CYTOMEGALOVIRUS - AN UNEXPECTED CAUSE OF VENTILATOR-ASSOCIATED PNEUMONIA

Background: Cytomegalovirus (CMV) frequently is observed in immunocomp romised hosts. The aim of this study was to report cases of ventilator -associated CMV pneumonia diagnosed by pathologic examination in inten sive care patients without acquired immunodeficiency syndrome or hemat ologic malignancy or who were not receiving immunosuppressive agents. Methods: From June 1, 1989, to May 31, 1994, 2,785 patients were hospi talized. During the study period, 60 autopsies and 26 open-lung biopsi es were performed in nonimmunocompromised patients who were seen with acute respiratory failure and/or symptoms suggestive of ventilator-ass ociated pneumonia. Cytomegalovirus pneumonia was diagnosed using pulmo nary samples by the identification of large cells with large nuclei co ntaining a basophilic or eosinophilic inclusion surrounded by a light halo. These typical findings always were associated with a diffuse int erstitial pneumonitis, Results: Cytomegalovirus pneumonia was diagnose d after histologic examination in 25 patients. The reason for admissio n to the intensive care unit was major surgery in 13 patients and medi cal problems in 12 patients. Ventilator-associated CMV pneumonia was d iagnosed by histologic examination 22.4 +/- 8.8 days after admission t o the intensive care unit (median 18 days; range 10-40 days). The clin ical description was similar with the 25 patients who were seen with v entilator-associated CMV pneumonia and the 61 patients without ventila tor-associated CMV pneumonia. However, there was a more severe hypoxem ia (72 +/- 16 vs, 95 +/- 41 mm Hg, P < 0.05) and a higher Weinberg's r adiologic score (9.2 +/- 1.9 vs. 7.4 +/- 2.7, P < 0.05) in the ventila tor-associated CMV pneumonia group, Diagnosis of ventilator-associated CMV pneumonia was made for 9 of 17 patients when shell-vial culture t echnique using fluorescein-labeled antibody E 13 was performed on bron choalveolar lavage products. Four of the eight patients treated by gan ciclovir therapy died of multiple organ dysfunction syndrome. Conclusi ons The diagnosis of ventilator-associated CMV pneumonia should not be excluded in intensive care patients, even those without acquired immu nodeficiency syndrome, hematologic malignancy, or immunosuppressive ag ents on admission.