Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands; Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, the Netherlands.
Erasmus University Medical Center, Department of Medical Microbiology & Infectious Diseases, Rotterdam, the Netherlands.
Clin Microbiol Infect. 2022 Oct;28(10):1335-1344. doi: 10.1016/j.cmi.2022.05.034. Epub 2022 Jun 13.
Cytomegalovirus (CMV) infection is a well-recognised complication of solid organ and hematopoietic cell transplantation. However, CMV infection also occurs in patients with human immunodeficiency virus infection, previously immunocompetent intensive care unit patients, and individuals on immunosuppressive medications for various underlying diseases.
This review describes the comparative effects of CMV infection in distinct types of acquired immunosuppression.
Selected peer-reviewed publications on CMV infections published until December 2021.
CMV infection affects various organ systems through direct cytolytic mechanisms but may also exert indirect effects by promoting pro-inflammatory and immunosuppressive responses. This has been well studied in transplant recipients, for whom antiviral prophylaxis and pre-emptive therapy have now become standard practice. These strategies not only prevent direct CMV disease manifestations but also mitigate various immunopathological processes to reduce graft-vs.-host disease, graft rejection, and the occurrence of secondary bacterial and fungal infections. The efficacy of neither prophylactic nor pre-emptive treatment of CMV infection has been demonstrated for patients with critical illness- or medication-induced immunosuppression. Many observational studies have shown an independent association between CMV reactivation and a prolonged duration of mechanical ventilation or increased mortality in the intensive care unit. Furthermore, data suggest that CMV reactivation may increase pulmonary inflammation and prolong the duration of mechanical ventilation.
A large number of observational and experimental studies suggest attributable morbidity and mortality related to CMV infection, not only in transplant recipients and patients with human immunodeficiency virus infection but also in patients with critically illness- or medication-induced immunosuppression. Adequately powered randomised controlled trials investigating the efficacy of prophylaxis or pre-emptive treatment of CMV infection in these patients are lacking, with a notable exception for transplant recipients.
巨细胞病毒（CMV）感染是实体器官和造血细胞移植的一种公认并发症。然而，CMV 感染也发生在人类免疫缺陷病毒感染、以前免疫功能正常的重症监护病房患者以及因各种基础疾病接受免疫抑制药物治疗的个体中。
本综述描述了不同类型获得性免疫抑制中 CMV 感染的比较效果。
截至 2021 年 12 月发表的关于 CMV 感染的精选同行评议出版物。
CMV 感染通过直接细胞溶解机制影响各种器官系统，但也可以通过促进促炎和免疫抑制反应产生间接影响。这在移植受者中得到了很好的研究，目前抗病毒预防和抢先治疗已成为标准做法。这些策略不仅可以预防直接的 CMV 疾病表现，还可以减轻各种免疫病理过程，减少移植物抗宿主病、移植物排斥反应以及继发性细菌和真菌感染的发生。对于因重症疾病或药物引起的免疫抑制的患者，既没有预防性也没有抢先治疗 CMV 感染的疗效得到证实。许多观察性研究表明，CMV 再激活与重症监护病房机械通气时间延长或死亡率增加独立相关。此外，数据表明 CMV 再激活可能增加肺部炎症并延长机械通气时间。
大量观察性和实验性研究表明，CMV 感染与发病率和死亡率有关，不仅在移植受者和人类免疫缺陷病毒感染患者中，而且在因重症疾病或药物引起免疫抑制的患者中也是如此。在这些患者中，缺乏针对 CMV 感染预防或抢先治疗疗效的充分有力的随机对照试验，除了移植受者之外，没有明显的例外。
