Diagnosis Of Cytomegalovirus Pneumonia Research Articles

HIV-Associated Opportunistic Pneumonia Case Mimicking Covid-19 Pneumonia

Cytomegalovirus (CMV) pneumonia is a rare opportunistic infection in the progression of human immunodeficiency virus (HIV) infection. Also, COVID-19 has been named a pandemic since the beginning of 2020. During this period, physicians were exposed to many COVID-19 cases, and it was challenged to consider different diagnoses in patients who applied to the emergency room with lung complaints and bilateral pneumonia. Here we reported a 30-year-old man diagnosed with HIV- associated opportunistic CMV pneumonia mimicking COVID-19. The diagnosis of CMV pneumonia was obtained through consistent clinical, radiological, microbiological and cytologic examinations. The patient made a complete clinical recovery after being initialized on anti-CMV treatment.

Association of cytomegalovirus viremia with pneumonia severity in South African children

Background: Sub-Saharan Africa is home to a large population of HIV-infected and HIV-exposed, -uninfected (HEU) children that are at risk for severe pneumonia attributed to opportunistic infections, including human cytomegalovirus (CMV). The role of CMV in pneumonia etiopathogenesis amongst these children is disputed, however. Methods & Materials: We evaluated whole blood CMV viral load using PCR in South African children enrolled in the Pneumonia Etiology Research for Child Health (PERCH) case–control study. Cases, 1–59 months of age hospitalized with World Health Organization-defined severe/very severe pneumonia, were matched by age and season to community controls. A composite measure of disease severity was derived for children with radiologically-confirmed pneumonia that had high-density nasopharyngeal CMV carriage and were either mechanically ventilated, hospitalised for >5 days, or died. CMV viral load on whole blood was compared between cases with severe-composite disease, all other cases and controls. Results: Cut-off densities of 3.33, 2.53 and 2.69 log10 copies/mL of CMV in whole blood, respectively, discriminated between HIV-unexposed, HEU and HIV-infected cases with radiologically-confirmed pneumonia and age-, season-matched controls. HIV-unexposed, HEU and HIV-infected children with severe composite disease were significantly younger (HIV-unexposed: 5.5 vs 6.0 vs 7.0 months; HEU: 4.0 vs 5.0 vs 9.0 months; HIV-infected: 5.5 vs 8.0 vs 9.5 months) and severely underweight (HIV-unexposed: 32.6% vs 8.7% vs 0.9%; HEU: 35.0% vs 14.4% vs 2.3%; HIV-infected: 30.4% vs 33.8% vs 12.6%) compared to all other cases and controls. CMV whole blood PCR discriminated between cases with severe-composite disease and all other cases in the HEU (adjusted odds ratio (aOR), 2.32; 95% CI, 1.09–4.91) and HIV-infected (aOR, 2.71; 95% CI, 1.15–6.39) groups. Additionally, CMV whole blood PCR discriminated between cases with severe-composite disease and controls in HIV-unexposed (aOR, 4.04; 95% CI, 1.59–10.25), HEU (aOR, 6.60; 95% CI, 1.31–33.31) and HIV-infected children (aOR, 10.29; 95% CI, 2.81–37.65). Conclusion: In African children <5 years of age hospitalized for severe community-acquired pneumonia, CMV detection in whole blood PCR discriminated between severe-composite disease and all other cases in HEU and HIV-infected patients. The test may guide choice of therapy in a select group of immunocompromised cases in whom a diagnosis of CMV pneumonia is being considered.

Diagnosis of cytomegalovirus pneumonia by quantitative polymerase chain reaction using bronchial washing fluid from patients with hematologic malignancies

BackgroundThe incidence of cytomegalovirus (CMV) pneumonia is increasing in patients diagnosed with hematologic malignancies. The utility of CMV-DNA viral load measurement has not been standardized, and viral cut-off values have not been established. This study was designed to investigate the utility of CMV quantitative real-time PCR (qRT-PCR) using bronchial washing fluid.MethodsWe retrospectively reviewed the microbiologic and pathologic results of bronchial washing fluid and biopsy specimens in addition to the patients' clinical characteristics.ResultsA total of 565 CMV qRT-PCR assays were performed using bronchial washing fluid from patients with hematologic malignancies. Among them, 101 were positive for CMV by qRT-PCR; of these, 24 were diagnosed with CMV pneumonia and 70 with CMV infection, and 7 were excluded due to a diagnosis of invasive pulmonary aspergillosis rather than viral pneumonia. The median CMV load determined by qPCR was 1.8 × 105 copies/mL (3.6 103-1.5 × 108) in CMV pneumonia patients and 3.0 × 103 copies/mL (5.0 × 102-1.1 × 105) in those diagnosed with CMV infection (P < 0.01). Using the ROC curve, the optimal inflection points were 18,900 copies/mL (137,970 IU/mL) in post-bone marrow transplantation (BMT) patients, 316,415 copies/mL (2,309,825 IU/mL) in no-BMT patients and 28,774 copies/mL (210,054 IU/mL) in all patients.ConclusionsThe CMV titers in bronchial washing fluid determined by qRT-PCR differed significantly between patients diagnosed with CMV pneumonia and those with CMV infection. The viral cut-off values in bronchial washing fluid were suggested for the diagnosis of CMV pneumonia, which were different depending on the BMT status.

