CICM SAQ 2010.2 Q21
Questions
- 21.1 Outline methods for diagnosing CMV infection in the critically ill immunocompetent patient.
- 21.2 List risk factors for CMV infection in the above patient group.
- 21.3 List the effects of CMV infection on outcomes in immunocompetent patients.
- 21.4 List drugs available for treating CMV infections.
Answers
Answer and interpretation
21.1 Outline methods for diagnosing CMV infection in the critically ill immunocompetent patient.
- Viral cultures: Obsolete because of low sensitivity and time consuming nature.
- Antigenemia: Direct detection of CMV protein pp65 using monoclonal antibodies. Sensitive, quantitative but requires sufficient white cells in peripheral blood.
- PCR assays: High sensitivity and rapid turnover time but not standardised.
21.2 List risk factors for CMV infection in the above patient group.
- Mechanical ventilation.
- Bacterial pneumonia and sepsis.
- Corticosteroid use: Not clear.
- Red cell transfusion: Immunomodulatory effect of transfusion, rather than potential transmission of CMV.
- Burns patients: Cell mediated immunity and T–helper 1 cells increase infection.
21.3 List the effects of CMV infection on outcomes in immunocompetent patients.
- Organ dysfunction: Increased liver and renal failure.
- Severe CMV disease: Pneumonitis, pneumonia, neurologic disease.
- ICU stay prolonged
- Mechanical ventilation duration increased
- Increased incidence of bacterial or fungal infection
- Mortality possibly increased
21.4 List drugs available for treating CMV infections.
- Ganciclovir / valganciclovir.
- Foscarnet.
- Cidofovir.
Examination Library
CICM
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC