1887

Abstract

A young, previously healthy and immunocompetent patient was transferred to our hospital to recover a suspected worm from his gall bladder. Although the diagnosis of infection could not be confirmed, the patient suffered from cholecystitis. To our surprise, the respiratory situation of the patient deteriorated within 24 h under antibiotic therapy and he had to be transferred to the intensive care unit for mechanical respiration. Human cytomegalovirus (HCMV) was isolated directly from a bronchoalveolar lavage (BAL) sample, and DNA was detected by PCR in an enrichment culture of the same BAL sample. Serology for HCMV and clearly supported a primary/post-primary infection for both agents (IgM detection, increase of IgG titres and, in the case of HCMV, a low avidity index of only 22 %). Therefore, we assumed that a rare HCMV and coinfection was the aetiology of the fulminant pneumonia. Under broad antibiotic and antiviral treatment, the situation of the patient improved only very slowly.

Loading

Article metrics loading...

/content/journal/jmm/10.1099/jmm.0.017988-0
2010-08-01
2024-03-29
Loading full text...

Full text loading...

/deliver/fulltext/jmm/59/8/980.html?itemId=/content/journal/jmm/10.1099/jmm.0.017988-0&mimeType=html&fmt=ahah

References

  1. Bartlett J. G., Mundy L. M. 1995; Community-acquired pneumonia. N Engl J Med 333:1618–1624 [CrossRef]
    [Google Scholar]
  2. Clyde W. A. Jr 1993; Clinical overview of typical Mycoplasma pneumoniae infections. Clin Infect Dis 17:S32–S36 [CrossRef]
    [Google Scholar]
  3. Cunha B. A. 2003; Liver involvement with Mycoplasma pneumoniae community-acquired pneumonia. J Clin Microbiol 41:3456–3457 [includes authors’ reply by C. Grüllich and T. F. Baumert Blum] [CrossRef]
    [Google Scholar]
  4. Grüllich C., Baumert T. F., Blum H. E. 2003; Acute Mycoplasma pneumoniae infection presenting as cholestatic hepatitis. J Clin Microbiol 41:514–515 [CrossRef]
    [Google Scholar]
  5. Haddad J. D., John J. F., Pappas A. A. 1984; Cytomegalovirus pneumonia in sickle cell disease. Chest 86:265–266
    [Google Scholar]
  6. Hamprecht K., Maschmann J., Vochem M., Dietz K., Speer C. P., Jahn G. 2001; Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding. Lancet 357:513–518 [CrossRef]
    [Google Scholar]
  7. Hamprecht K., Pfau M., Schaller H. E., Jahn G., Middeldorp J. M., Rennekampff H. O. 2005; Human cytomegalovirus infection of a severe-burn patient: evidence for productive self-limited viral replication in blood and lung. J Clin Microbiol 43:2534–2536 [CrossRef]
    [Google Scholar]
  8. Heininger A., Vogel U., Aepinus C., Hamprecht K. 2000; Disseminated fatal human cytomegalovirus disease after severe trauma. Crit Care Med 28:563–566 [CrossRef]
    [Google Scholar]
  9. Heininger A., Jahn G., Engel C., Notheisen T., Unertl K., Hamprecht K. 2001; Human cytomegalovirus infections in nonimmunosuppressed critically ill patients. Crit Care Med 29:541–547 [CrossRef]
    [Google Scholar]
  10. Ou Z. Y., Zhou R., Wang F. H., Lu J. P., Xia J. Q., Xia H. M., Zhang J. T., Gong S. T., Deng L., other authors H. E. 2008; Retrospective analysis of Mycoplasma pneumoniae infection in pediatric fatal pneumonia in Guangzhou, South China. Clin Pediatr (Phila) 47:791–796 [CrossRef]
    [Google Scholar]
  11. Rafailidis P. I., Mourtzoukou E. G., Varbobitis I. C., Falagas M. E. 2008; Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review. Virol J 5:47 [CrossRef]
    [Google Scholar]
  12. Romero-Gómez M., Otero M. A., Sánchez-Muñoz D., Ramírez-Arcos M., Larraona J. L., Suárez García E., Vargas-Romero J. 2006; Acute hepatitis due to Mycoplasma pneumoniae infection without lung involvement in adult patients. J Hepatol 44:827–828 [CrossRef]
    [Google Scholar]
  13. Schoppel K., Kropff B., Schmidt C., Vornhagen R., Mach M. 1997; The humoral immune response against human cytomegalovirus is characterized by a delayed synthesis of glycoprotein-specific antibodies. J Infect Dis 175:533–544 [CrossRef]
    [Google Scholar]
  14. van der Meer J. T., Drew W. L., Bowden R. A., Galasso G. J., Griffiths P. D., Jabs D. A., Katlama C., Spector S. A., Whitley R. J. 1996; Summary of the International Consensus Symposium on Advances in the Diagnosis, Treatment and Prophylaxis and Cytomegalovirus Infection. Antiviral Res 32:119–140 [CrossRef]
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/jmm/10.1099/jmm.0.017988-0
Loading
/content/journal/jmm/10.1099/jmm.0.017988-0
Loading

Data & Media loading...

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error