acyclovir and Pneumonia

We present a case of a patient with hairy cell leukemia and pulmonary aspergillosis who developed a cycotic pulmonary artery aneurysm despite prolonged antifungal therapy. A review of the literature in regards to incidence, etiology, clinical manifestations and treatment options is included.

Topics: Abscess; Acyclovir; Amphotericin B; Aneurysm, Infected; Anti-Bacterial Agents; Antifungal Agents; Antineoplastic Agents; Antiviral Agents; Aspergillus; Caspofungin; Ceftazidime; Clindamycin; Echinocandins; Fluconazole; Humans; Leukemia, Hairy Cell; Lipopeptides; Male; Middle Aged; Mouth; Ofloxacin; Pneumonia; Pulmonary Artery; Pulmonary Aspergillosis; Valacyclovir; Valine; Vancomycin

A case of pneumonia complicating the course of chickenpox in a previously healthy man is presented. Serious impairment of gas exchange developed, requiring multidisciplinary intensive care management, mechanical ventilation and intravenous acyclovir therapy. Additional complications of hepatitis and pancreatitis occurred. Varicella pneumonia is a potentially life-threatening complication that should be suspected in any adult with chickenpox and respiratory symptoms.

Topics: Acyclovir; Adult; Chickenpox; Humans; Male; Pneumonia

The prevention of cytomegalovirus (CMV) infection in individuals at the highest risk, such as CMV-seronegative recipients of allogeneic bone marrow transplants or of CMV-positive solid organ transplants, involves the use of blood products obtained from CMV-seronegative donors or the use of filtered blood products. In addition, the use of ganciclovir is becoming increasingly important as an early means of preventing serious disease. The options for use of ganciclovir include conventional prophylaxis early after engraftment or preemptive use after documented infection. Evidence is reviewed for selected use of this drug in only the highest-risk subjects to avoid unnecessary adverse effects. The optimal use of ganciclovir in specific patient groups needs to be evaluated, and general recommendations that fit all groups cannot be made at this time. Although the use of intravenous immunoglobulin (IVIG) in transplantation remains controversial, there is increasing evidence to support a recommendation of the use of IVIG as general support for the allogeneic bone marrow transplant recipient and of CMV antibody-enriched immunoglobulin in selected renal transplant recipients. For the treatment of CMV-associated pneumonitis, it is recommended that ganciclovir and IVIG be used in combination for the bone marrow transplant recipient and that ganciclovir be used with or without IVIG in patients in other transplantation groups.

Topics: Acyclovir; Cytomegalovirus Infections; Foscarnet; Ganciclovir; Humans; Immunoglobulins, Intravenous; Lung Diseases, Interstitial; Organ Transplantation; Pneumonia; Transplantation

The authors treated 93 adult patients (83 male, 10 female) with varicella from 1st June 1987 to 30th April 1991. 13 patients had varicella pneumonia, two patients died. Special attention has been focused upon the diagnostic and prognostic problems, including bacterial superinfection. Authors stress the importance of the early diagnosis and treatment and discuss in detail the recent therapeutical and prophylactic opportunities.

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Male; Pneumonia

Topics: Acyclovir; Anti-Bacterial Agents; Anti-Infective Agents; Antifungal Agents; Antiprotozoal Agents; Blood Transfusion; Bone Marrow Transplantation; Cytomegalovirus Infections; Drug Therapy, Combination; Graft vs Host Disease; Granulocytes; Herpes Simplex; Humans; Immunosuppressive Agents; Infection Control; Infections; Interferons; Intestines; Patient Isolation; Penicillins; Pneumonia; Vaccination; Viral Vaccines; Whole-Body Irradiation

HIV-related treatment and prevention strategies for opportunistic infections presented at the 1995 International Conference on Antimicrobial Agents and Chemotherapy (ICAAC) are highlighted. Research highlights include valaciclovir for CMV prophylaxis, oral ganciclovir for preventing CMV, resistant CMV, and cidofovir (HPMPC) for CMV. Other topics discuss treatments of Mycobacterium avium complex, opportunistic infections and HIV viremia; and reports on the effects of influenza and pneumococcal immunizations on HIV viral load.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Antiviral Agents; Bacterial Vaccines; CD4 Lymphocyte Count; Cidofovir; Clinical Trials as Topic; Cytomegalovirus Infections; Cytosine; Drug Resistance, Microbial; Ganciclovir; HIV; Humans; Influenza Vaccines; Mycobacterium avium-intracellulare Infection; Organophosphonates; Organophosphorus Compounds; Pneumonia; Pneumonia, Pneumocystis; Randomized Controlled Trials as Topic; United States; Valacyclovir; Valine; Viremia

