Cytomegalovirus Infection in Critically Ill Patients

Jaber, Samir; Chanques, Gérald; Borry, Jean; Souche, Bruno; Verdier, Raymond; Pérrigault, Pierre-François; Eledjam, Jean‐Jacques

doi:10.1378/chest.127.1.233

Cited by 167 publications

(173 citation statements)

References 36 publications

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“…Others have reported that CMV was found in 17% patients with unexplained prolonged fever after 10 days in hospital and was associated with higher morbidity and mortality [Jaber et al, 2005]. This figure is similar to the 19% found in respiratory secretions in this study in patients selected only by being in the ITU more than 4 days.…”

Section: Discussionsupporting

confidence: 89%

Detection of herpes viruses in respiratory secretions of patients undergoing artificial ventilation

Smith

Conroy

Pollock

et al. 2010

Journal of Medical Virology

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1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 AbstractThe significance of detection of herpes viruses in respiratory secretions of critically ill patients is controversial. The study aim was to determine the prevalence of herpes virus DNA in respiratory secretions in patients on artificial ventilation. Respiratory secretions taken thrice weekly from 174 patients in a tertiary centre Intensive Therapy Unit (ITU) were tested for Herpes Simplex Virus (HSV) by nested PCR. Samples from 61 patients in ITU for 4 days or more were also tested for Epstein Barr Virus (EBV) and Cytomegalovirus (CMV) using real-time PCR.HSV positivity increased with ITU stay with 18.6% admission samples positive, 32.5 % day 2-5 samples, and 65.9% day 6-39 samples. Being HSV positive on admission did not influence mortality (9/27, 33.3% v 38/118, 32.2%) however, subsequently, mortality of those negative but becoming positive was higher than in those remaining negative (10/35, 29% v 5/24 21%). At least one sample was EBV positive in 61% and CMV positive in 19% of patients tested. Of 63 patients tested for all three viruses, 4 were positive for three viruses, 23 patients for two viruses, 24 for one virus and 12 were negative for all the above viruses.Detection of HSV, EBV and CMV is common in ITU patients. Becoming HSV positive while in ITU may increase mortality. Word count 204

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Section: Discussionsupporting

confidence: 89%

Detection of herpes viruses in respiratory secretions of patients undergoing artificial ventilation

Smith

Conroy

Pollock

et al. 2010

Journal of Medical Virology

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“…CMV reactivation in apparently immunocompetent individuals with critical illness is becoming an area of emerging clinical significance. It has been observed that CMV infection occurs in critically sick patients admitted in ICUs and the prevalence ranges from 0-35% [12][13][14][15][16][17]. This wide variation observed in different studies is due to different study designs, limited sample size, lack of standardized diagnostic criteria, inclusion of only selected types of ICU patients, different inclusion and exclusion criteria, and/or failure to include comprehensive and rigorous statistical analysis.…”

Section: Epidemiologymentioning

confidence: 99%

“…Many studies have shown the importance of CMV infection in such patients [12][13][14][15][16][17]. Presence of CMV infection in critically ill ICU patients led to increased length of ICU stay and increased duration of mechanical ventilation as compared to patients negative for CMV infections even when both the groups had similar disease severity [8,12,13] Nosocomial infections were also significantly higher in patients positive for CMV as compared to non CMV patients [15]. The rates of renal failure and steroid therapy were also higher in CMV positive groups [8,14].…”

Section: Epidemiologymentioning

confidence: 99%

Cytomegalovirus infection in non-immunosuppressed critically ill patients

Jain

Duggal

Chugh

2011

J Infect Dev Ctries

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Cytomegalovirus (CMV) is an important and common cause of mortality and morbidity in immunocompromised patients such as those with HIV/AIDS, transplant recipients on immunosuppressive therapy, and malignant hematological disease. After primary infection with CMV the virus becomes latent in multiple organs and can later be reactivated during severe dysregulation of the immune system. A large population carry dormant virus and are thus at risk for reactivation. However, reactivation of CMV has been reported in "non-immunosuppressed patients" such as severe trauma, sepsis, shock, burns, cirrhosis and other critically ill patients lying in the intensive care units. Therefore, the intensivists are increasingly facing a dilemma of identifying such patients to treat and there is a debate if there is a scientific justification for prophylaxis in such immunocompetent patients.

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“…CMV reactivation may be associated with higher mortality among these patients [1]. Some studies have suggested that CMV reactivation may be associated with higher incidence of nosocomial pneumonia [2,3].…”

Section: Introductionmentioning

confidence: 99%

Cytomegalovirus reactivation enhances the virulence of Staphylococcus aureus pneumonia in a mouse model

Hraiech

Bordes

Mège

et al. 2017

Clinical Microbiology and Infection

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International audienceObjectives: Cytomegalovirus (CMV) reactivation in intensive care unit patients may increase mortality and favour bacterial pneumonia. We developed a murine model to compare the severity of staphylococcal pneumonia after CMV reactivation and in CMV-negative mice. Methods: Balb/c mice were primo-infected with murine cytomegalovirus (MCMV n = 90) or received saline (control n = 90). After latency, all mice underwent caecal ligation and puncture to trigger MCMV reactivation in MCMV primary-infected mice. Surviving animals received an intra-nasal inoculation with methicillin-susceptible Staphylococcus aureus (MSSA) to induce pneumonia. Mortality, lung bacterial count, histology and interferon-alpha and gamma serum levels were compared in MCMV reactivated and control mice 2, 5 and 15 days after pneumonia. Results: AfterMSSA pneumonia, MCMV mice showed a trend towards a higher mortality (9.4% versus 0%; p 0.09) and a higher weight loss (2.2 (0.6-4.1 g) versus 0.7 (-0.3 to 1.3 g); p 0.005). The lung bacterial countwas higher in MCMV mice 2 days (5 x 10(3) (10(3) to 3 x 10(5)) versus 10(2) (0 to 4 x 10(2)) CFU/lung; p 0.007) and 5 days (2.5 x 10(4) (1.6 x 10(4) to 6.5 x 10(5)) versus 15 (10-40) CFU/lung; p 0.005) after MSSA pneumonia. 8/40 (20%) MCMV mice developed lung abscesses compared to 0% in control (p 0.011). Interferon-alpha serum levels 2 days after staphylococcal pneumonia were higher in MCMV mice. Conclusions: MCMV reactivation decreased lung bacterial clearance and favoured the development of staphylococcal abscessing pneumonia. CMV reactivation may be responsible for a higher susceptibility to bacterial sepsis. (C) 2016 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. All rights reserved

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Cytomegalovirus Infection in Critically Ill Patients

Cited by 167 publications

References 36 publications

Detection of herpes viruses in respiratory secretions of patients undergoing artificial ventilation

Detection of herpes viruses in respiratory secretions of patients undergoing artificial ventilation

Cytomegalovirus infection in non-immunosuppressed critically ill patients

Cytomegalovirus reactivation enhances the virulence of Staphylococcus aureus pneumonia in a mouse model

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