Cytomegalovirus reactivation in left ventricular assist device patients: Case series and literature review
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Oxford University Press
Abstract
Background: Cytomegalovirus (CMV) reactivation after placing left ventricular assist device (LVAD) is not a well-known entity with few cases reported in the literature. Here, we are presenting three cases of CMV reactivation after placing LVAD. A literature review of all reported cases in the literature was done. Case summary: Three cases of advanced heart failure with reduced ejection fraction (Stage D9) had placed (LVAD) at the American University of Beirut Medical Center, a tertiary care centre in Lebanon. Within the first 2 weeks after LVAD implantation, the three patients spiked a high-grade fever for which sepsis workup was done, and antibiotics were initiated. Despite the escalating antibiotic regimens, the three patients had a persistent high-grade fever. The negative cultures and the continuous fever prompted an investigation for other causes of fever. Therefore, CMV polymerase chain reaction in blood was performed and revealed high titres. Patients received a full course of treatment with ganciclovir. The fever and the CMV titres declined after completing the antiviral therapy with better clinical outcomes. This raises the concern of CMV reactivation in LVAD patients. Discussion: This case series and literature review highlight the epidemiology, incidence, and management of CMV reactivation among LVAD patients. Awareness about this clinical entity should be raised, especially with the increase of LVAD surgeries. © The Author(s) 2021.
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Keywords
Case report, Cmv reactivation, Cytomegalovirus, Left ventricular assist device, Antibiotic agent, Colistin, Creatinine, Diuretic agent, Ganciclovir, Immunoglobulin g, Inotropic agent, Meropenem, Piperacillin plus tazobactam, Tigecycline, Vancomycin, Warfarin, Acinetobacter, Acute heart failure, Adult, Antibiotic therapy, Aortic regurgitation, Aortic valve replacement, Atrial fibrillation, Cardiorenal syndrome, Cause of death, Chronic kidney failure, Clinical article, Colonoscopy, Comorbidity, Congestive cardiomyopathy, Coronary artery bypass graft, Coronary artery disease, Cytomegalovirus infection, Disseminated intravascular clotting, Dyslipidemia, Escherichia coli, Extracorporeal oxygenation, Extubation, Fever, Follow up, Gastrointestinal hemorrhage, Haemophilus influenzae type a, Heart failure with reduced ejection fraction, Heart left ventricle failure, Hemorrhoid, Human, Hypertension, Hyperthyroidism, Hypervolemia, Klebsiella pneumoniae, Lebanon, Male, Middle aged, Nonhuman, Pneumonia, Polymerase chain reaction, Pulmonary hypertension, Renal replacement therapy, Review, Rheumatic heart disease, Sepsis, Septic shock, Thorax radiography, Tracheal aspiration procedure, Tricuspid annuloplasty, Ventilator associated pneumonia, Virus reactivation