Published online Jun 18, 2023. doi: 10.13105/wjma.v11.i5.151
Peer-review started: January 9, 2023
First decision: February 20, 2023
Revised: April 8, 2023
Accepted: June 9, 2023
Article in press: June 9, 2023
Published online: June 18, 2023
Cytomegalovirus (CMV) is a DNA virus that can cause severe disease in immunocompromised patients and is common in recipients of hematopoietic stem cell transplantation. CMV is acquired through direct contact with infected cells or body fluids, and transmission can occur from a CMV-seropositive donor organ. Congenital CMV, transmitted from infected mothers to their newborns, is a leading cause of miscarriage. CMV is one of the three most common causes of severe viral community-acquired pneumonia, but this has changed with the emergence of severe acute respiratory syndrome coronavirus 2 in 2020.
During the COVID-19 pandemic, it is important to differentiate clinical and radiological presentations from other diseases. Ground-glass opacities (GGOs) require evaluation along with other tests to reach a diagnosis. To diagnose CMV pneumonia, the virus can be detected in serum or respiratory samples, and quantitative real-time PCR can measure viral loads in blood and BAL fluid. Lung biopsy histopathology is the gold standard for diagnosing pulmonary CMV infections. However, the diagnostic yield of lung biopsy varies, and the study of CMV pneumonia in immunocompetent patients with GGOs remains limited.
This study aimed to report a case of CMV pneumonia in an immunocompetent patient with GGOs on chest CT, to review the literature on the clinical, radiological, and laboratory features of CMV pneumonia in immunocompetent hosts, and to discuss the diagnostic workup and management of CMV pneumonia.
This study followed PRISMA guidelines to identify case reports and case series studies on pulmonary complications of CMV infection. The selection criteria included studies that reported only CMV pneumonia without other co-existing causes of pneumonia. Data extraction involved identifying the characteristics of the subjects and the outcomes measured. The patient case report presented in the article was included in the study as it met the inclusion criteria, and the patient received ganciclovir therapy resulting in complete recovery from symptoms and sustained undetectable viral load after 6 wk of treatment.
The study found 45 case reports of pulmonary CMV infection after analyzing 435 references. The majority of the patients were males (58%) in the age group of 16-45 years (55.6%). Common symptoms included fever, dyspnea, and cough, with respiratory distress observed in 58% of the cases. Most patients (64%) were immunocompromised. Radiographic findings were reported in 71% of the patients, and blood/serum was the most commonly used method for diagnosis. Treatment was reported in 84% of the cases, with a high recovery rate of 89%, but the mortality rate was 9%. Early diagnosis and prompt treatment are crucial to improve outcomes and reduce mortality rates, especially in immunocompromised individuals.
The study analyzed 45 cases of CMV-induced pneumonia and found that it can occur in both immunocompetent and immunocompromised patients, with clinical findings of fever, dyspnea, cough, and respiratory distress. Radiological findings showed bilateral diffuse pulmonary infiltrates and bilateral GGOs. Blood serology was positive for CMV, and antiviral treatment was given with a successful outcome. The recovery rate was high, but four deaths were reported, with three among immunocompromised patients.
Future studies can investigate the prevalence of CMV pneumonia in different age groups and genders, and the possible link between CMV and COVID-19. The effectiveness of antiviral therapy in preventing severe CMV illness and the optimal duration of treatment can be evaluated. Pathophysiology and immunology of CMV pneumonia in immunocompromised patients need further research.