We herein report the case of a 78-year-old woman who was diagnosed as having disseminated herpes zoster (DHZ) complicated with probable varicella-zoster pneumonia during maintenance therapy for microscopic polyangiitis. Because the patient had severe renal dysfunction, amenamevir administration was started to avoid any neurotoxicity of acyclovir, which is suggested to be optimal for treatment. It ameliorated her symptoms without any adverse events. This is the first report suggesting the efficacy of amenamevir in the treatment of severe herpes zoster infection with coexisting DHZ and probable varicella-zoster pneumonia. Amenamevir could thus be a treatment option for severe varicella zoster virus infections.

Topics: Acyclovir; Aged; Antiviral Agents; Chickenpox; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Immunocompromised Host; Oxadiazoles; Pneumonia; Varicella Zoster Virus Infection

Varicella pneumonia is uncommon among adults and can present as potentially life-threatening complications of varicella. Here we report a case of a 43-year-old man with no known history of chronic disease and no allergic history who presented to our hospital emergency department with widespread skin eruptions over the entire body and hemoptysis. Varicella pneumonia was diagnosed based on the patient being in contact with his 6-year-old son who had contracted chickenpox 10 days back, typical cutaneous lesions, pulmonary symptoms and radiographic findings. The patient was treated with oral acyclovir and was admitted to the intensive care unit for monitoring. The patient recovered completely after 10 days of treatment.. chickenpox; pneumonia; skin eruptions.

Topics: Acyclovir; Adult; Chickenpox; Child; Exanthema; Hemoptysis; Humans; Lung; Male; Middle Aged; Pneumonia

Tumor necrosis factor-α (TNF-α) antagonists, most of which are monoclonal antibodies, became a widespread treatment for autoimmune diseases such as rheumatoid arthritis, ankylosing spondylitis, inflammatory bowel diseases, psoriasis, psoriatic arthritis, hidradenitis suppurativa and uveitis. Their use is based on the blockage of TNF-α, which plays an important role in granulomas formation, development of phagosomes, activation and differentiation of macrophages, immune response against viral pathogens. The multiple adverse effects of TNF-α inhibition have been identified, including a two-to four-fold increased risk of active tuberculosis and other granulomatous conditions and an increased occurrence of some other serious bacterial, fungal and certain viral infections.. A 34-year-old male patient with disseminated varicella and pneumonitis was admitted to our hospital. The diagnosis of varicella was established serologically by enzyme immunoassay (EIA) and by polymerase chain reaction confirmation of the virus in vesicular fluid. The patient has been receiving adalimumab and methotrexate for the last 3 years due to ankylosing spondylitis and was seropositive to varicella zoster virus prior to the introduction of TNF-α antagonists. Acyclovir was administered for 10 days with the resolution of clinical illness and radiological signs of pneumonitis.. Due to the use of biological agents, particularly TNF-α inhibitors, as a well-established therapy for some autoimmune diseases, new potential adverse events can be expected in the future and we wanted to point out one of them. To our knowledge this is the first case of recurrent disseminated varicella in a patient taking TNF-α antagonists.

Topics: Acyclovir; Adalimumab; Adult; Anti-Inflammatory Agents; Chickenpox; Herpesvirus 3, Human; Humans; Male; Methotrexate; Pneumonia; Spondylitis, Ankylosing

A 43-year-old man with malignant lymphoma who had been treated with the cyclosphamide, vincrstine, procarbazine, and prednisolone (C-MOPP) regimen was admitted to our hospital with skin eruption. He was diagnosed to have varicella, and treatment with acyclovir and immune globulin was started. Chest computed tomography revealed multiple nodules in the both lung fields. Diagnostic thoracoscopic lung biopsy specimens revealed granuloma formation, and polymerase chain reaction testing revealed the presence of varicella-zoster virus DNA in the granulomatous tissue. It was unusual for the lung nodule in varicella pneumonia to increase in size over time in a patient who had undergone antiviral therapy, while also demonstrating multiple granulomas.

