Pneumonia is an inflammation of the lungs, usually caused by an infection of the lung tissue.
What are the other Names for this Condition? (Also known as/Synonyms)
- CMV Pneumonia
- Pneumonia and Systemic Cytomegalovirus Infection
- Viral Pneumonia due to CMV
What is Cytomegalovirus Pneumonia? (Definition/Background Information)
- Cytomegalovirus (CMV) Pneumonia is a lung infection caused by the virus ‘cytomegalovirus’, leading to inflammation in the lung tissues in patients with poor immune system.
- This causes respiratory symptoms and rapid deterioration in clinical condition. It can cause infection in other organs such as liver, eyes, nerves, brain at the same time it affects the lungs.
- This infection mostly affects individuals in whom the immunity system is compromised; like AIDS or HIV infected persons, those who have undergone bone marrow transplant or organ transplant, those on chemotherapy for cancer treatment, those who have been treated with high dose steroids or other immune-suppressing medications for diseases, such as Crohn’s disease, rheumatoid arthritis, and Lupus.
- CMV is a common virus. A majority of the individuals are routinely exposed to this virus either during childhood or young adulthood. In individuals with normal immune system, CMV infection is generally self-limiting. The infection is easily handled by the body with only short flu-like symptoms, being observed.
Who gets Cytomegalovirus Pneumonia? (Age and Sex Distribution)
- Patients who underwent recent organ or bone marrow transplantations are at a high risk of contracting Cytomegalovirus Pneumonia infection. The virus can spread through blood transfusions, sexual body fluids (semen, vaginal secretions), solid organ transplants (liver, kidney, lung, heart), or bone marrow transplants. It is also present in urine, nasal secretions, saliva, stool, and breast milk
- All individuals (regardless of age), whose immune systems are weakened by immunodeficiency infections such as HIV, or other debilitating conditions, or had had recent organ/bone marrow transplants, are prone to contract Cytomegalovirus infection. The virus causes mild, or no infection in healthy persons who possess normal immune system
- The infection can be transmitted to babies before birth, through an infected birth canal. This is called congenital CMV infection
- The transmission of the virus also occurs in close contact settings, such as child day care centers
- About 50-60% of adults in the United States have serologic evidence (based on blood serum) of previous CMV infection
What are the Risk Factors for Cytomegalovirus Pneumonia? (Predisposing Factors)
- The most severe form of Cytomegalovirus Pneumonia affect patients who have undergone organ or bone marrow transplants (since they are also on immuno-suppressant drugs)
- Patients undergoing treatment for, or suffering from viral infections, such as HIV and AIDS; due to reduced blood lymphocyte count
- Individuals undergoing blood transfusions, kidney dialysis, for a prolonged period
- Individuals suffering from cancer, those undergoing chemotherapy for cancer
- Individuals on steroid therapy (either low or high dosage), or other immune-suppressing medications for various chronic medical conditions such as Crohn’s disease, rheumatoid arthritis, Lupus, etc.
- Alcohol dependence, malnourishment are other potential risk factors
- The virus also spreads with close contact, such as seen in child day care centers
It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.
Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.
What are the Causes of Cytomegalovirus Pneumonia? (Etiology)
- Cytomegalovirus Pneumonia is a viral infectious disease which occurs in patients with poor immune system, and sometimes in healthy people as well. It can cause pneumonia, while at the same time infecting other body organs too
- The CMV virus occurs latently in most humans, which means that an individual may carry the virus in the body without showing any signs and symptoms of the disease. It is estimated that up to 60% of the US population may have been exposed to the virus
What are the Signs and Symptoms of Cytomegalovirus Pneumonia?
Cytomegalovirus Pneumonia infection is usually present along with many other affected body organs. The signs and symptoms of CMV Pneumonia are:
- Fever, dry cough, and shortness of breath, are the most common symptoms. Examination reveals crackles in the lungs and low oxygenation
- Loss of appetite, discomfort, general malaise or tiredness
- Muscular ache, fatigue, excessive sweating (at nights)
- Coughing blood with severe pneumonia
- Co-existing infections in the lung, such as pneumocystis and aspergillus pneumonia
- Signs and symptoms of other organs involved, such as eyes, liver, heart, brain, kidneys, bone marrow (affecting blood counts), etc.
- Signs and symptoms of acute and chronic graft (organs, bone marrow transplant rejection)
How is Cytomegalovirus Pneumonia Diagnosed?
The immuno-compromised condition of an individual presenting with pneumonia should alert the physician(s) to consider CMV Pneumonia in the differential diagnosis, since untreated CMV Pneumonia in an immunocompromised patient is associated with high mortality.
Diagnostic tests that are performed include:
- Analyze specimens of lung tissue, using bronchoalveolar lavage, bronchial washing, bronchial brushings, bronchial biopsy, or open lung biopsy
- Chest X-ray, CT scan of the chest
- CT chest and lung biopsy may reveal findings suggestive of inflammation of the lungs, due to infection. Characteristic "owl eye cells" can be seen in histopathological examination of lung specimens. Special stains can be performed on the lung specimen, such as immunostains, in difficult cases by the pathologists
- Arterial blood gas analysis will reveal the quantity of oxygen and carbon-dioxide in blood. This indicates how well the lungs are functioning.
- Blood tests and blood culture
- CMV antigenemia test, PCR in blood and tissue samples; to diagnose any CMV infection
- Culture of urine
Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.
What are the possible Complications of Cytomegalovirus Pneumonia?
