valganciclovir and Pneumonia--Viral

CMV infection is highly prevalent in general population and its clinical picture generally ranges from asymptomatic disease to mononucleosis-like syndrome. While severe life-threatening CMV disease is well documented in certain immunocompromised risk groups, severe infection with symptomatic pneumonia in immunocompetent hosts has been rarely documented. In this paper we describe a case of primary CMV infection, complicated by severe CMV pneumonia in an immunocompetent host, successfully treated with oral valganciclovir. Moreover, we reviewed CMV pneumonia cases in immunocompetent adults reported in the literature.

Topics: Administration, Oral; Adult; Aged; Child; Cytomegalovirus; Cytomegalovirus Infections; Ganciclovir; Humans; Male; Middle Aged; Pneumonia, Viral; Treatment Outcome; Valganciclovir; Young Adult

Lung transplant (LT) recipients among solid organ transplant recipients are at high risk for cytomegalovirus (CMV) infections. We evaluated the effect of CMV-Immunoglobulins (CMV-IG) (Cytotect Biotest) on CMV pneumonia diagnosed in 303 follow-up transbronchial biopsies (TBB) of lung transplant recipients. 24 patients (control group, 155 TBB from 1999 to 2002) received acyclovir for 24 months and 33 recipients (study group, 148 TBB from 2003 to 2008) received a combined CMV prophylaxis consisting of CMV-IG (Cytotect Biotest) for 12 months and a short Ganciclovir or Valganciclovir therapy from 21th to 42th postoperative day followed by acyclovir up to 24 months. In our study the percentage of pneumonia at first month TBB was similar in the study group vs the control group, 9.1% (3/33) vs 8.3% (2/24), p=0.9 ns, but after the first month the percentage was significantly lower in the study group in the first year at follow-up TBB, 1% (1/99) vs 6.4% (5/78), p=0.048, and in first two years follow-up TBB, 0.8% (1/122) vs 6.5% 8/124), p=0.018 (STATISTICAL ANALYSIS: Chi-square test for proportion differences). Our data suggest a strong efficacy of CMV-IG prophylaxis in reducing CMV pneumonia after first month in lung transplant recipients.

Topics: Acyclovir; Antiviral Agents; Biopsy; Cytomegalovirus; Cytomegalovirus Infections; Drug Therapy, Combination; Follow-Up Studies; Ganciclovir; Graft Rejection; Humans; Immunoglobulins; Lung Transplantation; Pneumonia, Viral; Postoperative Complications; Time Factors; Treatment Outcome; Valganciclovir

Cytomegalovirus (CMV) is the most prevalent opportunistic infection after lung transplantation. Current strategies do not prevent CMV in most at-risk patients.. To determine whether extending prophylaxis with oral valganciclovir from the standard 3 months to 12 months after lung transplantation is efficacious.. Randomized, clinical trial. Patients were randomly assigned by a central automated system to treatment or placebo. Patients and investigators were blinded to treatment status. (ClinicalTrials.gov registration number: NCT00227370). Multicenter trial involving 11 U.S. lung transplant centers.. 136 lung transplant recipients who completed 3 months of valganciclovir prophylaxis.. 9 additional months of oral valganciclovir (n = 70) or placebo (n = 66).. The primary end point was freedom from CMV disease (syndrome or tissue-invasive) on an intention-to-treat basis 300 days after randomization. Secondary end points were CMV disease severity, CMV infection, acute rejection, opportunistic infections, ganciclovir resistance, and safety.. CMV disease occurred in 32% of the short-course group versus 4% of the extended-course group (P < 0.001). Significant reductions were observed with CMV infection (64% vs. 10%; P < 0.001) and disease severity (110 000 vs. 3200 copies/mL, P = 0.009) with extended treatment. Rates of acute rejection, opportunistic infections, adverse events, CMV UL97 ganciclovir-resistance mutations, and laboratory abnormalities were similar between groups. During the 6 months after study completion, a low incidence of CMV disease was observed in both groups.. Longer-term effects of extended prophylaxis were not assessed.. In adult lung transplant recipients who have received 3 months of valganciclovir, extending prophylaxis by an additional 9 months significantly reduces CMV infection, disease, and disease severity without increased ganciclovir resistance or toxicity. A beneficial effect with regard to prevention of CMV disease seems to extend at least through 18 months after transplantation.