Topics: Acyclovir; Adult; Antiviral Agents; Cyclophosphamide; DNA, Viral; Granuloma; Humans; Male; Pneumonia; Polymerase Chain Reaction; Prednisolone; Procarbazine; Tomography, X-Ray Computed; Treatment Outcome; Varicella Zoster Virus Infection; Vincristine

Pulmonary pathogenicity of herpes simplex virus type 1 in patients in intensive care without classic immunosuppression as well as the necessity of antiviral treatment in the case of herpes simplex virus detection in respiratory specimens in these patients is controversial. We present a case of acute respiratory distress syndrome in a patient with stable chronic lymphatic leukemia not requiring treatment, in whom we diagnosed herpes simplex virus type 1 bronchopneumonitis based on herpes simplex virus type 1 detection in bronchoalveolar lavage fluid and clinical response to antiviral treatment.. A 72-year-old white man presented with symptoms of lower respiratory tract infection. His medical history was significant for chronic lymphatic leukemia, which had been stable without treatment, arterial hypertension, multiple squamous cell carcinomas of the scalp, and alcohol overuse. Community-acquired pneumonia was suspected and appropriate broad-spectrum antibacterial treatment was initiated. Within a few hours, rapid respiratory deterioration led to cardiac arrest. He was successfully resuscitated, but developed acute respiratory distress syndrome. Furthermore, he remained febrile and inflammation markers remained elevated despite antibacterial treatment. Polymerase chain reaction from bronchoalveolar lavage fluid and viral culture from tracheobronchial secretions tested positive for herpes simplex virus type 1. We initiated antiviral treatment with acyclovir. Concomitantly we further escalated the antibacterial treatment, although no bacterial pathogen had been isolated at any point. Defervescence occurred rapidly and his C-reactive protein and leukocyte levels decreased. He was successfully weaned from mechanical ventilation, transferred to the ward, and eventually discharged to home.. Herpes simplex virus should be considered a cause for lower respiratory tract infection in critically ill patients, especially in the setting of an underlying disease.

Topics: Acyclovir; Aged; Antiviral Agents; Bronchoalveolar Lavage Fluid; Critical Illness; Herpesvirus 1, Human; Humans; Leukemia, Lymphocytic, Chronic, B-Cell; Male; Pneumonia; Respiratory Distress Syndrome; Treatment Outcome

Alternaria species have been reported as a rare cause of fungal infection in organ and stem cell transplant recipients, but to date, no reports have been published of infection in humans caused by Alternaria rosae. Here, we report cutaneous A. rosae infection in a 66-year-old farmer with a history of primary myelofibrosis who had undergone allogeneic unrelated donor hematopoietic stem cell transplantation. Forty-nine days post transplant, he presented with a nodule on the thumb with no findings suggestive of disseminated infection. Pathology, culture, and molecular speciation showed the nodule was caused by cutaneous A. rosae. He had been on voriconazole as antifungal prophylaxis, but was found to have a subtherapeutic voriconazole level. He was switched to posaconazole based on published in vitro data showing its superior efficacy in Alternaria treatment. Susceptibility testing showed that the A. rosae isolate was indeed susceptible to posaconazole. His cutaneous lesion remained stable, but he died from respiratory failure secondary to lobar pneumonia. At lung autopsy, A. rosae was not identified in the lungs. We believe this to be the first published report, to our knowledge, of A. rosae infection in humans.

Topics: Acute Kidney Injury; Acyclovir; Aged; Alternaria; Alternariosis; Antibiotic Prophylaxis; Antifungal Agents; Drug Therapy, Combination; Fatal Outcome; Graft vs Host Disease; Hand; Hematopoietic Stem Cell Transplantation; Humans; Immunosuppression Therapy; Levofloxacin; Magnetic Resonance Imaging; Male; Microbial Sensitivity Tests; Paranasal Sinuses; Phaeohyphomycosis; Pneumonia; Prednisone; Primary Myelofibrosis; Respiratory Insufficiency; Spores, Fungal; Transplantation, Homologous; Triazoles; Voriconazole

Topics: Acyclovir; Aged, 80 and over; Antiviral Agents; Bronchoscopy; Herpes Simplex; Herpesvirus 1, Human; Humans; Male; Pneumonia; Pulmonary Disease, Chronic Obstructive; Tomography, X-Ray Computed; Tracheostomy

