Since the clinical manifestations of cytomegalovirus pneumonia are non-specific, the diagnosis is mainly based on laboratory tests. In China, cytomegalovirus IgM, cytomegalovirus pp 65 and cytomegalovirus DNA quantitative tests are mostly used. Due to the application of immunosuppressive drugs, patients may lack antibody response or delay the appearance of antibodies, therefore, the cytomegalovirus IgM test is not very positive and cannot be used alone as a basis for the diagnosis of cytomegalovirus infection. The FQ PCR method is highly sensitive, convenient, and independent of leukocyte count, while the cytomegalovirus pp 65 antigen blood test is highly specific. the combined application of the two methods provides a reliable basis for early diagnosis and timely treatment of cytomegalovirus pneumonia.
The clinical diagnostic criteria for cytomegalovirus pneumonia: 1. fever, body temperature over 38.0 ℃ for more than 3 d; 2. cough, sputum, dyspnea and progressive worsening of hypoxemia; 3. chest X-ray showing interstitial pneumonia changes; 4. laboratory tests: enzyme-linked immunosorbent assay for positive cytomegalovirus IgM in serum and/or fluorescent quantitative polymerase chain reaction (FQ PCR) for positive cytomegalovirus DNA in blood Positive cytomegalovirus DNA and/or positive cytomegalovirus pp 65; 5. Early fever tests for bacteria, fungi, Pneumocystis carinii and tuberculosis were negative.
Treatment: Comprehensive treatment with ganciclovir antiviral therapy, specifically: 1. The currently accepted first choice of cytomegalovirus treatment is intravenous ganciclovir 5 mg/kg, intravenous infusion, repeated every 12 h, for 2-3 weeks, and then given a maintenance dose of 5 kg/m g intravenous infusion, repeated every 24 h. For severe disease, immunoglobulin should be used in combination. The duration of antiviral therapy should be decided according to cytomegalovirus monitoring, and it is safer to stop the drug after the symptoms disappear or the body temperature is normal for 1 week and the cytomegalovirus test is negative. Because of the high relapse rate after treatment, 20%-60%, cytomegalovirus should still be monitored regularly after discontinuing the drug, and ganciclovir should be given orally if necessary to prevent relapse.
2, hormone use: cytomegalovirus pneumonia interstitial lesions are mainly T-cell-mediated immunopathological state, and hormones can reduce alveolar exudation, reduce interstitial fibrosis, reduce the risk of acute rejection brought about by the withdrawal of immunosuppressive drugs, so organ transplant patients with cytomegalovirus pneumonia can add methylprednisolone 80-160mg/d short course of intravenous shock therapy, reduce or stop using Other immunosuppressive drugs can be reduced or stopped and gradually returned to normal dosage when the situation improves. However, in immunocompromised patients who have not undergone organ transplantation, especially some long-term hormone therapy patients, lung injury may be directly derived from the cytopathogenic effect of cytomegalovirus, then minimize the amount of hormone, and take early antiviral-based comprehensive treatment.
3.Correct hypoproteinemia;