Community-acquired pneumonia associated with cytomegalovirus persistence: prevalence and peculiarities of clinical course

Authors

  • K. D. Chichirelo-Konstantynovych National Pirogov Memorial Medical University, Vinnytsia, Ukraine,

DOI:

https://doi.org/10.14739/2310-1210.2018.3.132125

Keywords:

cytomegalovirus, pneumonia, PORT, antibodies

Abstract

The article discusses the problem of cytomegaloviral persistence asymptomatic course among young patients with community-acquired pneumonia and in healthy population group based on specific immunoglobulins M and G appearance in blood and antibody avidity value (the duration of persistent). The connection between viral persistence and prognosis of community-acquired pneumonia course (by pneumonia severity index in PORT) is also recognized.

Aim of the scientific work is to study the prevalence of cytomegaloviral persistence among young patients with community-acquired pneumonia for optimization the plan of clinical examination and prognosis for this patient category.

Materials and methods. One hundred and five patients with community-acquired pneumonia and 61 healthy individuals (aged from 18 to 44 years) were examined for cytomegaloviral biomarkers (CMV IgG, CMV IgG avidity) and by PORT-scale. Positive result for viral persistence was compared with gender, age subtypes and pneumonia severity index in both groups.

Results. Cytomegaloviral persistence prevalence rate among patients with community-acquired pneumonia was 48.2 % versus 20.5 % among healthy individuals (p = 0.003). The patients with community-acquired pneumonia had higher CMV IgG avidity value (p = 0.007), it was more common for female patients (P = 0.043; χ2 = 8.164). The cytomegaloviral persistence prevalence increased with age (P = 0,045) and correlated with pneumonia severity index according to PORT-scale (P < 0.0001).

Conclusions. The patients with community-acquired pneumonia differ in significantly higher cytomegaloviral prevalence rate (P = 0.003) from the healthy respondents. This rate increases with age, negatively impacts the pneumonia prognosis (by PORT-score). The duration of cytomegaloviral persistence (based on the CMV IgG avidity value recognition) does not depend on age in both comparison groups (P > 0.05).

References

Bao, L., Cowan, M., Dunham, K., Horn, B., McGuirk, J., Gilman, A., & Lucas, K. (2012). Adoptive Immunotherapy With CMV-specific Cytotoxic T Lymphocytes for Stem Cell Transplant Patients With Refractory CMV Infections. Journal Of Immunotherapy, 35(3), 293–298. doi: 10.1097/CJI.0b013e31824300a2.

Cook, C., Trgovcich, J., Zimmerman, P., Zhang, Y., & Sedmak, D. (2006). Lipopolysaccharide, Tumor Necrosis Factor Alpha, or Interleukin-1 Triggers Reactivation of Latent Cytomegalovirus in Immunocompetent Mice. Journal Of Virology, 80(18), 9151–9158. doi: 10.1128/JVI.00216-06.

Chalmers, J., Singanayagam, A., Akram, A., Mandal, P., Short, P., Choudhury, G., et al. (2010). Severity assessment tools for predicting mortality in hospitalised patients with community-acquired pneumonia. Systematic review and meta-analysis. Thorax, 65(10), 878–883. doi: 10.1136/thx.2009.133280.

Eguchi, H., Horita, N., Ushio, R., Kato, I., Nakajima, Y., Ota, E., & Kaneko, T. (2017). Diagnostic test accuracy of antigenaemia assay for PCR-proven cytomegalovirus infection-systematic review and meta-analysis. Clinical Microbiology And Infection., 23(12), 907–915. doi: 10.1016/j.cmi.2017.05.009.

Feshchenko, Yu. I., Holubovska, O. A., & Honcharov, K. A. (2014). Nehospitalna ta hospitalna (nozokomialna) pnevmoniia u doroslykh osib: etiolohiia, patohenez, klasyfikatsiia, diahnostyka, antybakterialna terapiia [Community-acquired and nosocomial pneumonia in adults: etiology, pathogenesis, classification, diagnostics, antibiotic therapy]. Kyiv. [in Ukrainian].

Goussard, P., Kling, S., Gie, R., Nel, E., Heyns, L., Rossouw, G., & Janson, J. (2010). CMV pneumonia in HIV-infected ventilated infants. Pediatric Pulmonology, 45(7), 650–655. doi: 10.1002/ppul.21228.

Lim, W. S., Baudouin, S. V., George, R. C., Hill, A. T., Jamieson, C., Le Jeune, I., et al. (2009). British Thoracic Society guidelines for the management of community acquired pneumonia in adults: update 2009. Thorax, 35(3), 293–298. doi: 10.1136/thx.2009.121434.

Palasanthiran, P., Starr, M., & Jones, C. (2014). Management of Perinatal Infections Australian Society for Infectious Diseases, 6–10.

Quan, T., Fawcett, N., Wrightson, J., Finney, J., Wyllie, D., Jeffery, K. et al. (2016). Increasing burden of community-acquired pneumonia leading to hospitalisation, 1998–2014. Thorax, 71(6), 535–542. doi: 10.1136/thoraxjnl-2015-207688.

Reeves, M., & Sinclair, J. (2008). Aspects of human cytomegalovirus latency and reactivation. Curr. Top. Microbiol. Immunol., 325, 297–313. https://doi.org/10.1007/978-3-540-77349-8_17.

Saletinger, R., Poljak, P., & Strle, F. (2015). Presence of human cytomegalovirus DNA in blood of patients with community-acquired pneumonia. Clinical Microbiology and Infection, 21(1), 97–102. doi: 10.1016/j.cmi.2014.09.001.

Tang, L., Li, Q., Bai, J., Zhang, H., Lu, Y., & Ma, S. (2014). Severe Pneumonia Mortality in Elderly Patients Is Associated With Downregulation of Toll-like Receptors 2 and 4 on Monocytes. The American Journal Of The Medical Sciences, 347(1), 34–41. doi: 10.1097/MAJ.0b013e3182798583.

Toussaint, N., Tan, M., Nicholls, K., Walker, R., & Cohney, S. (2011). Low-dose valaciclovir and cytomegalovirus immunoglobulin to prevent cytomegalovirus disease in high-risk renal transplant recipients. Nephrology, 16(1), 113–117. doi: 10.1111/j.1440-1797.2010.01379.x.

Welten, S. P. M., Redeker, A., Toes, R. E. M., & Arens, R. (2016) Viral Persistence Induces Antibody Inflation without Altering Antibody Avidity. Journal of Virology, 90(9), 4402–4411. doi: 10.1128/JVI.03177-15.

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1.
Chichirelo-Konstantynovych KD. Community-acquired pneumonia associated with cytomegalovirus persistence: prevalence and peculiarities of clinical course. Zaporozhye Medical Journal [Internet]. 2018May30 [cited 2024Dec.23];(3). Available from: http://zmj.zsmu.edu.ua/article/view/132125

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Original research