A woman with severe and longstanding systemic lupus erythematosus presented with a 1-week history of fever up to 38°C and pain in her right flank. Computed tomography scan of the chest revealed interstitial infiltrates and multiple nodules. Bronchoalveolar lavage did not show any inflammatory cells. Gram stain and cultures for aerobic and anaerobic bacteria, fungi, and Nocardia; acid-fast staining; polymerase chain reaction for tuberculosis, cytomegalovirus, herpesvirus 6, and parvovirus B19; and IF staining for pneumocystic and Legionella antigen were all negative. Transbronchial biopsy was nondiagnostic. Open lung biopsy with polymerase chain reaction and immunohistochemistry analyses revealed herpes simplex virus 1 infection. Acyclovir therapy was initiated and was followed by significant improvement. Herpes simplex virus 1 infection (although unusual) should be considered in patients with systemic lupus erythematosus with an atypical clinical presentation.

Topics: Acyclovir; Antiviral Agents; Biopsy; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Lung; Lupus Erythematosus, Systemic; Middle Aged; Pneumonia; Treatment Outcome

Varicella usually is a self-limited disease but sometimes can result in severe complications and death. Although infants, adults, and immunocompromised persons are at increased risk for severe disease, before varicella vaccine was introduced in 1995, the majority of hospitalizations and deaths from varicella occurred among healthy persons aged <20 years. Introduction of varicella vaccine has substantially decreased varicella incidence, hospitalizations, and deaths in the United States. This report describes a varicella death in an unvaccinated, previously healthy adolescent aged 15 years. In April 2012, as part of the routine review of vital statistics records, the Ohio Department of Health identified a 2009 death with the International Classification of Diseases, 10th Revision code for varicella as the underlying cause. Because varicella deaths are nationally reportable, the Ohio Department of Health conducted an investigation to validate that the coding was accurate. Investigators learned that, on March 12, 2009, the adolescent girl was admitted to a hospital with a 3-day history of a rash consistent with varicella and a 1-day history of fever and shortness of breath. The patient was started on intravenous acyclovir (on day 4 of illness) and broad-spectrum antibiotics and antifungals, but she died 3 weeks later. The case underscores the importance of varicella vaccination, including catch-up vaccination of older children and adolescents, to prevent varicella and its serious complications.

Topics: Acyclovir; Adolescent; Anti-Bacterial Agents; Antiviral Agents; Chickenpox; Chickenpox Vaccine; Fatal Outcome; Female; Humans; International Classification of Diseases; Lung; Ohio; Pneumonia; Respiratory Distress Syndrome; Sepsis

Meningitis or encephalitis by varicella-zoster virus (VZV) after hematopoietic stem cell transplantation (HSCT) is rarely reported. We encountered a case of meningoencephalitis with VZV re-activation 18 months after related bone marrow transplantation for recurrent acute lymphoblastic leukemia. The patient had been administered steroid and cyclosporine for chronic graft-versus-host disease. A high DNA copy number of VZV, 4.9×10(7) copies was detected in the cerebrospinal fluid. VZV also caused severe pneumonia and acute renal failure soon after the onset of meningoencephalitis. The patient was successfully treated with acyclovir, although he was left with persistent neurological sequelae. Both prompt diagnosis and early treatment of VZV reactivation are important to avoid a fatal outcome.

Topics: Acute Kidney Injury; Acyclovir; Adult; Antiviral Agents; Bone Marrow Transplantation; Chronic Disease; Cyclosporine; Encephalitis, Varicella Zoster; Graft vs Host Disease; Herpesvirus 3, Human; Humans; Immunosuppressive Agents; Male; Pneumonia; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisolone; Recurrence; Time Factors; Virus Activation

Topics: Acyclovir; Adult; Antiviral Agents; Exanthema; Herpesvirus 3, Human; Humans; Male; Pneumonia; Radiography

Topics: Acyclovir; Antiviral Agents; Drug Resistance, Viral; Herpesvirus 3, Human; Humans; Immunocompromised Host; Male; Middle Aged; Pneumonia; Tumor Necrosis Factor-alpha

Epstein-Barr virus is an unusual pathogen in the aetiology of alveolitis. We describe a case of Epstein-Barr virus induced pneumonitis and its successful treatment with Aciclovir.

