What intensivists need to know about cytomegalovirus infection in immunocompromised ICU patients

IF 27.1 1区 医学 Q1 CRITICAL CARE MEDICINE
Sara Fernández, Pedro Castro, Elie Azoulay
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引用次数: 0

Abstract

Purpose

Advances in therapeutic care are leading to an increase in the number of patients living with overt immunosuppression. These patients are at risk of cytomegalovirus (CMV) infection and disease that can lead to or develop during ICU admission. This manuscript aims to describe the clinical presentation, risk factors, and management of CMV infection and disease in this patient population.

Methods

We conducted a literature search in PubMed up to April 2024, focusing on CMV infection and disease in patients with overt immunosuppression (hematopoietic stem cell and solid organ transplantation, solid or hematologic malignancies, HIV infection, immunosuppressive drugs, including corticosteroids, and primary immunodeficiencies) admitted to the intensive care unit (ICU). As there is limited ICU-specific data on CMV in immunosuppressed patients, many of the findings were extrapolated from the general literature.

Results

CMV infection and disease in immunocompromised critically ill patients is associated with increased mortality and presents significant management challenges. Clinical manifestations are diverse, shaped by the underlying immune deficiency and primary disease. Pneumonia and encephalitis are among the most severe CMV end-organ diseases. CMV infection may also increase the risk of secondary infections and induce life-threatening conditions, such as thrombotic microangiopathy. Importantly, CMV reactivation is not synonymous with CMV disease, and qPCR testing of body fluids cannot reliably differentiate between viral shedding and tissue-invasive infection, which requires histopathological confirmation. Ganciclovir is commonly the first-line anti-viral, though maribavir shows potential for patients unresponsive to other antivirals. Identifying patients who require prophylactic or preemptive antiviral therapy is essential.

Conclusions

CMV infection and disease in critically ill immunocompromised patients pose a unique challenge for intensivists. The broad spectrum of clinical presentations and the difficulty in distinguishing CMV-related symptoms from other causes require a high level of clinical suspicion. Accurate interpretation of nucleic acid load levels and careful evaluation of CMV’s pathogenic role when it is found are critical. Further studies focusing specifically on CMV infection and disease in critically ill immunocompromised patients are needed to optimize management strategies.

对于免疫功能低下的ICU患者巨细胞病毒感染,重症监护医师需要了解什么
目的治疗护理的进步导致明显免疫抑制患者数量的增加。这些患者有巨细胞病毒(CMV)感染和疾病的风险,可能导致或在ICU住院期间发展。本文的目的是描述临床表现,危险因素,和管理巨细胞病毒感染和疾病在这一患者群体。方法:我们在PubMed检索了截至2024年4月的文献,重点研究了重症监护病房(ICU)住院的明显免疫抑制(造血干细胞和实体器官移植、实体或血液恶性肿瘤、HIV感染、免疫抑制药物(包括皮质类固醇)和原发性免疫缺陷)患者的巨细胞病毒感染和疾病。由于免疫抑制患者CMV的icu特异性数据有限,许多发现是从一般文献中推断出来的。结果免疫功能低下的危重患者的scmv感染和疾病与死亡率增加相关,并提出了重大的管理挑战。临床表现多样,受潜在免疫缺陷和原发疾病的影响。肺炎和脑炎是最严重的巨细胞病毒终末器官疾病。巨细胞病毒感染也可能增加继发感染的风险,并诱发危及生命的疾病,如血栓性微血管病。重要的是,巨细胞病毒再激活并不是巨细胞病毒疾病的同义词,体液的qPCR检测不能可靠地区分病毒脱落和组织侵袭性感染,这需要组织病理学证实。更昔洛韦通常是一线抗病毒药物,尽管马里巴韦对其他抗病毒药物无反应的患者有潜力。确定需要预防性或预防性抗病毒治疗的患者至关重要。结论免疫功能低下危重症患者的scmv感染和疾病对重症监护医师提出了独特的挑战。广泛的临床表现和难以区分巨细胞病毒相关症状与其他原因需要高度的临床怀疑。准确解释核酸负荷水平和在发现巨细胞病毒时仔细评估其致病作用至关重要。需要进一步研究CMV感染和危重免疫功能低下患者的疾病,以优化管理策略。
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来源期刊
Intensive Care Medicine
Intensive Care Medicine 医学-危重病医学
CiteScore
51.50
自引率
2.80%
发文量
326
审稿时长
1 months
期刊介绍: Intensive Care Medicine is the premier publication platform fostering the communication and exchange of cutting-edge research and ideas within the field of intensive care medicine on a comprehensive scale. Catering to professionals involved in intensive medical care, including intensivists, medical specialists, nurses, and other healthcare professionals, ICM stands as the official journal of The European Society of Intensive Care Medicine. ICM is dedicated to advancing the understanding and practice of intensive care medicine among professionals in Europe and beyond. The journal provides a robust platform for disseminating current research findings and innovative ideas in intensive care medicine. Content published in Intensive Care Medicine encompasses a wide range, including review articles, original research papers, letters, reviews, debates, and more.
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