Cytomegalovirus Pneumonitis in Patients with AIDS

Wallace, Jeanne M.; Hannah, James

doi:10.1378/chest.92.2.198

Cited by 108 publications

(38 citation statements)

References 15 publications

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“…Since the incidence of CMV pneumonitis in AIDS patients is relatively rare, the use of mega-dose steroid therapy may have been associated with the worsening of disseminated CMV infection in our patient (8,9). Another possible complication associated with the use of corticosteroids includes the increased risk of pneumothorax (1).…”

Section: Discussionmentioning

confidence: 99%

Fatal Pulmonary Co-infection with Pneumocystis and Cytomegalovirus in a Patient with Acquired Immunodeficiency Syndrome

et al. 2014

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A 33-year-old homosexual Japanese man who admitted to having sex with men presented with a two-week history of dyspnea and fever. Chest imaging showed diffuse pulmonary frosted-glass-like shadows. A blood test revealed positive HIV antibodies with a CD4 cell count of 66/μL. Bronchoalveolar lavage identified pneumocystis. Although the patient exhibited a transient response to anti-pneumocystis treatment and megadose steroid pulse therapy, he eventually died from respiratory failure. An autopsy suggested massive cytomegalovirus and pneumocystis pneumonitis. The pulmonary co-infection with cytomegalovirus may have been worsened by the use of mega-dose steroids, and such therapy should be avoided in patients with a high HIV viral load and low CD4 count.

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Section: Discussionmentioning

confidence: 99%

Fatal Pulmonary Co-infection with Pneumocystis and Cytomegalovirus in a Patient with Acquired Immunodeficiency Syndrome

et al. 2014

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“…42,43 Despite these findings, pneumonitis is a rare clinical feature of CMV disease in this population when compared with other CMV-related clinical complications such as retinitis, gastroenteritis and encephalomyelitis. Moreover, even in the rare cases, the decisive contribution of CMV to clinically significant pneumonitis in HIV infection has been questioned.…”

Section: Cytomegalovirus Pneumonitis In Hiv Infectionmentioning

confidence: 95%

“…42,46 One of the potentially disturbing predictions of the immunopathological hypothesis was that the reconstitution of immune responses in HIV infection should lead to an increasing rather than decreasing incidence of significant CMV-P. 1 Indeed, highly active anti-retroviral therapy (HAART) has been successfully introduced to recover immune reactivity to a variety of recall antigens and infectious agents, 47,48 but there have been no reported cases of clinical pneumonitis developing after the introduction of HAART as yet. This is somewhat surprising as HAART has been shown to occasionally lead to a significant clinical deterioration in patients with Mycobacterium tuberculosis, [49][50][51] Mycobacterium avium intracellulari infection 52,53 and with CMV retinitis.…”

Section: Cytomegalovirus Pneumonitis In Hiv Infectionmentioning

confidence: 99%

Cytopathology or immunopathology? The puzzle of cytomegalovirus pneumonitis revisited

Barry

Jánossy

2000

Bone Marrow Transplant

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Summary:Various hypotheses have been proposed to explain why cytomegalovirus pneumonitis (CMV-P) is frequent and severe in bone marrow transplant patients while remaining rare and mild in HIV infected patients. One hypothesis suggests that CMV-P is an immunopathological condition that is common in bone marrow transplantation (BMT) under the effects of an abnormally regenerating immune system that reacts against CMV infected lung tissue. Such a hypothesis implicates CD4 T lymphocytes as one of the critical cell populations involved in immunopathology and also suggests that this process would be aborted by CD4 T cell deficiency in HIV infection. However, studies correlating the onset of CMV-P with lymphocyte reconstitution following BMT have revealed that CD4 cells are present at very low frequencies in the blood during the early period after transplantation when most cases of CMV-P occur. Furthermore, studies directly investigating bronchoalveolar lavage cell types during episodes of CMV-P in BMT patients have also failed to demonstrate significant CD4 involvement and, instead, have emphasized a predominance of natural killer (NK) cells and CD8 cells. These findings serve as the basis for questioning the validity of a CD4-driven immunopathological model of CMV-P in BMT. On the other hand, a variety of experimental and clinical observations support the protective role of CMV-specific CD3 + CD8 T lymphocytes against CMV in both immunocompetent individuals and BMT patients. In a murine BMT model, adoptive transfer of syngeneic BM cells was associated with massive increases in lung CD8 cells which resulted in the resolution rather than the exacerbation of existing CMV-P. In the light of these findings a more plausible hypothesis for CMV-P in BMT is that during the early period after transplantation adequate protective CD8 responses are absent and an uncontrolled CMV proliferation is allowed to develop. Once a critical viral load is reached a cytokine 'storm' may be triggered in the lung tissue that aggravates direct CMV-associated cytopathic

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“…Cytomegalovirus (CMV) is the most common viral pathogen to cause morbidity and mortality in patients with AIDS [41,42]. Although commonly recovered from the lungs of AIDS patients at autopsy and isolated from bronchial washings or biopsy samples, the presence of CMV does not necessarily indicate clinical infection.…”

Section: Viral Infectionsmentioning

confidence: 99%

Computed tomography of the thorax in HIV disease

Padley

King

1999

European Radiology

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A wide variety of thoracic disorders can arise in patients infected with the human immunodeficiency virus (HIV), although recent developments in the therapeutic management of AIDS patients has resulted in a changing pattern of chest disease. The use of CT in the diagnosis and management of these thoracic manifestations is discussed along with the CT appearances of the various infectious and non-infectious complications of the acquired immune deficiency syndrome (AIDS) which are commonly encountered in clinical practice.

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Cytomegalovirus Pneumonitis in Patients with AIDS

Cited by 108 publications

References 15 publications

Fatal Pulmonary Co-infection with Pneumocystis and Cytomegalovirus in a Patient with Acquired Immunodeficiency Syndrome

Fatal Pulmonary Co-infection with Pneumocystis and Cytomegalovirus in a Patient with Acquired Immunodeficiency Syndrome

Cytopathology or immunopathology? The puzzle of cytomegalovirus pneumonitis revisited

Computed tomography of the thorax in HIV disease

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