disease (reactivation of previously latent infection or newly acquired infection) frequently develops in immunocompro mised patients . Cytomegalovirus can cause a wide spectrum of infection in immunocompetent hosts and multisystem involvement (fever of unknown origin).. The case challenges diagnosis and identification of CMV and patient management.
Case report: 32 year old man,caucasion,was admitted in ICU after vehicle accident. Antibacterial treatment was based on datas of microb sensitivity . Regardless of suitable treatment, patient state was worsened .Developed Repiratory distress syndrom ,hepatic desfunction,acute renal failure, permanent hyperthermia .Blood inveastigation detected CMV .By CMV DNA PCR quantitative testing was revealed CMV - 1812 copies/ml. Patient was treated with ganciklovir 5mg/kg twice a day within 2 week. From fifth day after treatment patient state was improved, temperature decreased, respiratory parameters was normalized.
Conclusion: In case of our patient , the diagnosis of CMV reactivation was established by blood investigation. Cytomegalovirus can be pathogenic by decreasing host defences against other microorganisms, enhancing inflammatory response. There is dilemma ,to treat or not to treat? Some randomized controlled trials evaluated the effectiveness of an antiviral therapy and one study to show increased the number of day free of mechanical ventilation .This case presented diagnoisis and identification of CMV, patient management and and effectiveness of an antiviral therapy in improving outcomes.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Cunha BA. Cytomegalovirus pneumonia: community-acquired pneumonia in immunocompetent hosts. Infect Dis Clin North Am. 2010 Mar. 24(1):147-58
II. Orlikowski D, Porcher R, Sivadon-Tardy V, et al. Guillain-Barre Syndrome following Primary Cytomegalovirus Infection: A Prospective Cohort Study. Clin Infect Dis. 2011 Apr. 52(7):837-44.
III. Klemola E, Stenström R, von Essen R. Pneumonia as a clinical manifestation of cytomegalovirus infection in previously healthy adults. Scand J Infect Dis. 1972. 4(1):7-10.
IV. Jaber S, Chanques G, Borry J, Souche B, Verdier R, Perrigault PF. Cytomegalovirus infection in critically ill patients: associated factors and consequences. Chest. 2005 Jan. 127(1):233-41.
V. von Müller L, Klemm A, Weiss M, et al. Active cytomegalovirus infection in patients with septic shock. Emerg Infect Dis. 2006 Oct. 12(10):1517-22. [Medline]
VI. Caldés A, Gil-Vernet S, Armendariz Y, Colom H, Pou L, Niubó J, et al. Sequential treatment of cytomegalovirus infection or disease with a short course of intravenous ganciclovir followed by oral valganciclovir: efficacy, safety, and pharmacokinetics. Transpl Infect Dis. 2009 Dec 9. [Medline].
VII. Jaber S, Chanques G, Borry J, Souche B, Verdier R, Perrigault PF, Eledjam JJ (2005) Cytomegalovirus infection in critically ill patients: associated factors and consequences. Chest 127:233–241
VIII. Brenner T, Rosenhagen C, Hornig I, Schmidt K, Lichtenstern C, Mieth M, Bruckner T, Martin E, Schnitzler P, Hofer S, Weigand MA (2012) Viral infections in septic shock (VISS-trial)-crosslinks between inflammation and immunosuppression. J Surg Res 176:571–58
IX. Heininger A, Haeberle H, Fischer I, Beck R, Riessen R, Rohde F, Meisner C, Jahn G, Koenigsrainer A, Unertl K, Hamprecht K (2011) Cytomegalovirus reactivation and associated outcome of critically ill patients with severe sepsis. Crit Care 15:R77
X. Kalil AC, Florescu DF (2009) Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit. Crit Care Med 37:2350–2358
XI. Kalil AC, Florescu DF (2011) Is cytomegalovirus reactivation increasing the mortality of patients with severe sepsis? Crit Care 15:138
XII. Limaye AP, Kirby KA, Rubenfeld GD, Leisenring WM, Bulger EM, Neff MJ, Gibran NS, Huang ML, Santo Hayes TK, Corey L, Boeckh M (2008) Cytomegalovirus reactivation in critically ill immunocompetent patients. JAMA 300:413–422
XIII. Osawa R, Singh N (2009) Cytomegalovirus infection in critically ill patients: a systematic review. Crit Care 13:R68
XIV. Kutza AS, Muhl E, Hackstein H, Kirchner H, Bein G (1998) High incidence of active cytomegalovirus infection among septic patients. Clin Infect Dis 26:1076–1082CrossRefPubMedGoogle Scholar
XV. Laurent Papazian Samuel Lehingue, Antoine Roch, Laurent Chiche, Sandrine Wiramus, Jean-Marie Forel. Cytomegalovirus reactivation in ICU patients. Intensive Care Medicine January 2016, Volume 42, Issue 1, pp 28–37
XVI. Severe systemic cytomegalovirus infection in an immunocompetent patient outside the intensive care unit: a case report..Carpani G, Foresti S, Dell'Oro R, Grassi G, Bombelli M.BMC Infect Dis. 2019 Jan 9;19(1):34. doi: 10.1186/s12879-018-3621-8.PMID: 30626344 Free PMC article.
XVII. Effect of cytomegalovirus reactivation on the time course of systemic host response biomarkers in previously immunocompetent critically ill patients with sepsis: a matched cohort study.
XVIII. van de Groep K, Nierkens S, Cremer OL, Peelen LM, Klein Klouwenberg PMC, Schultz MJ, Hack CE, van der Poll T, Bonten MJM, Ong DSY; MARS consortium.Crit Care. 2018 Dec 18;22(1):348. doi: 10.1186/s13054-018-2261-0.PMID: 30563551 Free PMC article.
XIX. Reactivation of latent human cytomegaloviral infection in critically ill patients. Uladzimiravich HV, Ivanovna DT, Mikhailovich SV, Kanstantinavich YS, Yurievich MV, Viktorovich KA.Indian J Med Res. 2022 Jun;156(6):771-778. doi: 10.4103/ijmr.ijmr_1197_21.PMID: 37056077 Free PMC article.