• Air pollution
• Health
• Lung cancer
• Pathogenesis

• Air Pollutants/analysis
• Air Pollution/adverse effects
• Air Pollution, Indoor/analysis
• Epigenesis, Genetic
• Humans
• Lung Neoplasms/chemically induced
• Particulate Matter/analysis
• Particulate Matter/toxicity
• Polycyclic Aromatic Hydrocarbons/analysis
• Polycyclic Aromatic Hydrocarbons/toxicity

Cytomegalovirus (CMV) is a linear double-stranded DNA virus that may cause severe and potentially fatal infection in immunocompromised hosts. In immunocompetent individuals, the infection is typically mild or asymptomatic. However, in the last years, some cases of severe cytomegalovirus infection in immunocompetent individuals have been described. Clinical Presentation. The authors present a male patient aged 42 years, without specific medical history, who presented a 15-day history of fever, headache, night sweats, odynophagia, and bilateral otalgia, without improvement after four days of therapy with amoxicillin/clavulanic acid. Blood count and biochemistry were performed with liver cytolysis pattern. Chest teleradiography showed diffuse interstitial infiltrate. Thoracic CT scan revealed areas in a ground glass with a cross-linking component in the left and right upper lung lobes compatible with an inflammatory/infectious process. Blood serology was positive for CMV IgG and IgM. The detection on blood and bronchoalveolar lavage of CMV DNA by polymerase chain reaction (PCR) was also positive. Ganciclovir was started based on the clinical features and the result of CMV serology. After 48 hours, there was a significant clinical improvement, with remission of fever, and he was discharged on the 13th day of hospitalization with oral valganciclovir, completing a 21-day antiviral course at home.

With this clinical case, the authors highlight the importance of considering CMV infection in evaluating patients with pneumonia, even in immunocompetent ones, particularly in those with no clinical improvement with antibiotics instituted for bacterial pneumonia, and when other causes have been ruled out.

• atypical
• cytomegalovirus
• immunotherapy
• pseudotumor
• transplant
• tumor mimic

• Cytomegalovirus
• Cytomegalovirus Infections
• Humans
• Immunocompromised Host

• Adrenal gland
• Cytomegalovirus
• Disseminated infection
• Hematologic malignancy
• Pseudotumor

• pneumonia (infectious disease)
• pneumonia (respiratory medicine)
• respiratory medicine

Cytomegalovirus (CMV) infection in healthy adults is usually asymptomatic or causes a mild mononucleosis syndrome, while severe infections are rare in immunocompetent patients and poorly documented. When described, gastrointestinal tract and the central nervous systems are the most frequent sites of severe CMV infection. Lung disease can occur, but it’s rare.

A 29 years old man presenting with a 2-weeks history of fever, headache, malaise, dry non-productive cough and thoracic pleuritic pain, without improvement after one-week therapy with levofloxacin. Blood exams showed lymphocytosis of almost 50%, nine percent of atypical lymphocytes and elevated transaminases. Thoracic CT-scan showed bilateral infiltrate with internal air bronchogram. Blood serology showed positivity for CMV IgG and IgM, with low CMV IgG avidity. Serum and bronchoalveolar detection of CMV by polymerase chain reaction (PCR) technique was also positive. Cultures were all negative. The patient became increasingly hypoxemic and the liver transaminases worsening, the reason for which ganciclovir was started. He made a full recovery and was discharged seven days later with oral valganciclovir, completing a 3 weeks antiviral course at home.

CMV pneumonia is a rare condition, however it’s one of the three most common cause of severe viral community acquired pneumonia (CAP), along with influenza and adenovirus. CMV pneumonia should be considered in patients with atypical lymphocytes and mildly elevated serum transaminases.

In immunocompetent hosts, even with severe CMV-CAP, the prognosis is good. However, antiviral treatment should be considered in the rare occasion of severe CMV infection. Nevertheless, more studies are needed to clarify the clinical benefit of antiviral treatment.

