Prevalence and characteristics of persisent cytomegalovirus infection with community-acqured pneumonia
Introduction. There are many literature data about cytomegaloviral (CMVI) as direct cause and background for much somatic pathology, a favorable factor for the realization of pathological immune and neuroendocrine reactions which often leads to resistance in therapy of pathological processes in immune-compromised people. At the same time, scientific progress in the diagnosis of community-acquired pneumonia (CAP) and development of highly effective antibacterial drugs for treatment can not provide positive effect that can be explained by the transformation of the conditions of emergency, changes in virulence of the pathogen and the immune reactivity of the patient′s organism. By this time CMVI was considered an indicator disease, immunodeficiency persons. Therefore, and pneumonia, which was observed in similar cohorts of patients was regarded purely as viral etiological factor. And consequently, the latent prevalence of CMVI in patients with CAP has not been studied. The article presents data about the prevalence of cytomegalovirus infection in the population and among patients in community-acquired pneumonia with the presence of specific antibodies - immunoglobulins M and G. Also shows the performance persistence of cytomegalovirus in severity persistence among patients in community-acquired pneumonia and healthy individuals, the prevalence of persistent CMV infection in patients with CAP and healthy subjects on the basis of IgG content depending on the severity of the CAP Pneumonia Patient Outcomes Research Team (PORT) - scale.
The purpose of our work: to establish the prevalence and characteristics of persistent CMV infection in patients with community acquired pneumonia young age.
Materials and methods. 43 patients withe CAP (21 (48,8%) men and 22 (51,2%) women), who were treated in the pulmonary department of the Vinnytsia clinical hospital № 1 during 2015 year were examined. For control the 32 (14 (43,8%) male and 18 (56,2%) women) of practically healthy persons were examined. The average age of patients in group CAP was (40,1+1,7) years in the control group the average age of patients was (36,0+1,7) years. The diagnosis of CAP was determined according to the requirements of the Order MHO of Ukraine № 128 (19.03.2007) and National Clinical Protocol "Community-Acquired and Hospital (Nosocomial) Pneumonia in Adults: etiology, pathogenesis, classification, diagnostics, antibacterial therapy [Feshchenko Y. and etc., 2014]. The presence of CMVI in the study and control groups was made by determining specific antibodies of immunoglobulin M (Ig M CMV) and immunoglobulin G (CMV IgG) in serum using enzyme-linked immunosorbent method [National Committee for Clinical Laboratory Standards]. Statistical processing of the obtained results is performed on a personal computer using the statistical program package SPSS 12.0 for Windows (Grand Pack, Serial Number 9593869).
Results. CAP patients differed significantly according to their virological status (based on analysis of the content of CMV IgM and CMV IgG). According to our data IgM was detected in 4 cases (9.3 %) in clinically meaningless and titer was not typical for the patients of the control group. The average value of the titer of IgG class antibodies to CMV in the group of patients with CAP was (6,13±0,87) % and ranged from 0 to 27,8%, while in the healthy group the average titer values of IgG class antibodies to CMV was (4,07±0,82) units and ranged from 0 to 13,50% (the difference was t=1,664, p=0.1). In all cases (75 observations) the average value of the titer of IgG class antibodies to CMV was (5,25±0,85) units. CAP patients with a high level of statistical significance (p=0.002) differed from healthy subjects on the prevalence of persistent CMVI depending on the level of severity – mild level of persistence of 53.5% versus 25.0%, a high level of persistence is 11.6% versus 0. We haven't revealed statistical significant of differences in the rate of clinically significant severity of CMVI persistence according to the titer of antibodies in IgG class according to gender in both groups of comparison (p>0.05).
However, according to our data, individuals in the control group were characterized by absence of severe CMVI persistence, while in the group of patients with CAP the account 14%. Research of the average values of antibody titer of IgG class CMV showed that in the group of patients for CAP women, the rate was lower and amounted to (levels lower than the 5,37±1,05) units, as above men respectively (6,93±1,41)units, while statistical difference was not found (t=0,888, p=0,379). In the group of healthy women the average values of antibody titres of CMV IgG was higher and amounted to (4,76±1,17) units, while in men it was lower and amounted to (3,18±1,13) units, in this case also the differences were incredible (t=0,950, p=0,350). When assessing the prevalence rate of persistence CMVI according to age, statistically significant differences in both the comparison groups was revealed (p>0,05), however, the patients in group CAP there was a significantly increase in the severity with increasing patient age (p=0,047). For CAP patients in PORT-risk class II (30 patients), the prevalence rate amounted to 76.6% and were observed in 23 patients. For CAP patients-risk class III (13 patients), the prevalence of persistent CMVI amounted to 84,6% and was observed in 11 patients, which was significantly higher compared with the group of patients who had class II risk of a negative outcome on the PORT scale (p<0,05) and is higher than the average group index, which amounted in the whole to 79,1%.
Conclusions. 1. CAP patients differed significantly according to their virological status (based on analysis of the content of CMV IgM and CMV IgG). 2. The study was refuted CMVI-nature as the primary etiological factor of CAP. 3. The presence in the body CMVI-persistency is an aggravating factor for adherence comorbidities of lower respiratory tract, which is probably caused by changes in the immune status that CMVI provokes. 4. No significant difference was found in the analysis of the prevalence of persistent CMVI depending on the age and gender of respondents. 5. For patients who had class III risk according to the scale PORT, which corresponds to a more severe clinical understanding of the flow of CAP, it is on average (9,40±2,21) against the average (4,71±0,69) p=0,012, which was determined on NP in patients with II class of risk on the scale of PORT, and, which are respectively easier in understanding the clinical course of CAP.