Abstract
Cytomegalovirus (CMV) pneumonia causes significant morbidity and mortality in immunocompromised hosts. Incidence rates vary from 1% to 10%, according to the underlying hematologic malignancy. Symptoms include fever, cough, and dyspnea, which can rapidly progress to hypoxia requiring mechanical ventilation. Diagnosis is difficult and requires a compatible clinical picture, radiographic findings, and detection of CMV in bronchoalveolar lavage (BAL) fluid or lung-tissue specimens by culture, cytology, immunohistochemical staining, histopathologic examination, or in situ hybridization. Treatment for CMV pneumonia may include administration of both intravenous ganciclovir and intravenous immunoglobulins, but even with the use of aggressive antiviral therapy, the mortality rate remains high in patients with hematologic malignancies. Antiviral prophylaxis and preventative therapies, however, have been shown to be effective in decreasing the incidence of CMV pneumonia in patients with hematologic malignancies. This chapter focuses on the epidemiologic characteristics, clinical presentation, diagnosis, treatment, and prevention of CMV pneumonia in patients with hematologic malignancies.
This is a preview of subscription content, log in via an institution to check access.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
Boeckh M, Gooley TA, Myerson D et al (1996) Cytomegalovirus pp 65 antigenemia guided early treatment with ganciclovir marrow transplantation: a randomized double blind study. Blood 88:4063–4071
Boeckh M, Leisenring WM, Riddell S et al (2003) Late cytomegalovirus disease and mortality in recipients of allogeneic hematopoietic stem cell transplants: importance of viral load and T-cell immunity. Blood 101:407–414
Bowden RA, Slichter SJ, Sayers MH et al (1991) Use of leukocyte-depleted platelets and cytomegalovirus-seronegative red blood cells for prevention of primary cytomegalovirus infection after marrow transplant. Blood 78:246–250
Cathomas G, Morris P, Pekle K et al (1993) Rapid diagnosis of cytomegalovirus pneumonia in marrow transplant recipients by bronchoalveolar lavage using the polymerase chain reaction, virus culture, and the direct immunostaining of alveolar cells. Blood 81:1909–1914
Chemaly RF, Torres HA, Hachem RY et al (2005) Cytomegalovirus pneumonia in patients with lymphoma. Cancer 104:1213–1220
Chemaly RF, Yen-Lieberman B, Castilla EA et al (2004) Correlation between viral loads of cytomegalovirus in blood and bronchoalveolar lavage specimens from lung transplant recipients determined by histology and immunohistochemistry. J Clin Microbiol 42:2168–2172
Chemaly RF, Yen-Lieberman B, Chapman J et al (2005) Clinical utility of cytomegalovirus viral load in bronchoalveolar lavage in lung transplant recipients. Am J Transplant 5:544–548
Crawford SW, Bowden RA, Hackman RC et al (1988) Rapid detection of cytomegalovirus pulmonary infection by bronchoalveolar lavage and centrifugation culture. Ann Intern Med 108:180–185
de Medeiros CR, Moreira VA, Pasquini R (2000) Cytomegalovirus as a cause of very late interstitial pneumonia after bone marrow transplantation. Bone Marrow Transplant 26:443–444
Demirkazik FB, Akin A, Uzun O et al (2008) CT findings in immunocompromised patients with pulmonary infections. Diagn Interv Radiol 14:75–82
Drew WL (2010) Cytomegalovirus resistance testing: pitfalls and problems for the clinician. Clin Infect Dis 50: 733–736
Einsele H, Ehninger G, Hebart H et al (1995) Polymerase chain reaction monitoring reduces the incidence of cytomegalovirus disease and the duration and side effects of antiviral therapy after bone marrow transplantation. Blood 86: 2815–2820
Emanuel D, Peppard J, Stover D et al (1986) Rapid immunodiagnosis of cytomegalovirus pneumonia by bronchoalveolar lavage using human and murine monoclonal antibodies. Ann Intern Med 104:476–481
