Cytomegalovirus infection pneumonia

According to the CDC, the diagnosis of AIDS constitutes certain opportunistic infections, neoplasms, encephalopathy or wasting syndrome in the presence of HIV infection. In 1993, the CDC expanded the criteria to also include CD4+ T-cell count below 200 cells/p,l in the presence of HIV infection. The most common opportunistic infections includepneumocystis carinii pneumonia, pneumonitis, toxoplasmosis, mycobacterial disease, recurrent herpes simplex virus infection and/or cytomegalovirus infection. Kaposi s sarcoma is the most common form of cancer. HIV-related nervous system diseases include acute septic meningitis, AIDS dementia complex, subacute encephalitis, HIV encephalopathy and CNS opportunistic infections and neoplasm. 

Pneumocystis jiroveci pneumonia has been precipitated or aggravated by glucocorticoids (SEDA-20, 377 SEDA-22, 450 272,350,351). There is some concern about the use of glucocorticoids as adjunctive therapy in patients with AIDS who develop Pneumocystis jiroveci pneumonia. The immunosuppressant properties of glucocorticoids have been reported to enhance the risk of tuberculosis and other AIDS-related diseases (for example Kaposi s sarcoma or cytomegalovirus infection). 

Organism Viral infections Cytomegalovirus Type of Infection Pneumonia hepatitis chorioretinitis involvement of many other organs Drug Treatment Foscarnet or ganciclovir... 

Miller SA, Bia FJ, Coleman DL, et al Pulmonary Macrophage Function During Experimental Cytomegalovirus Interstitial Pneumonia. Infect. Immun. 1985 47(1) 211-6. 

Infection risk Recurrent oral herpes simplex virus type 1 was seen in 1.4% of patients with multiple sclerosis immediately after each cycle of alemtuzumab [138 ]. Inactive tuberculosis was incidentally identified in one patient who received alemtuzumab 24 mg. There were no cases of progressive multifocal leukoencephalo-pathy, cytomegalovirus infection, or pneu-mocystis pneumonia. 

Cytomegalovirus (CMV) is a herpesvirus, which causes an inapparent infection in immunocompetent persons. Worldwide, approximately 40% of people are infected with CMV. In immunocompromised patients, transplant recipients and neonates, CMV can cause serious and potentially lethal disease manifestations like pneumonia, retinitis and blindness, hepatitis, infections of the digestive tract, deafness or mental retardation. 

Cytomegalovirus (CMV) Enveloped, icosahedral particles 150nm in diameter CMV is generally acquired in childhood as a subclinical infection. About 50% of adults carry the virus in a dormant state in white blood cells. The virus can cause severe disease (pneumonia, hepatitis, encephalitis) in immunocompromised patients. Primary infections during pregnancy can induce serious congenital abnormalities in the fetus... 

Cytomegalovirus (CMV) is a member of the herpes virus family, as are the varicella zoster and Epstein-Barr viruses described earlier. CMV is a common virus, and many people are infected early in the childhood. Children tend to get an asymptomatic infection, while infected young adults may develop a mono-nucleosis-like illness. Infection of a fetus is very serious and can lead to permanent brain damage or death of the fetus. In AIDS patients, CMV infection can recur and tend to infect the retinas of eyes, leading to blindness. The virus also infects the adrenal gland, leading to hormonal imbalance. CMV pneumonia in patients who have PCP at the same time is usually fatal. 

Infants with SCID have profound immunodehciency and present with frequent episodes of diarrhea, pneumonia, otitis, sepsis, and cutaneous infections. Persistent infections with opportunistic organisms such as Pneumocystis carinii, Epstein-Barr virus, Candida albicans, cytomegalovirus, parainhuenzae 3 virus, respiratory syncitial virus, adenovirus, varicella, and bacille Calmette-Guerin (BCG) lead to death within the hrst or second year of life. ADA dehciency also occurs in adults, but with a much later onset and nhlder, but clinically discernible, immunodehciency [3,5]. 

Nephrotic patients (especially children) are prone to bacterial infections. Before antibiotics and corticosteroids were introduced into the therapy, pneumonia, peritonitis, and sepsis (usually caused by pneumococci) were the most frequent cause of death of nephrotic children with minimal change disease. Infections are more frequent in nephrotic children and after the age of 20 their prevalence markedly decreases because the majority of adults have antibodies against the capsular antigens of pneumococci. Infections remain an important complication of nephrotic syndrome in developing countries. In developed countries, nephrotic patients treated by immunosuppressive agents may frequently suffer from viral infections (mainly herpesvirus infections, e.g., cytomegalovirus and Epstein-Barr virus infections). 

