Acute respiratory infection: first clinical manifestation of active infection with cytomegalovirus in HIV patients presenting to the emergency department

. Traditionally, digestive and ophthalmic symptoms have been described as predominant in the clinical presentation of active infection with cytomegalovirus (AICMV). Nevertheless, it seems that this has changed following the introduction of antiretroviral therapy (ART). Nowadays, respiratory infection (RI) in HIV-infected patients is the first reason for consulting an Emergency Department (ED). Among these patients, the mortality is important. Aim. To determine if RI in HIV-infected patients is a common manifestation of AICMV and to describe the changes in clinical presentation of AICMV in relation to what was previously described. Methods. A single-center, retrospective study was conducted over the duration of nine years (2005-2015). All HIV patients who consulted our emergency department with respiratory symptoms and were diagnosed with AICMV were included. Isolation of other co-infecting microorganisms and mortality in the series are also described. Results. 56 HIV-infected patients with AICMV were identified. RI was diagnosed in 34 (61%), 31(91%) patients had pneumonia and 3(9%) pulmonary tuberculosis. The most frequently isolated microorganism was P. jirovecii, in 21 (68%) patients. Bacteria were isolated in five patients (15%). Five patients died from RI (9%). No patient had acute retinitis or any other ophthalmic involvement. Conclusion. Clinical manifestation of AICMV in HIV patients has changed, and RI is the most common manifestation, caused by opportunistic microorganisms with 9% mortality.