Cytomegalovirus pneumonia

　　The cytomegalovirus (CMV) belongs to the B subgroup of herpesviruses. The infection of CMV is strictly species-specific, and humans are only infected with human cytomegalovirus. After infection, the virus grows and reproduces slowly in cells (manifesting obvious lesions after 2-3 months). The infected cell nuclei enlarge, and the cytoplasm increases, forming typical eosinophilic inclusions in the nucleus and cytoplasm.

　　The progressive type of cytomegalovirus pneumonia occurs 3 to 4 months after transplantation, the symptoms are similar to those of the aggressive type, but progress slowly, symptoms are mild, and mortality is low. Can be complicated with retinitis, colitis, cholangitis, esophagitis, systemic viral sepsis, and secondary bacterial or fungal infections.

　　Most CMV infected individuals with good immune function show asymptomatic latent infection, thus becoming a source of infection for CMV infection in bone marrow and organ transplant recipients. Therefore, it is very important to perform CMV serological tests on donors before transplantation. The clinical manifestations of CMV pneumonia after transplantation include the following:

　　1. The aggressive type appears 1 to 2 months after transplantation with symptoms such as fever, cough, discomfort, dyspnea, decreased activity, hypoxia, and respiratory failure; there are usually no signs on lung auscultation, and wheezes can be heard in patients with secondary bacterial or fungal infections; the condition progresses rapidly, can deteriorate quickly, and can lead to death. Common in primary infection, without specific antibodies in the body, therefore, the onset is acute, severe, and prone to systemic viral sepsis and secondary bacterial or fungal infections.

　　2. The progressive type occurs 3 to 4 months after transplantation, the symptoms are similar to those of the aggressive type, but progress slowly, symptoms are mild, and mortality is low; the lung X-ray shows diffuse interstitial pneumonia and fibrosis; the pathological manifestations are alveolar interstitial edema, varying degrees of fibrosis, lymphocytic infiltration, and epithelial cell hyperplasia. Commonly occurs due to CMV re-infection or latent virus activation. CMV pneumonia in AIDS patients is non-specific, often complicated with systemic CMV infection, such as retinitis, colitis, cholangitis, and esophagitis.

　　The key to the prevention of CMV pneumonia is the prevention of CMV infection. Some have used high-titer immune serum as passive immunization to prevent disease in susceptible children who are CMV antibody-negative or have undergone organ transplantation and immunosuppressive drug treatment after contact with CMV, but the expected effect was not achieved. There is no therapeutic effect on the infected. Many attempts have been made to prevent CMV infection with vaccines, which have confirmed that it is possible to prepare a human CMV vaccine that induces antibodies in susceptible individuals without severe reactions and排毒 phenomena. Neff et al. reported the use of the ADL68 strain to produce a live vaccine, which was tested on a small scale, with all antibodies turning positive, mild clinical reactions, and no virus detected in throat swabs, urine, and white blood cells. Therefore, it is meaningful to vaccinate normal women who are pregnant and CMV antibody-negative and those who are going to undergo organ transplantation. Since CMV can cause intrauterine infection, leading to congenital malformations, it is also a complication after organ transplantation and massive blood transfusions. Since the herpesvirus genus has potential carcinogenic effects, although there is currently no sufficient epidemiological evidence to show a link between CMV and human cancer, it also affects the wide development of this work. For fetuses suspected of having congenital infection, therapeutic abortion can be used for control. CMV infected patients, the virus can exist in urine, saliva, cervical secretions, and breast milk, and can be transmitted through contact, so it is recommended that patients be isolated.

　　1. Decreased peripheral blood leukocyte count. Cytomegalovirus can be isolated from human embryo fibroblast culture medium by inoculating respiratory secretions, saliva, urine, cervical secretions, liver, and lung biopsy specimens. The presence of eosinophilic intranuclear inclusions in the bronchial secretions and fiberoptic bronchoscope lung tissue biopsy specimens can confirm the diagnosis. The level of cytomegalovirus antibodies in serum, when the titer of double serum antibodies shows a 4-fold or more increase, is helpful for diagnosis.

　　2. X-ray examination mainly shows diffuse interstitial or alveolar infiltration in both lungs, a few cases may present as nodular shadows, and occasionally there are signs of pleural effusion. Lung consolidation suggests concurrent bacterial or fungal infection.

　　Firstly, eat

　　1. Eat antiviral foods.

　　2. Eat antibacterial and anti-inflammatory foods.

　　3. Eat foods rich in high-quality protein.

　　Secondly, avoid eating

　　1. Avoid eating high-fat foods; such as lard, pork oil, beef oil, mutton oil, chicken oil.

　　2. Avoid eating刺激性饮料；such as coffee, white wine, yellow wine, strong tea.

　　3. Avoid eating easy-to-heat-up foods; such as pancakes, fried dough sticks.

　　There is currently no effective medicine, mainly treated with acyclovir or ganciclovir, which has a selective inhibitory effect on the DNA polymerase of herpesvirus. However, high doses can suppress white blood cells and worsen the condition. Acyclovir and cytomegalovirus immunoglobulin can effectively prevent cytomegalovirus infection in kidney transplant patients.