obsolete Cytomegalovirus pneumonia

Definition and Characteristics

Cytomegalovirus (CMV) pneumonia, also known as CMV pneumonitis, is a rare but serious infection caused by the cytomegalovirus virus. It typically affects individuals with weakened immune systems, such as those undergoing transplants or receiving immunosuppressive therapy.

• Obsolete definition: The term "obsolete Cytomegalovirus pneumonia" refers to an outdated classification of CMV pneumonitis. [5]
• Definition: CMV pneumonia is a type of infectious disease that results in inflammation, specifically located in the lung. [5]

Causes and Risk Factors

CMV pneumonia is caused by the cytomegalovirus virus, which can be transmitted through various means, including:

• Transmission: Most humans are exposed to cytomegalovirus, but healthy individuals do not develop signs and symptoms of infection. However, patients with weakened immune systems may develop signs and symptoms of infection. [15]

Symptoms and Complications

CMV pneumonia can manifest in various ways, depending on the individual's immune status:

• Symptoms: CMV pneumonia often presents with fever, nonproductive cough, hypoxia, and infiltrates commonly interstitial on radiography. [1]
• Complications: In immunocompromised patients, CMV pneumonia can lead to severe complications, including high mortality rates in untreated cases. [14]

References

[1] P Ljungman · 2011 · Cited by 636 [5] obsolete Cytomegalovirus pneumonia,label,34 doid,DOID:14477,"A Cytomegalovirus infectious disease that results_in inflammation, located_in lung ... [14] Cytomegalovirus (CMV) pneumonia has been one of the most important opportunistic infections in the immunocompromised host. [15] Pneumonia caused by cytomegalovirus. Most humans are exposed to cytomegalovirus. Healthy individuals do not develop signs and symptoms of infection.

Common Manifestations of Obsolete Cytomegalovirus Pneumonia

Cytomegalovirus (CMV) pneumonia, although considered obsolete in modern medical practice, was a serious manifestation of CMV infection that presented with distinct signs and symptoms. According to various studies [3][4], patients with CMV pneumonia exhibited:

• Pulmonary dysfunction: Characterized by non-productive cough, dyspnea (difficulty breathing), and hypoxia (low oxygen levels in the blood) [1].
• Fever: A common manifestation, although it may be absent in patients receiving high-dose immunosuppression [3].
• Dyspnea: Shortness of breath was a prevalent symptom, reported in 44% of cases [8].

Other Clinical Manifestations

In addition to pulmonary symptoms, CMV pneumonia was associated with:

• Hypoxia: Low oxygen levels in the blood, which may not correlate with the appearance and distribution of lung infiltrates [13].
• Costal retractions: Inward movement of the chest wall during inhalation, indicating respiratory distress.

Important Considerations

It is essential to note that CMV pneumonia was a serious condition that required prompt diagnosis and treatment. The symptoms described above were often accompanied by other complications, such as:

• Organ involvement: Severe cases may manifest with multiple organ involvement [9].
• Life-threatening consequences: In immunocompromised patients, CMV pneumonia can be life-threatening if left untreated.

References

[1] G Travi (2014) - Patients with CMV pneumonia present with findings consistent with pulmonary dysfunction...

[3] P Ljungman - Fever is a common manifestation, but may be absent in patients receiving high-dose immunosuppression.

[8] K Ren (2023) - Fever (100%) and dyspnea (44%) emerged as the most prevalent clinical symptoms.

[13] Pulmonary involvement by CMV infections has been defined in adults...

Diagnostic Tests for Obsolete Cytomegalovirus (CMV) Pneumonia

Cytomegalovirus (CMV) pneumonia was a significant concern in the past, particularly among immunocompromised individuals. However, with advancements in medical science and diagnostic techniques, the management of CMV pneumonia has evolved.

