title: Cytomegalovirus infection during immunosuppressive therapy for diffuse parenchymal lung disease.
abstract: OBJECTIVE
  Cytomegalovirus (CMV) infection is a life-threatening condition in patients with diffuse parenchymal lung diseases (DPLDs), who are receiving immunosuppressive therapy. The aim of this study was to describe the clinical features of CMV infection and to propose a strategy for managing CMV infection in patients with DPLD who are receiving immunosuppressive therapy.
  
  
  METHODS
  A retrospective longitudinal observational study was performed on 69 patients with DPLDs (39 with acute/subacute onset, 30 with chronic onset) who were receiving immunosuppressive therapy and were positive for CMV pp65 antigen (CMV-pp65Ag) in peripheral blood leukocytes (PBLs).
  
  
  RESULTS
  Clinical CMV disease and subclinical CMV antigenaemia developed in 23 and 46 patients, respectively. The cut-off level of CMV-pp65Ag indicating clinical CMV disease, as determined by receiver operator characteristic curve analysis, was 7.5 cells per 5 × 10(4) PBLs. Multivariate analysis revealed that early CMV infection was associated with acute/subacute onset of underlying DPLD and with respiratory dysfunction at the commencement of immunosuppressive therapy. Multivariate analysis also suggested that the acute/subacute onset of underlying DPLD, a CMV-pp65Ag titre of >7.5 cells per 5 × 10(4) PBLs, and C-reactive protein levels ≥ 10 mg/L indicated a poor prognosis.
  
  
  CONCLUSIONS
  We recommend that CMV-pp65Ag antigenaemia of >7.5 cells per 5 × 10(4) PBLs in patients with DPLD should be treated with ganciclovir. Patients with lower levels of CMV-pp65Ag antigenaemia should be closely monitored or treated with ganciclovir if the clinical findings suggest a poor prognosis.
authors.affiliation: Department of Respiratory Medicine, Diffuse Lung Diseases and Respiratory Failure, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Arai
authors.forename: Yoshikazu
authors.initials: Y
authors.lastname: Inoue
authors.forename: Kazunobu
authors.initials: K
authors.lastname: Tachibana
authors.forename: Kazunari
authors.initials: K
authors.lastname: Tsuyuguchi
authors.forename: Akihide
authors.initials: A
authors.lastname: Nishiyama
authors.forename: Chikatoshi
authors.initials: C
authors.lastname: Sugimoto
authors.forename: Yumiko
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Tomoko
authors.initials: T
authors.lastname: Kagawa
authors.forename: Yoshinobu
authors.initials: Y
authors.lastname: Matsuda
authors.forename: Seiji
authors.initials: S
authors.lastname: Hayashi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000956:Antigens, Viral / Q000097:blood* / Q000276:immunology; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000276:immunology* / Q000628:therapy*; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D008137:Longitudinal Studies; D017563:Lung Diseases, Interstitial / Q000150:complications / Q000188:drug therapy* / Q000276:immunology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies
chemical_list: D000956:Antigens, Viral; D007166:Immunosuppressive Agents