Complications due to Cytomegalovirus Pneumonia include:
- Respiratory failure due extensive lung tissue involvement (lung failure)
- Side effects from the medications used to treat CMV Pneumonia, like kidney impairment, low WBC count
- CMV infection at other locations: Esophagus, eye, intestine, brain, heart, nervous system, and kidneys
- Risk of death from an ‘overwhelming’ infection
- Superimposed bacterial and fungal infections
- Recurrence of the CMV infection
How is Cytomegalovirus Pneumonia Treated?
Quick, early diagnosis and appropriate treatment is the key to improve survival from Cytomegalovirus Pneumonia.
- The combination of antiviral drugs, such as Ganciclovir and intravenous CMV immune globulin, can reduce the mortality in some high-risk transplant patients from 90% to 50% or lower. Prompt, early treatment can also prevent transmission of the virus to other body organs.
- Patients would require hospitalization and must be placed under isolation conditions. Visitors should be avoided
- CMV Pneumonia in immuno-compromised patients carries a high mortality. Hence, this requires a multi-disciplinary treatment approach involving various doctors (primary medicine, pulmonology, and infectious disease), transplant team, pharmacists, nutritionists, respiratory therapists, etc.
- One has to be vigilant against the development of any co-existing pneumonias, such as pneumocystis, aspergillus, and opportunistic bacterial infections
- Intravenously or orally administered antiviral medications, such as Ganciclovir, Valganciclovir, Foscarnet, Cidofovir are used in the treatment of CMV Pneumonia
- Those affected by HIV/AIDS are also (often) treated with anti-retroviral medications for HIV infection
- Sometimes, patients with an overwhelming infection may need to be placed on ventilator support, due to lung inflammation and low oxygen problems. This is done in an intensive care unit set up in the hospital
- In some cases dialyses may be performed, if the patient suffers a kidney failure
- If immune system is decreases due to medications for organ transplant (liver, kidney, and heart transplants), then adjustment of the anti-transplant rejection medication dose may be necessary
- If an individual is on chronic steroid therapy, then discontinuation of the steroids may be considered by your healthcare provider after analyzing risks and benefits of such as measure
How can Cytomegalovirus Pneumonia be Prevented?
Cytomegalovirus Pneumonia is an opportunistic infection; hence, avoiding CMV virus exposure is very important, especially when the immune system is weak.
- Antiviral prophylaxis (preemptive medication) for organ and bone marrow transplant patients, individuals who are at high risk
- Ensure that the organ and bone marrow transplant donors and recipients are screened for CMV
- Blood products, such as packed red cells, should be screened for CMV
- Avoid close physical contact with CMV-infected persons
- Educating the immune-compromised patients to seek early medical help
What is the Prognosis of Bardet-Biedl Syndrome? (Outcomes/Resolutions)
- Cytomegalovirus Pneumonia and related infections in immunocompromised patients are serious medical conditions
- The mortality for CMV Pneumonia in bone marrow transplant patients treated with Ganciclovir and immune globulin is between 30-60%. In such cases, the mortality approaches 90%, if the patients are not treated with these drugs
- The need for mechanical ventilation is a sign of poor prognosis
Additional and Relevant Useful Information for Cytomegalovirus Pneumonia:
Some home care tips for those with a mild form of the disease, especially in those with a healthy immune system include:
- Drink plenty of liquids
- Take lots of rest
- Use NSAIDs (under physician’s advice)
- Stop smoking
- Avoid exposure to smoke
- Use a vaporizer/humidifier when necessary
- Take cough medications, if needed
What are some Useful Resources for Additional Information?
References and Information Sources used for the Article:
http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001685/ (accessed on 3/12/13)
Uptodate: Clinical manifestations, diagnosis and treatment of cytomegalovirus infection in lung transplant patients (accessed on 3/12/13)
Murray and Nadel's Textbook of Respiratory Medicine: 4th edition; Viral infections; 880-883
Helpful Peer-Reviewed Medical Articles:
Cascio, A., Iaria, C., Ruggeri, P., & Fries, W. (2012). Cytomegalovirus pneumonia in patients with inflammatory bowel disease: a systematic review. Int J Infect Dis, 16(7), e474-479. doi: 10.1016/j.ijid.2012.03.008
Grilli, E., Galati, V., Bordi, L., Taglietti, F., & Petrosillo, N. (2012). Cytomegalovirus pneumonia in immunocompetent host: case report and literature review. J Clin Virol, 55(4), 356-359. doi: 10.1016/j.jcv.2012.08.010
Ison, M. G., & Fishman, J. A. (2005). Cytomegalovirus pneumonia in transplant recipients. Clin Chest Med, 26(4), 691-705, viii. doi: 10.1016/j.ccm.2005.06.013
Nichols, W. G., & Boeckh, M. (2000). Recent advances in the therapy and prevention of CMV infections. J Clin Virol, 16(1), 25-40.
Franquet, T., Lee, K. S., & Muller, N. L. (2003). Thin-section CT findings in 32 immunocompromised patients with cytomegalovirus pneumonia who do not have AIDS. American Journal of Roentgenology, 181(4), 1059-1063.
Konoplev, S., Champlin, R. E., Giralt, S., Ueno, N. T., Khouri, I., Raad, I., ... & Nguyen, Q. (2001). Cytomegalovirus pneumonia in adult autologous blood and marrow transplant recipients. Bone marrow transplantation, 27(8), 877.
Nguyen, Q., Estey, E., Raad, I., Rolston, K., Kantarjian, H., Jacobson, K., ... & Whimbey, E. (2001). Cytomegalovirus pneumonia in adults with leukemia: an emerging problem. Clinical infectious diseases, 32(4), 539-545.
Gasparetto, E. L., Ono, S. E., Escuissato, D., Marchiori, E., Roldan, L., Marques, H. L., & Frare e Silva, R. L. (2004). Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings. The British journal of radiology, 77(921), 724-727.