title: Cellular immunity and active human cytomegalovirus infection in patients with septic shock.
abstract: BACKGROUND
  Human cytomegalovirus (CMV) is an important opportunistic pathogen after transplantations. In the present study, monitoring of CMV in patients with septic shock was used to discover whether T helper cell type 1 (Th1) cell and natural killer (NK) cell functions interact with CMV reactivation in patients not undergoing immunosuppressive therapy.
  
  
  METHODS
  Thirty-eight patients with septic shock were monitored, and the 23 CMV-seropositive patients were included in this prospective study.
  
  
  RESULTS
  Seven patients (30.4%) developed an active CMV infection despite the detection of CMV-reactive Th1 cells. After active CMV infection, the frequency of CMV-reactive Th1 cells increased from a median of 0.52% to 5.04% (P=.009). Active CMV infections were terminated without antiviral therapy within 2 weeks. In parallel, the frequency of staphylococcal enterotoxin B (SEB; superantigen)-reactive Th1 cells increased from a median of 1.11% to 8.48% (P=.027). In patients without active CMV infection, the frequency of CMV-reactive (median, 0.39%) and SEB-reactive (median, 1.11%) Th1 cells did not increase. Cytotoxic NK cell activity was persistently suppressed despite the presence of CD56(+)CD16(+) NK cells. Moreover, interleukin-2 application in vitro did not restore NK cell activity.
  
  
  CONCLUSIONS
  A proinflammatory immune response may contribute to CMV reactivation in patients with septic shock. Adaptive T cell immunity, more likely than NK cell immunity, may contribute to termination of active CMV infection without antiviral therapy in these patients.
authors.affiliation: Institute of Virology, University Hospital Ulm, Ulm, Germany. lutz.mueller@uniklinikum-saarland.de
authors.forename: Lutz
authors.initials: L
authors.lastname: von Muller
authors.forename: Anke
authors.initials: A
authors.lastname: Klemm
authors.forename: Nilgun
authors.initials: N
authors.lastname: Durmus
authors.forename: Manfred
authors.initials: M
authors.lastname: Weiss
authors.forename: Heide
authors.initials: H
authors.lastname: Suger-Wiedeck
authors.forename: Marion
authors.initials: M
authors.lastname: Schneider
authors.forename: Walter
authors.initials: W
authors.lastname: Hampl
authors.forename: Thomas
authors.initials: T
authors.lastname: Mertens
mesh_terms: D000328:Adult; D000368:Aged; D003586:Cytomegalovirus Infections / Q000150:complications* / Q000276:immunology*; D005260:Female; D006801:Humans; D007111:Immunity, Cellular; D007694:Killer Cells, Natural / Q000502:physiology; D008297:Male; D008875:Middle Aged; D012772:Shock, Septic / Q000150:complications* / Q000276:immunology*; D018417:Th1 Cells / Q000502:physiology; D013997:Time Factors