Impaired cell-mediated immunity leaves the host prey to many (opportunistic) infections including candidiasis, coccidioidomycosis, cryptosporidiosis, cytomegalovirus disease, herpes simplex, histoplasmosis, Pneumocystis carinii pneumonia, toxoplasmosis and tuberculosis (with multiply-resistant organisms). Treatment of these conditions is referred to elsewhere in this text for a comprehensive review of the antinticrobial prophylaxis of opportunistic infections in patients with HIV infection, readers are referred to Kovacs Masur 2000 New England Journal of Medicine 342 1416. 

Nguyen Q, Champlin R, Giralt S, et al. Late cytomegalovirus pneumonia in adult allogeneic blood and marrow transplant recipients. Clin Infect Dis 1999 28 618-623. 

Surveillance data indicate that the incidence of certain OIs in HIV-infected persons in the United States continues to change. The three major OIs—Pneumocystis carinii pneumonia (PCP), Mycobacterium avium complex (MAC) disease, and cytomegalovirus (CMV) retinitis—all have decreased in incidence. Potent antiretroviral reg-... 

Antiphospholipid syndrome Pneumonia, urinary tract infection, hepatitis C virus, human immunodeficiency virus, cytomegalovirus... 

Chlamydia is a eubacteria that causes widespread infection in humans (Hogan et al., 2004). CP respiratory infection occurs in almost all humans during lifetime (Hogan et al., 2004) and results in 10% of community-acquired pneumonia and 5% of bronchitis and sinusitis cases (Kuo et al., 1995). Association between CP and coronary heart disease (CHD) is equivocal. Some studies show an association between CP and CHD (Danesh et al., 1997 Kuo et al., 1993 Saikku et al., 1988), while others found none (Caligiuri et al., 2001 Hoffmeister et al., 2000). Hoffmeister et al. (2000) reported that indicators of atherogenic lipid profile, like decreased HDL-C, HDL-C to total cholesterol ratio, apoAI, and increased apoB, were associated with current infection with Helicobacter pylori, but not with CP or Cytomegalovirus (Hoffmeister et al., 2001). 

Hoffmeister, A., Rothenbacher, D., Bode, G., Persson, K., Marz, W., Nauck, M.A., Brenner, H., Hombach, V., and Koenig, W. 2001. Current infection with Helicobacter pylori, but not seropositivity to Chlamydia pneumoniae or cytomegalovirus, is associated with an atherogenic, modified lipid profile. Arterioscler. Thromb. Vase. Biol 21, 427-432. 

Cytomegalovirus (CMV) is a ubiquitous beta-herpesvirus that has the distinguishing characteristic of all herpesviruses, the ability to persist in the host. Persistent CMV causes serious infections such as interstitial pneumonia, gastrointestinal mucosal ulceration, retinitis, and hepatitis in immunosuppressed patients. Elucidating mechanisms of CMV persistence is critical to a complete model of pathogenesis as CMV infection, morbidity, and mortality often are the result of dissemination of virus acquired before the onset of immunosuppression. 

In a phase II study of alemtuzumab, symptomatic cytomegalovirus reactivation occurred in six of 20 patients there were two deaths, one from bacterial pneumonia and one from an adenovirus infection [145 ]. 

In an open-label, multicenter trial, de novo kidney transplant recipients (KTRs) were randomised at week 7 posttransplant to remain on ciclosporin (n = 100, controls) or convert to everolimus (n = 102), both with enteric-coated mycophenolate sodium and corticosteroids. The incidence of oedema, acne, anaemia, mouth ulceration and hypercholesterolaemia was higher in the everolimus arm. Serious adverse events or infections that occurred in more than two everolimus-treated patients comprised pneumonia, lymphocele, increased plasma creatinine, sepsis, gastroenteritis, cytomegalovirus (CMV) infection, rejection and hydronephrosis. Two malignant neoplasms occurred in each group (everolimus malignant parathyroid tumour, adenocarcinoma of the prostate) [ll -]. 

Bacterial Infection 190 Mycobacterial Infection 191 Fungal Infections 191 Pneumocystis Jiroveci (Formerly Pneumocystis Carinii) 191 Aspergillosis 192 Mucormycosis 194 Cryptococcal Pneumonia 194 Histoplasmosis 195 Candidiasis 195 Viral Infection 195 Community Respiratory Viruses 195 Cytomegalovirus (CMV) 196... 

---