Emery V, Sabin C, Cope A et al (2000) Application of viral load kinetics to identify patients who developed cytomegalovirus disease after transplantation. Lancet 355:2032–2036
Enright H, Haake R, Weisdorf D et al (1993) Cytomegalovirus pneumonia after bone marrow transplantation.Risk factors and response to therapy. Transplantation 55:1339–1346
Gasparetto EL, Ono SE, Escuissato D et al (2004) Cytomegalovirus pneumonia after bone marrow transplantation: high resolution CT findings. Br J Radiol 77:724–727
Gleaves CA, Smith TF, Shuster EA et al (1985) Comparison of standard tube and shell vial cell culture techniques for the detection of cytomegalovirus in clinical specimens. J Clin Microbiol 21:217–221
Kim EA, Lee KS, Primack SL et al (2002) Viral pneumonias in adults: radiologic and pathologic findings. Radiographics 22:S137–S149
Ljungman P, Aschan J, Lewensohn-Fuchs I et al (1998) Results of different strategies for reducing cytomegalovirus-associated mortality in allogeneic stem cell transplant recipients. Transplantation 66:1330–1334
Ljungman P, Griffiths P, Paya C (2002) Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis 34:1094–1097
Machado CM, Dulley FL, Boas LS et al (2000) CMV pneumonia in allogeneic BMT recipients undergoing early treatment of pre-emptive ganciclovir therapy. Bone Marrow Transplant 26:413–417
Meyers JD, Flournoy N, Thomas ED (1986) Risk factors for cytomegalovirus infection after human marrow transplantation. J Infect Dis 153:478–488
Meyers JD, Ljungman P, Fisher LD (1990) Cytomegalovirus excretion as a predictor of cytomegalovirus disease after marrow transplantation: importance of cytomegalovirus viremia. J Infect Dis 162:373–380
Nakamura R, Battiwalla M, Solomon S et al (2004) Persisting posttransplantation cytomegalovirus antigenemia correlates with poor lymphocyte proliferation to cytomegalovirus antigen and predicts for increased late relapse and treatment failure. Biol Blood Marrow Transplant 10:49–57
Nguyen Q, Estey E, Raad I et al (2001) Cytomegalovirus pneumonia in adults with leukemia: an emerging problem. Clin Infect Dis 32:539–545
Nichols WG, Corey L, Gooley T et al (2001) Rising pp 65 antigenemia during preemptive anticytomegalovirus therapy after allogeneic hematopoietic stem cell transplantation: risk factors, correlation with DNA load, and outcomes. Blood 97:867–874
Reusser P (2002) Management of viral infections in immunocompromised cancer patients. Swiss Med Wkly 132: 374–378
Staras SA, Dollard SC, Radford KW et al (2006) Seroprevalence of cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis 43:1143–1151
Torres HA, Aguilera E, Safdar A et al (2008) Fatal cytomegalovirus pneumonia in patients with hematologic malignancies: an autopsy-based case-control study. Clin Microbiol Infect 14:1160–1166
Torres HA, Kontoyiannis DP, Aguilera EA et al (2006) Cytomegalovirus infection in patients with lymphoma: an important cause of morbidity and mortality. Clin Lymphoma Myeloma 6:393–398
Wingard JR, Chen DY, Burns WH et al (1988) Cytomegalovirus infection after autologous bone marrow transplantation with comparison to infection after allogeneic bone marrow transplantation. Blood 71:1432–1437
Winston DJ, Young JA, Pullarkat V (2008) Maribavir prophylaxis for prevention of cytomegalovirus infection in allogeneic stem cell transplant recipients: a multicenter, randomized, double-blind, placebo-controlled, dose-ranging study. Blood 111:5403–5410
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2011 Springer-Verlag Berlin Heidelberg
About this chapter
Cite this chapter
Vigil, K.J., Chemaly, R.F. (2011). Cytomegalovirus Pneumonia in Patients with Hematologic Malignancies. In: Azoulay, E. (eds) Pulmonary Involvement in Patients with Hematological Malignancies. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-15742-4_23
Download citation
DOI: https://doi.org/10.1007/978-3-642-15742-4_23
Published:
Publisher Name: Springer, Berlin, Heidelberg
Print ISBN: 978-3-642-15741-7
Online ISBN: 978-3-642-15742-4
eBook Packages: MedicineMedicine (R0)