Topics: Administration, Oral; Adult; Antiviral Agents; Cytomegalovirus Infections; Double-Blind Method; Drug Administration Schedule; Female; Follow-Up Studies; Ganciclovir; Humans; Lung Transplantation; Male; Middle Aged; Opportunistic Infections; Pneumonia, Viral; Prospective Studies; Valganciclovir; Viremia

Topics: Antiviral Agents; Betacoronavirus; Cidofovir; Coronavirus Infections; COVID-19; Dideoxynucleosides; Ganciclovir; Guanine; Nucleotides; Pandemics; Pneumonia, Viral; Prodrugs; RNA-Dependent RNA Polymerase; RNA, Viral; SARS-CoV-2; Severe Acute Respiratory Syndrome; Severe acute respiratory syndrome-related coronavirus; Stavudine; Valganciclovir

Topics: Anti-Bacterial Agents; Antiviral Agents; Coinfection; Cytomegalovirus Infections; Female; Ganciclovir; Heart Failure; Heart Transplantation; Humans; Immunocompromised Host; Immunosuppressive Agents; Middle Aged; Neutropenia; Pneumonia, Bacterial; Pneumonia, Viral; Postoperative Complications; Preoperative Care; Pseudomonas aeruginosa; Shock, Septic; Tomography, X-Ray Computed; Valganciclovir

We present a case of a 71-year-old woman who initially presented with renal-limited antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis. Following standard therapy with cyclophosphamide, steroids and plasma exchange, her renal function began to improve. However, despite appropriate treatment, her renal function subsequently deteriorated and she suffered haemoptysis. Owing to diagnostic uncertainty, bronchoscopy and a repeat renal biopsy were performed. The bronchoscopy washings demonstrated positivity for cytomegalovirus (CMV) DNA, and in combination with a positive serum CMV PCR, immunosuppression was withheld. Treatment with ganciclovir was started. Repeat renal biopsy demonstrated active vasculitis and, following successful treatment of CMV disease, immunosuppression was re-started alongside prophylactic valganciclovir. This resulted in a successful outcome for the patient. Pulmonary CMV disease may mimic pulmonary disease associated with vasculitis, posing a diagnostic challenge to clinicians. We recommend a low threshold when testing for CMV in these patients.

Topics: Adrenal Cortex Hormones; Aged; Anti-Neutrophil Cytoplasmic Antibody-Associated Vasculitis; Antiviral Agents; Bronchoscopy; Cyclophosphamide; Cytomegalovirus; Cytomegalovirus Infections; DNA, Viral; Female; Ganciclovir; Hematuria; Hemoptysis; Humans; Immunocompromised Host; Immunosuppressive Agents; Induction Chemotherapy; Kidney Diseases; Plasma Exchange; Pneumonia, Viral; Proteinuria; Valganciclovir

Topics: Aged; Antiviral Agents; Bronchoalveolar Lavage Fluid; Cytomegalovirus; Cytomegalovirus Infections; Diagnosis, Differential; Ganciclovir; Humans; Lung Neoplasms; Male; Pneumonia, Viral; Radiography; Treatment Outcome; Valganciclovir

Interstitial pneumonitis is a rare complication of cytomegalovirus (CMV) infection in the immunocompetent. There is a paucity of literature regarding treatment in these patients. A previously healthy, immunocompetent female patient presented with fever, shortness of breath, a dry non-productive cough and myalgia and was subsequently diagnosed with CMV interstitial pneumonitis. She was treated with valganciclovir and swiftly improved but experienced neutropenia, which resolved on treatment cessation.

Topics: Adult; Antiviral Agents; Cytomegalovirus Infections; Female; Ganciclovir; Humans; Immunocompetence; Pneumonia, Viral; Valganciclovir

Among solid-organ recipients, those with lung transplants are at highest risk of cytomegalovirus (CMV) infection or to die of CMV-associated disease. We evaluated the effect of combined CMV antiviral prophylaxis and CMV-immunoglobulin prophylaxis on CMV-associated pneumonia diagnosed in 303 follow-up transbronchial biopsy (TBB) specimens from lung transplant recipients. At our center, 24 recipients (control group; 1999-2002) received acyclovir for 24 months and 33 recipients (study group; 2003-2008) received combined CMV prophylaxis consisting of CMV immunoglobulin on days 1, 4, 8, 15, and 30 and monthly for 12 months plus gancyclovir or valgancyclovir from postoperative day 21 for 3 weeks followed by acyclovir for up to 24 months. The percentage of pneumonia-positive TBB specimens at 1-month follow-up was similar in the study and control groups: 9.1% (3 of 33 specimens) vs 8.3% (2 of 24) (P = .90). However, after the first month, the percentage of pneumonia-positive TBB specimens was significantly lower in the study group in the first year (months 3, 6, 9, and 12) of follow-up, at 1% (1 of 99) vs 6.4% (5 of 78) (P = .048), and in the first 2 years (months 3, 6, 9, 12, 18, and 24), at 0.8% (1 of 122) vs 6.5% (8 of 124) (P = .02). These data suggest the efficacy of combined prophylaxis to decrease the incidence of CMV-associated pneumonia after the first month in lung transplant recipients. The effect of combined prophylaxis after transplantation seems useful to prevent CMV-associated pneumonia not only in the first year after lung transplantation but also in the second year, which suggests a long-lasting immunologic role of prophylaxis.

Topics: Antiviral Agents; Cytomegalovirus Infections; Drug Therapy, Combination; Ganciclovir; Humans; Incidence; Lung Transplantation; Pneumonia, Viral; Valganciclovir