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.

Exams LITFL ACEM 700

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Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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