Cytomegalovirus Reactivation in Critically ill Patient

Introduction: The role of cytomegalovirus infection in contributing to outcomes In critically ill immunocompetent patient has not been fully Defined. More studies are needed to identify factors that could predict the risk of developing a CMV reactivation ,mechanism causing CMV pathogenicity and predisposing immunologic conditions associated with the development of CMV reactivation. Clinically significant CMV disease (reactivation of previously latent infection or newly acquired infection) frequently develops in immunocompro mised patients . Cytomegalovirus can cause a wide spectrum of infection in immunocompetent hosts and multisystem involvement (fever of unknown origin).. The case challenges diagnosis and identification of CMV and patient management. Case report: 32 year old man,caucasion,was admitted in ICU after vehicle accident. Antibacterial treatment was based on datas of microb sensitivity . Regardless of suitable treatment, patient state was worsened .Developed Repiratory distress syndrom ,hepatic desfunction,acute renal failure, permanent hyperthermia .Blood inveastigation detected CMV .By CMV DNA PCR quantitative testing was revealed CMV - 1812 copies/ml. Patient was treated with ganciklovir 5mg/kg twice a day within 2 week. From fifth day after treatment patient state was improved, temperature decreased, respiratory parameters was normalized. Conclusion: In case of our patient , the diagnosis of CMV reactivation was established by blood investigation. Cytomegalovirus can be pathogenic by decreasing host defences against other microorganisms, enhancing inflammatory response. There is dilemma ,to treat or not to treat? Some randomized controlled trials evaluated the effectiveness of an antiviral therapy and one study to show increased the number of day free of mechanical ventilation .This case presented diagnoisis and identification of CMV, patient management and and effectiveness of an antiviral therapy in improving outcomes.