• Citomegalovirus
• Immunocompetent host
• Viral pneumonia

• Lung cancer
• dermatofibrosarcoma
• infection
• tuberculosis (TB)

• Aged
• Cytomegalovirus Infections/complications
• Cytomegalovirus Infections/diagnosis
• Cytomegalovirus Infections/microbiology
• Diagnosis, Differential
• Humans
• Lung/diagnostic imaging
• Lung/microbiology
• Lung/virology
• Lung Diseases, Interstitial/diagnosis
• Lung Diseases, Interstitial/microbiology
• Lung Diseases, Interstitial/virology
• Male
• Nocardia/isolation & purification
• Nocardia Infections/complications
• Nocardia Infections/diagnosis
• Nocardia Infections/virology
• Radiography

Respiratory viral infections are one of the leading causes of morbidity and mortality, particularly in children, the elderly and immunocompromised persons. Rapid identification of viral etiology is critical in ruling out non‐viral infections, initiating antiviral treatment and limiting the spread of the infection. Multiplex assays of more than one viral gene target in a single tube have the advantage of rapid screening of a large number of potential viral pathogens in a short time. A multiplex real‐time PCR assay was used in this study for detection of respiratory RNA and DNA viral infections in 728 specimens received from 585 adult and pediatric patients comprised of symptomatic and asymptomatic organ transplant recipients and non‐recipients for diagnosis of respiratory illnesses and for routine clinical monitoring. Multiplex PCR was more sensitive than the multiplex immunofluoresence culture assay (R‐mix) and also detected additional respiratory viruses that were not covered by the R‐mix panel. The number of respiratory viruses detected in symptomatic patients was significantly higher than asymptomatic patients in both adult and pediatric patients. Herpesviral infections were the predominant cause of lower respiratory tract infection in the organ transplant recipients, whereas respiratory syncytial virus was the most common pathogen in non‐transplant patients particularly children. Multiplex real‐time PCR for detection of respiratory viruses has the potential for rapid identification of viral pathogens. In this era of emerging viral infections, addition of newer viral targets to the multiplex PCR panels will be beneficial in determining both patient management and public health epidemiology. J. Med. Virol. 84:162–169, 2011. © 2011 Wiley Periodicals, Inc.

• Antiviral Agents/therapeutic use
• Bronchoalveolar Lavage Fluid/virology
• Cytomegalovirus Infections/diagnostic imaging
• Cytomegalovirus Infections/drug therapy
• Cytomegalovirus Infections/immunology
• Female
• Humans
• Immunocompromised Host
• Immunosuppressive Agents/adverse effects
• Lupus Erythematosus, Systemic/drug therapy
• Middle Aged
• Tomography, X-Ray Computed

• Adult
• Aged
• Biopsy
• Bronchoscopy
• Contrast Media
• Cryptogenic Organizing Pneumonia/diagnostic imaging
• Cryptogenic Organizing Pneumonia/etiology
• Cryptogenic Organizing Pneumonia/pathology
• Cryptogenic Organizing Pneumonia/surgery
• Female
• Humans
• Male
• Middle Aged
• Radiography, Thoracic
• Respiratory Function Tests
• Retrospective Studies
• Risk Factors
• Tomography, X-Ray Computed
• Treatment Outcome

• Aged
• Arthritis, Rheumatoid/complications
• Arthritis, Rheumatoid/diagnostic imaging
• Cytomegalovirus Infections/diagnostic imaging
• Humans
• Immunocompromised Host
• Lung Diseases, Interstitial/complications
• Lung Diseases, Interstitial/diagnostic imaging
• Male
• Opportunistic Infections/complications
• Opportunistic Infections/diagnostic imaging
• Tomography, X-Ray Computed

• Cytomegalovirus Retinitis/diagnosis
• Cytomegalovirus Retinitis/epidemiology
• Cytomegalovirus Retinitis/etiology
• Cytomegalovirus Retinitis/therapy
• Humans

• Cryptogenic Organizing Pneumonia/diagnosis
• Cryptogenic Organizing Pneumonia/drug therapy
• Cryptogenic Organizing Pneumonia/etiology
• Diagnosis, Differential
• Humans
• Risk Factors