Cytomegalovirus pneumonia in hematopoietic stem cell recipients

Abstract

Cytomegalovirus (CMV) is a frequently encountered infection following hematopoietic cell transplantation, and tissue invasive pneumonia is a dreaded complication of the virus in this population. In this review of CMV pneumonia, we address epidemiology, pathogenesis, diagnostics, current therapy, and strategies to prevent the development of CMV. We also review emerging treatment and prevention options for this challenging disease.

Keywords: CMV pneumonia; antiviral; cytomegalovirus; hematopoietic cell transplant; prevention.

Figure 1. Methods Used to Diagnose CMV Pneumonia

In order to make a diagnosis of patients must have signs and/or symptoms of pulmonary disease combined with the detection of CMV in bronchoalveolar lavage fluid or lung tissue samples. Detection of CMV can be by any one of the methods described in this figure. *A positive PCR test is not considered diagnostic by current guidelines, but is nonetheless used at many centers for diagnosis of CMV pneumonia. Abbreviations: CMV, cytomegalovirus; DFA, direct fluorescent antigen; PCR, polymerase chain reaction.

Figure 2. Radiographic Findings of CMV Pneumonia

A 45 y/o female 34 days post-hematopoietic cell transplantation with CMV pneumonia. Anterior posterior chest radiograph demonstrates a diffuse interstitial process consistent with viral pneumonia.