CMV pneumonitis: Difference between revisions
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[[CMV pneumonitis medical therapy|Medical therapy]] | [[CMV pneumonitis surgery|Surgical options]] | [[CMV pneumonitis primary prevention|Primary prevention]] | [[CMV pneumonitis secondary prevention|Secondary prevention]] | [[CMV pneumonitis cost-effectiveness of therapy|Financial costs]] | [[CMV pneumonitis future or investigational therapies|Future therapies]] | [[CMV pneumonitis medical therapy|Medical therapy]] | [[CMV pneumonitis surgery|Surgical options]] | [[CMV pneumonitis primary prevention|Primary prevention]] | [[CMV pneumonitis secondary prevention|Secondary prevention]] | [[CMV pneumonitis cost-effectiveness of therapy|Financial costs]] | [[CMV pneumonitis future or investigational therapies|Future therapies]] | ||
=== History and Symptoms === | === History and Symptoms === | ||
=== Laboratory Findings === | === Laboratory Findings === | ||
Revision as of 14:13, 1 February 2012
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For the WikiPatient page for this topic, click here
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Please Take Over This Page and Apply to be Editor-In-Chief for this topic: There can be one or more than one Editor-In-Chief. You may also apply to be an Associate Editor-In-Chief of one of the subtopics below. Please mail us [2] to indicate your interest in serving either as an Editor-In-Chief of the entire topic or as an Associate Editor-In-Chief for a subtopic. Please be sure to attach your CV and or biographical sketch.
Overview
Historical Perspective
Pathophysiology
Epidemiology & Demographics
Risk Factors
Screening
Causes
Differentiating CMV pneumonitis
Complications & Prognosis
Diagnosis
History and Symptoms | Physical Examination | Staging | Laboratory tests | Electrocardiogram | X Rays | CT | MRI Echocardiography or Ultrasound | Other images | Alternative diagnostics
Treatment
Medical therapy | Surgical options | Primary prevention | Secondary prevention | Financial costs | Future therapies
History and Symptoms
Laboratory Findings
Electrolyte and Biomarker Studies
- LDH elevation in 94% – mean 450 IU/l
- pO2 reduced in most – severity is predictive of mortality
- Microangiopathic hemolytic anemia develops in some patients
Chest X Ray
- Chest x-ray (CXR) – findings present in most patients. Usually bilateral.
- Interstitial changes are most common
- Alveolar consolidation in ~25%
- Ground glass appearance may be present in some
- Nodular opacities in ~10%
- Pleural effusion in ~30%
- Adenopathy in ~10%
- Most patients with normal CXR will have findings on CT scan and gallium scan.
Differential Diagnosis
- Pneumonia due to bacteria
- Fungal infection
- Mycobacteria
- PCP (Pneumocystis carinii)
Risk Stratification and Prognosis
- Prognosis is poor. Particularly in significantly immunocompromised hosts, mortality from significant CMV pneumonitis may be greater than 50%.
Treatment
Pharmacotherapy
- Treatment is most commonly with ganciclovir 5 mg/kg q12h, though results are disappointing. BMT patients characteristically respond, but clinical response is quite variable in AIDS patients, inconsistently showing a significant benefit in different studies.
Transplantation
- Prophylaxis is now being used at some transplant centers. Options include CMV hyperimmune globulin or antiviral treatment such as ganciclovir.
Future or Investigational Therapies
- Trials of ganciclovir with CMV IgG have not shown a consistent benefit in all studies.
- Foscarnet is an alternative agent but data on its efficacy is lacking