Topics: Acyclovir; Antiviral Agents; Epstein-Barr Virus Infections; Female; Herpesvirus 4, Human; Humans; Middle Aged; Pneumonia

Topics: Acyclovir; Aged; Antiviral Agents; Female; Giant Cells; Herpes Zoster; Humans; Kidney Transplantation; Pneumonia; Skin

The incidence of varicella infection is increasing in adults, where primary pneumonitis is the main complication. Little information exists concerning treatment of those patients who require admission to a high dependency unit (HDU) facility. A study was performed to examine the risk factors for developing varicella pneumonitis (VP), to document disease progression and assess prognosis for patients with VP requiring HDU admission.. A 10-year retrospective casenote review of patients admitted to the Regional Infectious Diseases Unit HDU. Varicella pneumonitis (VP) was defined as diffuse nodular shadowing on a chest X-ray (CXR) of a patient with a classical chickenpox rash. Severe pneumonitis was defined as an hypoxaemia index (pO2 in mmHG/FiO2) of less than 150 at any time during hospital stay. All patients were treated with intravenous acyclovir at a dose of 10 mg/kg.. A total of 33 patients were admitted to the HDU with VP over the study period, 30 were included in the study. Annual admission rates remained constant. Most patients (76.7%) had at least one recognised risk factor for severe VP: smoking 18/30, pregnancy 9/30, chronic lung disease 7/30. Twelve (40%) patients had severe VP, eight (26.7%) required assisted ventilation. The presence of greater than one risk factor (p < 0.02) was associated with progression to severe VP. There was one death: a 63-year-old man with a long history of chronic airflow limitation whose treatment had included domicillary long-term oxygen therapy. Nine (30%) patients developed secondary bacterial pneumonia; all recovered with appropriate antibiotic treatment. The period of stay in HDU for the majority of patients was short (mean 4.5 days).. The prognosis for severe adult VP with current available treatment is good. The only predictor on admission for severe VP is the presence of more than one recognised risk factor for developing VP.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Chickenpox; Critical Care; Female; Herpes Zoster; Herpesvirus 3, Human; Humans; Lung Diseases; Male; Middle Aged; Pneumonia; Pregnancy; Prognosis; Retrospective Studies; Risk Factors; Smoking; Statistics, Nonparametric; Treatment Outcome

We report a patient with acute myeloblastic leukaemia who presented with a pneumonia and herpes simplex viraemia associated with primary herpes simplex virus-1 infection. The importance of detecting and treating viral infections in haematology patients is discussed.

Topics: Acyclovir; Aged; Female; Herpes Simplex; Herpesvirus 1, Human; Humans; Leukemia, Myeloid, Acute; Opportunistic Infections; Pneumonia; Viremia

Topics: Acyclovir; Anti-Bacterial Agents; Bacterial Infections; Humans; Incidence; Liver Transplantation; Pneumonia; Postoperative Complications; Retrospective Studies; Treatment Outcome

Acyclovir has become the drug of choice for prevention of visceral dissemination of Varicella-zoster virus infections in immunocompromised individuals. This article describes a 6-year-old girl taking cytotoxic therapy and radiotherapy for treatment of Hodgkin lymphoma who developed cutaneous varicella infection. Despite the early administration of acyclovir a fatal varicella pneumonia occurred and she died on the 4th day of hospitalization. Since the resistance is inducible, the increase of unresponsiveness to acyclovir in immunocompromised hosts with varicella infection is a potential risk that can cause to increase in fatalities in these patients.

Topics: Acyclovir; Chickenpox; Child; Female; Hodgkin Disease; Humans; Immunocompromised Host; Pneumonia; Radiography; Risk Factors; Treatment Outcome

We report five cases of varicella pneumonia during pregnancy. Prompt diagnosis along with aggressive management, including antiviral chemotherapy and ventilatory support, may improve maternal and neonatal outcome.

Topics: Acyclovir; Adult; Chickenpox; Female; Humans; Pneumonia; Pregnancy; Pregnancy Complications, Infectious; Pregnancy Outcome; Respiration, Artificial; Vidarabine

Sixteen bone marrow transplant recipients with cytomegalovirus pneumonia diagnosed by rapid, non-invasive methods were treated with ganciclovir. Seven patients survived the acute infection and there were five long term survivors. Excellent in-vivo suppression of cytomegalovirus was observed. Marrow toxicity was noted in four patients but was rapidly reversible and not life threatening. Clinical features common to surviving patients included good clinical condition, insidious development of infection and evidence of normal alveolar gas exchange. The fulminant onset of symptoms, radiographic abnormalities and hypoxaemia were characteristic of non-survivors. These results offer some encouragement towards further study of ganciclovir for the early treatment of cytomegalovirus pneumonia. To identify such patients, the use of rapid diagnostic methods and aggressive viral surveillance is recommended. Convincing evidence for the efficacy of this drug will only emerge from randomized prospective studies.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Bone Marrow Transplantation; Child; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Male; Pneumonia

