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1 November 2007

Volume 196, Number 9
The Journal of Infectious Diseases 2007;196:1288–1295
© 2007 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2007/19609-0006$15.00
DOI: 10.1086/522429
MAJOR ARTICLE

Cellular Immunity and Active Human Cytomegalovirus Infection in Patients with Septic Shock

Lutz von Müller,1,a

Anke Klemm,1,2

Nilgün Durmus,1

Manfred Weiss,2

Heide Suger‐Wiedeck,2

Marion Schneider,2

Walter Hampl,1 and

Thomas Mertens1

1Institute of Virology and 2Department of Anesthesiology, University Hospital Ulm, Ulm, Germany

Background.Human cytomegalovirus (CMV) is an important opportunistic pathogen after transplantations. In the present study, monitoring of CMV in patients with septic shock was used to discover whether T helper cell type 1 (Th1) cell and natural killer (NK) cell functions interact with CMV reactivation in patients not undergoing immunosuppressive therapy.

Methods.Thirty‐eight patients with septic shock were monitored, and the 23 CMV‐seropositive patients were included in this prospective study.

Results.Seven patients (30.4%) developed an active CMV infection despite the detection of CMV‐reactive Th1 cells. After active CMV infection, the frequency of CMV‐reactive Th1 cells increased from a median of 0.52% to 5.04% ( ). Active CMV infections were terminated without antiviral therapy within 2 weeks. In parallel, the frequency of staphylococcal enterotoxin B (SEB; superantigen)–reactive Th1 cells increased from a median of 1.11% to 8.48% ( ). In patients without active CMV infection, the frequency of CMV‐reactive (median, 0.39%) and SEB‐reactive (median, 1.11%) Th1 cells did not increase. Cytotoxic NK cell activity was persistently suppressed despite the presence of CD56+CD16+ NK cells. Moreover, interleukin‐2 application in vitro did not restore NK cell activity.

Conclusions.A proinflammatory immune response may contribute to CMV reactivation in patients with septic shock. Adaptive T cell immunity, more likely than NK cell immunity, may contribute to termination of active CMV infection without antiviral therapy in these patients.

Received 10 January 2007; accepted 17 April 2007; electronically published 1 October 2007.

  • (See the editorial commentary by Cook, on pages 1273–5.)

Reprints or correspondence: Dr. Lutz von Müller, Institute of Medical Microbiology and Hygiene, University of Saarland Hospital, Kirrberger Str., Bldg. 43, 66421 Homburg/Saar, Germany ().

Cited by

Laurent Chiche, Jean-Marie Forel, Antoine Roch, Christophe Guervilly, Vanessa Pauly, Jérôme Allardet-Servent, Marc Gainnier, Christine Zandotti, Laurent Papazian. (2009) Active cytomegalovirus infection is common in mechanically ventilated medical intensive care unit patients*. Critical Care Medicine 37:6, 1850-1857
Online publication date: 1-Jul-2009.
CrossRef
C. H. Cook, A. A. Bickerstaff, J-J. Wang, P. D. Zimmerman, M. R. Forster, T. Nadasdy, R. B. Colvin, G. A. Hadley, C. G. Orosz. (2009) Disruption of Murine Cardiac Allograft Acceptance by Latent Cytomegalovirus. American Journal of Transplantation 9:1, 42-53
Online publication date: 1-Feb-2009.
CrossRef
Lutz Müller, Thomas Mertens. (2008) Human cytomegalovirus infection and antiviral immunity in septic patients without canonical immunosuppression. Medical Microbiology and Immunology 197:2, 75-82
Online publication date: 1-Jul-2008.
CrossRef
Charles H. Cook. (2007) Cytomegalovirus Reactivation in “Immunocompetent” Patients: A Call for Scientific Prophylaxis. The Journal of Infectious Diseases 196:9, 1273-1275
Online publication date: 1-Nov-2007.
Citation-Full Text-PDF Version (152 kB)

  • Potential conflicts of interest: none reported.

    Presented in part: Jahrestagung der Gesellschaft für Virologie 2006, Munich, 15–18 March 2006 (abstract 233).

    Financial support: Deutsche Forschungsgemeinschaft, Sonderforschungsbereich 451; Roche Diagnostics.

  • Present affiliation: Institute of Medical Microbiology and Hygiene, University of Saarland Hospital, Homburg/Saar, Germany.

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