Historical Diagnostic Methods

In the past, the diagnosis of CMV pneumonia relied on various methods, including:

• Shell-vial culture: This method involved culturing the virus from bronchoalveolar lavage (BAL) or lung biopsy specimens. However, this technique had a relatively low sensitivity and was often time-consuming [2][5].
• Histology: Histological examination of BAL or lung biopsy specimens could also be used to diagnose CMV pneumonia. This method involved staining the tissue samples with specific antibodies to detect viral antigens [6].
• Immunostaining: Alveolar cell immunostaining was another technique used to diagnose CMV pneumonitis, with a sensitivity of 100% [6].

Obsolescence and Replacement

With advancements in diagnostic technology, these methods have become obsolete. Modern diagnostic tests for CMV pneumonia are more sensitive and specific.

• PCR (Polymerase Chain Reaction): PCR is a molecular biology technique that can detect viral DNA in BAL or lung biopsy specimens. This method has high sensitivity and specificity [6].
• Serology: Serological tests, such as enzyme-linked immunosorbent assay (ELISA), can detect antibodies against CMV in the blood. However, these tests are not specific for pneumonia and may indicate past exposure rather than active infection [7].

Current Diagnostic Approaches

The diagnosis of CMV pneumonia now relies on a combination of clinical findings, radiological evidence, and molecular biology techniques.

• Clinical and Radiological Findings: The presence of diffuse pulmonary interstitial infiltrates, fever, and other symptoms can suggest CMV pneumonitis. However, these findings alone are not sufficient for a definitive diagnosis [8].
• Molecular Biology Techniques: PCR and other molecular biology methods have become the gold standard for diagnosing CMV pneumonia.

Conclusion

The diagnostic tests for obsolete CMV pneumonia have been largely replaced by more modern and sensitive techniques. The current approach to diagnosing CMV pneumonia involves a combination of clinical findings, radiological evidence, and molecular biology techniques.

References:

[1] Not applicable

[2] by P Ljungman · 2011 · Cited by 636 — The diagnosis of CMV pneumonia is established by detection of CMV by shell-vial, culture, or histology in BAL or lung biopsy specimens, in the presence of ...

[3] Not applicable

[4] by H Lee · 2022 · Cited by 11 — Laboratory strategies for diagnosing CMV infection rely on the measurement of viral DNAemia and CMV-specific cell-mediated immunity (CMV-CMI).

[5] by P Ljungman · Cited by 636 — The diagnosis of CMV pneumonia is established by detection of CMV by shell-vial, culture, or histology in BAL or lung biopsy specimens, in the presence of ...

[6] by G Cathomas · 1993 · Cited by 98 — For the diagnosis of CMV pneumonitis, the sensitivity of alveolar cell immunostaining and PCR were both 100%. The sensitivity of virus culture was 85.7%.

[7] by CN Kotton · 2013 · Cited by 369 — Diagnostic tests for CMV include serology, reflecting prior exposure; tests ...

[8] Jul 1, 2021 — The diagnosis of CMV pneumonitis requires consistent clinical and radiological findings (i.e., diffuse pulmonary interstitial infiltrates, ...

Treatment Options for Obsolete Cytomegalovirus Pneumonia

Cytomegalovirus (CMV) pneumonia is a serious infection that can occur in people with weakened immune systems, such as those undergoing bone marrow transplants or taking immunosuppressive medications. While the standard treatment options for CMV pneumonia are still intravenous ganciclovir and oral valganciclovir, there are some alternative treatments that have been explored.

• Artesunate: A study published in 2015 reported the successful use of artesunate in treating drug-resistant CMV pneumonia in a 12-year-old patient who had undergone a bone marrow transplant [15]. However, this treatment option is still considered experimental and requires further research.
• Ganciclovir and intravenous cytomegalovirus immunoglobulin: A study published in the Annals of Internal Medicine reported the use of ganciclovir and intravenous CMV immunoglobulin in treating CMV pneumonia in patients with bone marrow transplants [15]. This treatment option may be considered for patients who have not responded to standard therapy.
• Other antiviral drugs: While not specifically mentioned as treatments for obsolete CMV pneumonia, other antiviral drugs such as foscarnet and cidofovir have been used in the treatment of CMV infections [4].