Twelve liver and 5 kidney transplant recipients with severe cytomegalovirus infection were treated with Ganciclovir (7.5 mg/kg/day, intravenously). Ten were evaluable (compatible clinical picture, organ involvement shown histopathologically or by culture, viremia, and absence of concomitant infection). All 17 patients were studied for adverse drug side effects. A total of 9 evaluable patients survived the infection; 1 died during treatment due to infection or drug toxicity. A death 19 days after completion of treatment was due to unrelated causes. Patients became afebrile after 2-9 days (mean, 5.3 days) of treatment. Liver function improved, pulmonary infiltrates cleared, and hypoxemia reversed during therapy. Viremia ceased during therapy in 9 patients; asymptomatic viruria persisted or recurred in 6 of 7 patients studied. No relapses occurred during follow-up (7-17 months; mean, 13 months). Transient neutropenia and thrombocytopenia occurred in 3 and 1 patients, respectively. Ganciclovir appears promising for treatment of severe CMV infection in patients with kidney or liver transplants.

Topics: Acyclovir; Cytomegalovirus Infections; Ganciclovir; Humans; Kidney Transplantation; Liver Transplantation; Opportunistic Infections; Pneumonia; Time Factors

The pharmacokinetics of the antiviral drug 9-[2-hydroxy-1-(hydroxymethyl) ethoxymethyl]guanine (DHPG) were examined in six patients receiving 2.5 or 5.0 mg/kg every 8 or 12 hours for human cytomegalovirus (HCMV) pneumonitis or retinitis. Biexponential decay with a mean distribution t1/2 of 0.23 hours and terminal t1/2 of 2.53 hours was observed. Total clearance correlated well with and exceeded creatinine clearance by a factor of 2.4. Mean volume of the central compartment was 15.26 L/1.73 m2 and the volume of distribution at steady state was 32.8 L/1.73 m2. Peak (model predicted) and trough plasma concentrations were 4.75 to 6.20 micrograms/ml and less than 0.25 to 0.63 microgram/ml, respectively, in patients receiving 2.5 mg/kg. Peak concentrations are well above those needed to inhibit HCMV at the 50% level (ID50) and troughs are near this ID50. Cerebrospinal fluid concentrations of DHPG indicate a penetration of 24% to 67%. No accumulation of DHPG was apparent in these patients. However, dosage reduction is necessary in renal insufficiency. Neutropenia occurred in one patient. The plasma concentration profile of DHPG suggests potential beneficial activity against HCMV.

Topics: Acyclovir; Adolescent; Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Kinetics; Male; Middle Aged; Neutropenia; Pneumonia; Retinitis; Time Factors

Forty-four heart and five heart-lung transplant recipients with cytomegalovirus (CMV) infection were investigated for risk factors associated with symptomatic CMV infection (17 patients) and CMV pneumonia (eight patients). Symptomatic infection was associated with primary rather than reactivated infection (P less than .005), younger age (P less than .005), heart-lung transplantation (P less than .001), and significant rises in titer of antibody to the early antigen of Epstein-Barr virus (P less than .001). Among recipients of heart transplants, patients with cardiomyopathy more often had symptomatic disease due to CMV (P less than .05). CMV pneumonia was associated with heart-lung transplantation and, in patients with primary CMV infection, earlier positive cultures for CMV after transplantation (P less than .02). CMV viremia was found in all patients with symptomatic infection, including the eight patients with CMV pneumonia, and the frequency of positive buffy coat cultures for CMV was significantly higher in patients with symptoms than in patients without symptoms (P less than .001). Neither symptomatic CMV infection nor CMV pneumonia was significantly associated with the use of antithymocyte globulin, restricted to therapy for rejection, and the use of high doses of acyclovir in 11 patients had no demonstrable impact on CMV culture positivity.

Topics: Acyclovir; Adult; Age Factors; Antibodies, Viral; Antilymphocyte Serum; Cyclosporins; Cytomegalovirus Infections; Female; Heart Transplantation; Heart-Lung Transplantation; Herpesviridae Infections; Humans; Infectious Mononucleosis; Lung Transplantation; Male; Pneumonia; Postoperative Complications; Risk; Sex Factors; Syndrome; Time Factors