免疫正常的重症病人之巨細胞病毒感染

Integrated studies have shown that the incidence of cytomegalovirus (CMV) infection ranges from 0% to 35% among critically ill patients hospitalized in an intensive care unit (ICU). It has also been found that critically ill patients infected with CMV have increased risk of organ dysfunction, nosocomial infection, and mortality, and experience more ventilator indwelling days and ICU hospitalization days. Guidelines for the treatment of CMV infection specific to critically ill and non-immunocompromised patients have been lacking. Furthermore, there has been no consensus among clinicians regarding the optimal detection and treatment of CMV. There is clinical evidence that the administration of antiviral drugs to patients with biopsy-and histology-proven CMV pneumonia can improve outcomes and increase the chances of survival. Many physicians, nonetheless, remain concerned about the risk of bone marrow suppression caused by antiviral drugs in non-immunocompromised critically ill patients. Some patients in our institution with delayed-resolution pneumonia or colonic ulcers with bleeding were eventually diagnosed with unexpected CMV infection. Unfortunately, without the necessary treatment, some of these patients died. Therefore, we reviewed the literature on CMV infections in critically ill non-immunocompromised patients. We undertook a comprehensive discussion, particularly focusing on the pathogenesis, diagnosis, incidence, and risk factors of CMV infection, and whether treatment is advisable for critically ill patients. We also integrated the literature reporting cases of common CMV infections including colitis, pneumonitis, hepatitis, and encephalitis hoping to raise awareness and provide a reference for relevant medical teams.