A 40 year old man underwent kidney transplantation for end stage renal disease. Two months after transplantation, he developed fever and features suggestive of bilateral diffuse interstitial pneumonia. Which one of the following is the most likely etiological agent?

Ans. is 'b' i.e. CytomegalovirusRef.: L&B 23rd/e p133 Harrison 16th/e p 783 (15th/e p861, 862, 863)It is a case of CMV pneumonia developing after renal transplantCMV is the predominant cause of infection in patients with renal transplant between the period 1-4 months after renal transplantRadiological features of CMV pneumoniaB/L interstitial or reticulonodular infiltrate which begins in the periphery of lower lobes and spreads centrally and peripherallyMethods to prevent CMV disease in renal transplant patientAdministration of immunoglobulin preparation enriched with antibodies to CMV (CMV Ig)Prophylaxis with Ganciclovir or ValacyclovirInfectious complications of kidney transplantEarly infections (< 1 month)Usually associated with Bacterial infections Common infections are UTI, and lung infections Lung infection in early period is caused by LegionellaMiddle period infectionsUsually associated with lung infections similar to the patients with T Lymphocyte deficiency.Most common cause of Lung infection in middle period - CMV Other common Lung infections during middle period Pneumocystis carinii Aspergillus LegionellaInfections during Late period (> 6 months)CMV retinitis* Cryptococcal meningitisInvasive fungal infections Aspergillus RhizopusAlso RememberMost common cause of bacteremia in renal transplant patient > 1 month - Listeria monocytogenes