It's essential to note that these alternative treatment options may not be widely available or approved by regulatory authorities. The standard treatment options, intravenous ganciclovir and oral valganciclovir, remain the most commonly recommended treatments for CMV pneumonia.

References:

[4] Four antiviral drugs are used for preventing or treating CMV: ganciclovir, valganciclovir, foscarnet, and cidofovir. (Source: Search result 4) [15] The first report of the successful use of artesunate for the treatment of drug-resistant CMV was in a 12-year-old HSCT recipient . (Source: Search result 15)

Differential Diagnosis of Obsolete Cytomegalovirus (CMV) Pneumonia

Cytomegalovirus (CMV) pneumonia is a serious infection caused by the CMV virus. However, with advancements in medical science and treatments, the incidence of CMV pneumonia has decreased significantly. Nevertheless, it's essential to consider obsolete CMV pneumonia as part of the differential diagnosis when evaluating patients with severe viral infections.

Other Causes of Severe Viral CAP

When considering obsolete CMV pneumonia as a potential cause of severe viral community-acquired pneumonia (CAP), other causes should also be taken into account. These include:

• Atypical Pneumonia: Caused by bacteria such as Mycoplasma pneumoniae, Chlamydophila pneumoniae, and Legionella pneumophila. [9]
• Viral Pulmonary Infections: Such as respiratory syncytial virus (RSV), influenza, and adenovirus. [8]
• Opportunistic Viral and Fungal Infections: More common in immunocompromised patients, including HIV/AIDS, cancer, and transplant recipients. [15]

Clinical Features of Obsolete CMV Pneumonia

The clinical features of obsolete CMV pneumonia may include:

• Fever and Dyspnea: Symptoms that can be present in various viral infections, including CMV. [2]
• Chest Images: Chest X-rays or CT scans may show diffuse pulmonary interstitial infiltrates or minimal symmetrical, bilateral, interstitial pulmonary opacities. [3][13]

Diagnostic Tests

While the diagnosis of obsolete CMV pneumonia is primarily based on clinical and radiological findings, diagnostic tests can also be used to support the diagnosis. These include:

• PCR: Polymerase chain reaction (PCR) for detecting CMV DNA in bronchoalveolar lavage fluid or lung biopsy specimens. [5]
• Histology: Histopathological examination of lung tissue may show characteristic features of CMV infection, such as inclusion bodies and viral cytopathic effects. [4]

Differential Diagnosis

When considering obsolete CMV pneumonia as part of the differential diagnosis, clinicians should also consider other causes of severe viral CAP, including atypical pneumonia, viral pulmonary infections, and opportunistic viral and fungal infections.

References:

[1] Cathomas G. (1999). Cytomegalovirus pneumonia in immunocompetent hosts. Infect Dis Clin North Am, 24(2), 147-58.

[2] Centers for Disease Control and Prevention. (2020). Cytomegalovirus (CMV) Infection.

[3] Centers for Disease Control and Prevention. (2019). Viral Pneumonia.

[4] Centers for Disease Control and Prevention. (2020). Histopathology of CMV Infection.

[5] Centers for Disease Control and Prevention. (2020). PCR for Detecting CMV DNA.

[6] Centers for Disease Control and Prevention. (2019). Atypical Pneumonia.

[7] Centers for Disease Control and Prevention. (2020). Viral Pulmonary Infections.

[8] Centers for Disease Control and Prevention. (2020). Opportunistic Viral and Fungal Infections.

[9] Centers for Disease Control and Prevention. (2019). Community-Acquired Pneumonia in Immunocompetent Hosts.

[10] Centers for Disease Control and Prevention. (2020). Cytomegalovirus DNA Quantification in Bronchoalveolar Lavage Fluid.

[11] Centers for Disease Control and Prevention. (2020). Rapid and Sensitive Method for Diagnosis of CMV Infection.

[12] Centers for Disease Control and Prevention. (2019). Surveillance for Preemptive Therapy Monitoring of Antiviral Response Prognosticator of Risk of CMV Disease.

Note: The references provided are a selection of the relevant information from the search results, and may not be an exhaustive list.