CMV pneumonitis: Difference between revisions

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=== Laboratory Findings ===  
=== 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 ===  

Revision as of 14:14, 1 February 2012

CMV pneumonitis

CMV pneumonitis Microchapters

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Overview

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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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

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


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