Virological and immunological features of active cytomegalovirus infection in nonimmunosuppressed patients in a surgical and trauma intensive care unit

Abstract

Cytomegalovirus (CMV) reactivation occurs frequently in critically ill patients. The natural course of CMV infection and the interaction between CMV and the adaptive immune system in this setting remain poorly defined. Fifty‐three CMV‐seropositive patients in a surgical and trauma intensive care unit were included in this study. The CMV DNA load in tracheal aspirates (TA) and plasma (PL) was monitored by qPCR. CMV‐specific T‐cell immunity was assessed by intracellular cytokine staining. Plasma TNF‐α levels were determined by ELISA. CMV reactivation occurred in 39.7% of patients (23% had CMV DNA detected only in TA). The analysis of TA allowed an earlier diagnosis in 28% of patients. Clearance of CMV DNAemia preceded that of CMV DNA in TA in some episodes. Peak CMV DNA levels were significantly higher in TA than in PL (P = 0.02). CMV reactivation developed in the presence of CMV‐specific T cells. Termination of CMV reactivation was associated with an expansion of functional CMV‐specific T cells. Plasma levels of TNF‐α did not allow for the prediction of the occurrence of CMV reactivation. CMV‐specific T‐cell immunity is preserved in most critically ill patients experiencing CMV reactivation. Analysis of respiratory specimens is imperative for an optimal monitoring of CMV reactivation in this setting. J. Med. Virol. 82:1384–1391, 2010. © 2010 Wiley‐Liss, Inc.

Prevalence of Human Herpes Viruses in Bronchoalveolar Lavage of Critically Ill Children Undergoing Mechanical Ventilation at a Pediatric Intensive Care Unit

“…Based on the author's knowledge, this high prevalence of HHV6 among HHVs is not reported by other prospective studies on ventilated pediatric patients at the PICU. Although there was no significant differences between clinical outcome (mortality) in VAP+/HHV+ and VAP+/HHVgroups (P value: 0.326), yet patients with positive HHVs had greater mortality (24.7%), which is in agreement with previous reports (13,21,(41)(42)(43)(44)(45). On the other hand, patients with VAP (+) had a greater chance of HHVs positivity (36.8%) than VAP (-) patients (18.7%) (P value = 0.124) (34).…”

Cytomegalovirus reactivation in ICU patients

“…However, in another study using different immunological methods, active CMV infection was reported in septic shock patients despite detectable levels of CMV-specific IFN-c-producing CD4? T cell precursors in blood, suggesting that CMV reactivation is not primarily triggered by T cell immunosuppression [22]. CMV-specific T cell immunity (CD4?)…”

Presence of human cytomegalovirus DNA in blood of patients with community-acquired pneumonia

“…This heterogeneity makes interpretation of the distinct proportions of patients with HCMV presence found in these studies (from 8.3% to 55.2%) difficult. In four studies in which identical approaches for detection of HCMV (real-time PCR) were used for equivalent specimens as in our study, HCMV DNA was demonstrated in 8.3% to 33% of patients in plasma and in 55.2% of patients in blood [5,7,10,12]. Even comparison of these results may be biased by distinct sensitivities (and specificities) of the assays used in individual study.…”

“…In the last decade the role of serious infections in activation of latent HCMV infection in immunocompetent patients also is being scrutinised. The studies comprised critically ill patients treated at intensive care units (ICU) [4][5][6][7][8][9][10].…”