This virus has come up three times in the college exams. Question 4 from the first paper of 2019 involved immunocompromised patients, whereas in Question 21 from the second paper of 2010 the college had asked specifically about infection in the immunocompetent host. And in Question 28.3 from the first paper of 2022,
Oh's Manual only discusses cytomegalovirus in the context of organ or bone marrow transplants, as well as pediatric pneumonia and encephalitis. One my need to resort to Harrison's (Ch. 182) for more details.
A brief summary of what a CICM trainee is expected to know about CMV has been cobbled together from this chapter, as well as from articles such as this piece by Gandhi et al (2004).
CMV among the immunocompetent ICU population is also explored in this 2008 JAMA paper, andits complications are detailed in this excellent CID article from 1997.
Disease causd by CMV is generally divided into "CMV syndrome" and "CMV end-organ disease". The actual distinction is probably more relevant to the stratification of patients in trials (Ljungman et al, 2016) rather than as a guide to therapy. For trial purposes, CMV syndrome is appicabe only to solid organ transplant recipients, and is defined as viraemia plus any two of the following:
Immunocompetent host
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Immunocompromised host
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Risk factors for reactivation in the immunocompetent ICU population
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Immunocompetent host
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Immunocompromised (transplant) host
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There is little literature to guide your decisionmaking in the critically ill immunocompetent host. Fortunately, extensive literature exists concerning CMV in the immunocompromised.
Gandhi, Maher K., and Rajiv Khanna. "Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments." The Lancet infectious diseases 4.12 (2004): 725-738.
Tejedor Cerdena, María Auxiliadora, et al. "Cytomegalovirus ileitis in an immunocompetent patient." Rev Esp Enferm Dig 103 (2011): 154-6.
Grilli, Elisabetta, et al. "Cytomegalovirus pneumonia in immunocompetent host: case report and literature review." Journal of Clinical Virology 55.4 (2012): 356-359.
Limaye, Ajit P., et al. "Cytomegalovirus reactivation in critically ill immunocompetent patients." Jama 300.4 (2008): 413-422.
Osawa, Ryosuke, and Nina Singh. "Cytomegalovirus infection in critically ill patients: a systematic review." Critical care 13.3 (2009): R68.
Jain, Manisha, Shalini Duggal, and Tulsi Das Chugh. "Cytomegalovirus infection in non-immunosuppressed critically ill patients." The Journal of Infection in Developing Countries 5.08 (2011): 571-579.
Chou, Suowen. "Newer methods for diagnosis of cytomegalovirus infection." Review of Infectious Diseases 12.Supplement 7 (1990): S727-S736.
Razonable, Raymund R., and Randall T. Hayden. "Clinical utility of viral load in management of cytomegalovirus infection after solid organ transplantation."Clinical microbiology reviews 26.4 (2013): 703-727.
Vancikova, Z., and P. Dvorak. "Cytomegalovirus infection in immunocompetent and immunocompromised individuals--a review." Current drug targets. Immune, endocrine and metabolic disorders 1.2 (2001): 179-187.
Eddleston, M., et al. "Severe cytomegalovirus infection in immunocompetent patients." Clinical infectious diseases 24.1 (1997): 52-56.
Andrews, Peter A., Vincent C. Emery, and Chas Newstead. "Summary of the British Transplantation Society guidelines for the prevention and management of CMV disease after solid organ transplantation." Transplantation 92.11 (2011): 1181-1187.
Kotton, Camille N., et al. "Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation." Transplantation96.4 (2013): 333-360.
Jacobson, Mark A. "Review of the toxicities of foscarnet." JAIDS Journal of Acquired Immune Deficiency Syndromes 5 (1992): S11-17.
Lalezari, Jacob P., et al. "Randomized, controlled study of the safety and efficacy of intravenous cidofovir for the treatment of relapsing cytomegalovirus retinitis in patients with AIDS." JAIDS Journal of Acquired Immune Deficiency Syndromes 17.4 (1998): 339-344.
Boeckh, Michael. "Complications, diagnosis, management, and prevention of CMV infections: current and future." ASH Education Program Book 2011.1 (2011): 305-309.
Kotton, C. N. "CMV: prevention, diagnosis and therapy." American Journal of Transplantation 13.s3 (2013): 24-40.
Fryer, J. F., et al. "Collaborative study to evaluate the proposed 1st WHO international standard for human cytomegalovirus (HCMV) for nucleic acid amplification (NAT)-based assays WHO/BS/10.2138." World Health Organiztion, Geneva, Switzerland (2010).
Ljungman, P., et al. "Use of intravenous immune globulin in addition to antiviral therapy in the treatment of CMV gastrointestinal disease in allogeneic bone marrow transplant patients: a report from the European Group for Blood and Marrow Transplantation (EBMT). Infectious Diseases Working Party of the EBMT." Bone marrow transplantation 21.5 (1998): 473-476.
Erard, V., et al. "Cytomegalovirus pneumonia after hematopoietic cell transplantation: outcomes and factors associated with mortality." Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago, IL. 2007. - this is not even available as an abstract, but is widely cited; a reference to it an be found in the following article:
Travi, Giovanna, and Steven A. Pergam. "Cytomegalovirus pneumonia in hematopoietic stem cell recipients." Journal of intensive care medicine 29.4 (2014): 200-212.
Ljungman, Per, et al. "Definitions of cytomegalovirus infection and disease in transplant patients for use in clinical trials." Clinical Infectious Diseases (2016): ciw668.