Characteristics of multi-slice CT in diagnosis of cytomegalovirus pneumonia after kidney transplantation

Objective To improve the diagnosis of cytomegalovirus pneumonia in patients who have undergone kidney transplantation. Methods The CT appearances of 10 cases were retrospectively analyzed. Results Ground glass opacity was seen in all cases, and disseminated several lobes were seen in 7 cases, diffuse distribution was seen in 3 cases. In addition,lung fibrosis happened in 3 cases,nodule in 2 cases,and consolidation in 3 cases.Conclusion Multi-slice CT could provide very valuable information for early diagnosis of cytomegalovirus pneumonia. Key words: Kidney transplantation; Cytomegalovirus; Pneumonia; CT

Atteinte pulmonaire au cours d’une infection à Cytomegalovirus chez un adulte immunocompétent

Cytomegalovirus (CMV) infection in the immunocompetent is generally silent or it may present as a mononucleosis like syndrome but, rarely, it can lead to symptomatic manifestations. An immunocompetent and previously healthy 43- year-old woman presented with fever, dyspnoea, liver cell necrosis and a mononucleosis syndrome. The CT scan showed diffuse ground-glass opacity. BAL and blood cultures were sterile. Urinary antigens (Legionella pneumophila, Streptococcus pneumoniae) and serology for atypical respiratory pathogens (Mycoplasma pneumoniae and Chlamydia sp.) were negative. A diagnosis of CMV pneumonia was established on serology (presence of anti-CMV IgM) and PCR detection of viral DNA in the serum. Without antiviral therapy, there was a favourable clinical outcome 1 week later and 1 month later the CT scan was normal. CMV infection can lead, exceptionally. to a hypoxic pneumonia in the immunocompetent host. Antiviral therapy should not be prescribed systematically.

Diagnosis of Cytomegalovirus Pneumonia by the Polymerase Chain Reaction With Archived Frozen Lung Tissue and Bronchoalveolar Lavage Fluid

The authors developed a polymerase chain reaction (PCR) procedure to detect cytomegalovirus (CMV) in archived, frozen lung tissue and bronchoalveolar lavage (BAL) fluid preparations. The procedure incorporated an internal beta-globin control to assess the adequacy of the sample. Twenty-nine lung tissue and 96 archived BAL specimens from marrow transplant recipients were tested. One of the lung tissue specimens and 46 of the BAL specimens had insufficient tissue for PCR analysis because they did not show a beta-globin band. In lung tissue, the PCR had a sensitivity of 100% and specificity of 89% compared with conventional tube culture. In BAL specimens, the PCR had a sensitivity of 87% and specificity of 90% compared with conventional tube culture or centrifugation culture. Provided tissue was sufficient, the results suggest that the PCR can be used to diagnose CMV interstitial pneumonia effectively from frozen specimens of lung tissue or BAL fluid.

Use of Indium 111-Labeled White Blood Cell Scan in the Diagnosis of Cytomegalovirus Pneumonia in a Renal Transplant Recipient with a Normal Chest Roentgenogram*

Opportunistic infections are common in patients after renal transplantation. This report describes a case of cytomegalovirus pneumonia in a renal transplant recipient with a normal chest roentgenogram and normal arterial oxygenation. An abnormal 111In-white blood cell scan led to the discovery of a pulmonary source of his recurrent fevers.

Monoclonal antibodies to cytomegalovirus: rapid identification of clinical isolates and preliminary use in diagnosis of cytomegalovirus pneumonia.

Two monoclonal antibodies which react specifically with cells infected by cytomegalovirus (CMV) are described. One antibody, 6-E3, reacts with a 72,000-dalton protein that appears early in infection and remains localized in the cell nucleus. The other antibody, 6-C5, reacts with an 80,000-dalton protein that appears late in infection and remains localized in cytoplasmic inclusion bodies. Both monoclonal antibodies react with conventional laboratory strains of CMV and can be used in immunofluorescence assays to identify clinical isolates of CMV in culture. Preliminary tests on lung tissues from patients with CMV pneumonia show that only antibody 6-C5 detects CMV infection in primary clinical specimens. A comparison of culture, histological, and immunological methods demonstrates that the monoclonal antibodies possess sufficient specificity and sensitivity to warrant their continued development as immunodiagnostic tools for the detection of CMV infection in both tissue culture and tissues obtained directly from patients.

Diagnosis of cytomegalovirus pneumonia in compromised hosts

Sixteen patients with cytomegalovirus pulmonary infection are described. In 11 the diagnosis was made antemortem by lung aspirate or biopsy, and in five the diagnosis was made at postmortem by typical lung histology and positive viral lung cultures. All patients were immunosuppressed by both their underlying diseases and treatment with corticosterolds and other chemotherapy. Although other pathogens were identified at lung biopsy in most patients (73 per cent), primarily Pneumocystis carinii, evidence is offered to demonstrate that cytomegalovirus can cause significant pulmonary disease alone, leading to respiratory failure and death.

Diagnosis of cytomegalovirus pneumonia in compromised hosts: Abdallah PS, Mark JBD, Merigan TC: Am J Med 61: 326–332, 1976

Diagnosis of cytomegalovirus pneumonia in compromised hosts: Abdallah PS, Mark JBD, Merigan TC: Am J Med 61: 326–332, 1976