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CMV pneumonia

Pneumonia - cytomegalovirus; Cytomegalovirus pneumonia; Viral pneumonia

 

Cytomegalovirus (CMV) pneumonia is an infection of the lungs that can occur in people who have a suppressed immune system.

Causes

 

CMV pneumonia is caused by a member of a group of herpes-type viruses. Infection with CMV is very common. Most people are exposed to CMV in their lifetime, but typically only those with weakened immune systems become ill from CMV infection.

Serious CMV infections can occur in people with weakened immune systems as a result of:

  • HIV/AIDS
  • Bone marrow transplant
  • Chemotherapy or other treatments that suppress the immune system
  • Organ transplant

In people who have had organ and bone marrow transplants, the risk of infection is greatest 5 to 13 weeks after the transplant.

 

Symptoms

 

In otherwise healthy people, CMV usually produces no symptoms, or it produces a temporary mononucleosis-type illness. However, those with a weakened immune system can develop serious symptoms. Symptoms may include:

  • Cough
  • Fatigue
  • Fever
  • General discomfort, uneasiness, or ill feeling (malaise)
  • Loss of appetite
  • Muscle aches or joint pains
  • Shortness of breath
  • Sweating, excessive (night sweats)

 

Exams and Tests

 

The doctor or nurse will perform a physical exam. In addition, the following tests may be done:

  • Arterial blood gas
  • Blood culture
  • Blood tests to detect and measure substances specific to CMV infection
  • Bronchoscopy (may include biopsy)
  • Chest x-ray
  • CT scan of chest
  • Urine culture (clean catch)
  • Sputum gram stain and culture

 

Treatment

 

The goal of treatment is to use antiviral drugs to stop the virus from copying itself in the body. Some people with CMV pneumonia need IV (intravenous) medicines. Some people may need oxygen therapy and breathing support with a ventilator to maintain oxygen until the infection is brought under control.

 

Outlook (Prognosis)

 

Antiviral drugs stop the virus from copying itself, but do not destroy it. The CMV suppresses the immune system, and may increase your risk of other infections.

Low oxygen levels in the blood in people with CMV pneumonia often predicts death, especially in those who need to be placed on a breathing machine.

 

Possible Complications

 

Complications of CMV infection in people with HIV/AIDS include spread of disease to other parts of the body, such as the esophagus, intestine, or eye.

Complications of CMV pneumonia include:

  • Kidney impairment (from drugs used to treat the condition)
  • Low white blood cell count (from drugs used to treat the condition)
  • Overwhelming infection that doesn't respond to treatment
  • Return of CMV infections (may be due to the virus becoming resistant to the antiviral drug)

 

When to Contact a Medical Professional

 

Call your health care provider if you have symptoms of CMV pneumonia.

 

Prevention

 

The following have been shown to help prevent CMV pneumonia in certain people:

  • Using organ transplant donors who don't have CMV
  • Using CMV-negative blood products for transfusion
  • Using CMV-immune globulin in certain people

Preventing HIV/AIDS avoids certain other diseases, including CMV, that can occur in people who have a weakened immune system.

 

 

References

Crothers K, Morris A, Huang L. Pulmonary complications of HIV infection. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 90.

Crumpacker CS. Cytomegalovirus (CMV). In: Bennett JE, Dolin R, Blaser MJ, eds. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders; 2015:chap 140.

Madtes DK. Pulmonary complications of stem cell and solid organ transplantation. In: Broaddus VC, Mason RJ, Ernst JD, et al, eds. Murray and Nadel's Textbook of Respiratory Medicine. 6th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 91.

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  • CMV pneumonia

    CMV pneumonia

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  • CMV (cytomegalovirus)

    CMV (cytomegalovirus)

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    • CMV pneumonia

      CMV pneumonia

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    • CMV (cytomegalovirus)

      CMV (cytomegalovirus)

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        Tests for CMV pneumonia

         
           

          Review Date: 12/10/2015

          Reviewed By: Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School; Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital, Boston, MA. Also reviewed by David Zieve, MD, MHA, Isla Ogilvie, PhD, and the A.D.A.M. Editorial team.

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