Cytomegalovirus infections in non-immunocompromised and immunocompromised patients in the intensive care unit

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Abstract

Infection, inflammatory response, activation of coagulation cascade and sepsis are tightly interconnected. In the initial phase, sepsis is characterized by a pro-inflammatory state, while in the late phase, by an anti-inflammatory state which favors cytomegalovirus reactivation. Cytomegalovirus infection would accentuate the sepsis-induced immunologic effects increasing the risk for other infections. The rate of CMV infection is 17% in critically ill non-immunocompromised patients, up to 30% in hematopoietic stem cell transplant and up to 60% in solid organ transplant recipients. Cytomegalovirus infection in critically ill patients is associated with prolonged ventilator support, nosocomial infections, prolonged hospital and/or ICU stay and increased mortality. In immunocompromised patients, cytomegalovirus causes direct effects (viral syndrome, pneumonia, meningo-encephalitis, and gastro-intestinal tract involvement) and indirect (immunomodulatory) effects. These indirect effects would predispose the patients to secondary infections, delay immune recovery after hematopoietic stem cell transplant, and increase the risk of EBV-related B-cell lymphoproliferative disease and allograft rejection. Cytomegalovirus serology is not useful for the diagnosis of active infections. Cytomega-lovirus culture is impractical for clinical purposes. The shell vial assay has low sensitivity. pp65 antigen is a sensitive and specific diagnostic method. Real-time PCR is more sensitive and specific (earlier detection) than pp65 antigen test and it is a more reliable marker to monitor the clearance of viremia. Ganciclovir and valganciclovir are the first-line antiviral therapies for the treatment of immunocompromised patients, while foscarnet and cidofovir are reserved mainly for treatment of ganciclovir-resistant cytomegalovirus infections.

Original languageEnglish (US)
Pages (from-to)354-364
Number of pages11
JournalInfectious Disorders - Drug Targets
Volume11
Issue number4
StatePublished - Aug 1 2011

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Cytomegalovirus Infections
Immunocompromised Host
Intensive Care Units
Cytomegalovirus
Sepsis
Ganciclovir
Hematopoietic Stem Cells
Infection
Transplants
Critical Illness
Viral Pneumonia
Foscarnet
Antigens
Viremia
Encephalitis
Serology
Mechanical Ventilators
Cross Infection
Human Herpesvirus 4
Coinfection

Keywords

  • Cytomegalovirus
  • Immunocompromised
  • Intensive care unit
  • Non-immunocompromised
  • Transplant

ASJC Scopus subject areas

  • Molecular Medicine
  • Pharmacology
  • Microbiology (medical)

Cite this

@article{34dd47e1bea0429492c00d815421048b,
title = "Cytomegalovirus infections in non-immunocompromised and immunocompromised patients in the intensive care unit",
abstract = "Infection, inflammatory response, activation of coagulation cascade and sepsis are tightly interconnected. In the initial phase, sepsis is characterized by a pro-inflammatory state, while in the late phase, by an anti-inflammatory state which favors cytomegalovirus reactivation. Cytomegalovirus infection would accentuate the sepsis-induced immunologic effects increasing the risk for other infections. The rate of CMV infection is 17{\%} in critically ill non-immunocompromised patients, up to 30{\%} in hematopoietic stem cell transplant and up to 60{\%} in solid organ transplant recipients. Cytomegalovirus infection in critically ill patients is associated with prolonged ventilator support, nosocomial infections, prolonged hospital and/or ICU stay and increased mortality. In immunocompromised patients, cytomegalovirus causes direct effects (viral syndrome, pneumonia, meningo-encephalitis, and gastro-intestinal tract involvement) and indirect (immunomodulatory) effects. These indirect effects would predispose the patients to secondary infections, delay immune recovery after hematopoietic stem cell transplant, and increase the risk of EBV-related B-cell lymphoproliferative disease and allograft rejection. Cytomegalovirus serology is not useful for the diagnosis of active infections. Cytomega-lovirus culture is impractical for clinical purposes. The shell vial assay has low sensitivity. pp65 antigen is a sensitive and specific diagnostic method. Real-time PCR is more sensitive and specific (earlier detection) than pp65 antigen test and it is a more reliable marker to monitor the clearance of viremia. Ganciclovir and valganciclovir are the first-line antiviral therapies for the treatment of immunocompromised patients, while foscarnet and cidofovir are reserved mainly for treatment of ganciclovir-resistant cytomegalovirus infections.",
keywords = "Cytomegalovirus, Immunocompromised, Intensive care unit, Non-immunocompromised, Transplant",
author = "Florescu, {Diana F} and Kalil, {Andre C}",
year = "2011",
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AU - Florescu, Diana F

AU - Kalil, Andre C

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N2 - Infection, inflammatory response, activation of coagulation cascade and sepsis are tightly interconnected. In the initial phase, sepsis is characterized by a pro-inflammatory state, while in the late phase, by an anti-inflammatory state which favors cytomegalovirus reactivation. Cytomegalovirus infection would accentuate the sepsis-induced immunologic effects increasing the risk for other infections. The rate of CMV infection is 17% in critically ill non-immunocompromised patients, up to 30% in hematopoietic stem cell transplant and up to 60% in solid organ transplant recipients. Cytomegalovirus infection in critically ill patients is associated with prolonged ventilator support, nosocomial infections, prolonged hospital and/or ICU stay and increased mortality. In immunocompromised patients, cytomegalovirus causes direct effects (viral syndrome, pneumonia, meningo-encephalitis, and gastro-intestinal tract involvement) and indirect (immunomodulatory) effects. These indirect effects would predispose the patients to secondary infections, delay immune recovery after hematopoietic stem cell transplant, and increase the risk of EBV-related B-cell lymphoproliferative disease and allograft rejection. Cytomegalovirus serology is not useful for the diagnosis of active infections. Cytomega-lovirus culture is impractical for clinical purposes. The shell vial assay has low sensitivity. pp65 antigen is a sensitive and specific diagnostic method. Real-time PCR is more sensitive and specific (earlier detection) than pp65 antigen test and it is a more reliable marker to monitor the clearance of viremia. Ganciclovir and valganciclovir are the first-line antiviral therapies for the treatment of immunocompromised patients, while foscarnet and cidofovir are reserved mainly for treatment of ganciclovir-resistant cytomegalovirus infections.

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