Plotkin et al developed a score determining severity of cytomegalovirus (CMV) infections in renal transplant patients. The authors are from the University of Pennsylvania and the Children's Hospital for Philadelphia.
Parameters:
(1) duration of fever
(2) leukopenia
(3) thrombocytopenia
(4) hepatitis
(5) pneumonia
(6) gastrointestinal bleeding
(7) central nervous system changes
(8) renal insufficiency
(9) arthritis or muscle wasting
(10) superinfection (by bacteria, protozoa or fungus)
|
Parameter |
Finding |
Points |
|---|---|---|
|
duration of fever |
< 38.3°C orally or rectally |
0 |
|
|
>= 38.3°C orally or rectally for 1 day |
0 |
|
|
>= 38.3°C orally or rectally for 2 - 4 days (mild) |
1 |
|
|
>= 38.3°C orally or rectally for 5 - 20 days (moderate) |
1 |
|
|
>= 38.3°C orally or rectally for >= 21 days (severe) |
3 |
|
leukopenia |
>= 4,000 per µL |
0 |
|
|
< 4,000 per µL |
1 |
|
thrombocytopenia |
>= 100,000 per µL |
0 |
|
|
< 100,000 per µL |
1 |
|
hepatitis |
none |
0 |
|
|
increase liver function tests >= 2 times normal |
1 |
|
|
jaundice |
3 |
|
pneumonia |
none |
0 |
|
|
infiltrate on chest X-ray |
1 |
|
|
infiltrate and symptomatic |
2 |
|
|
ventilator support |
3 |
|
gastrointestinal tract |
no bleeding or ulceration |
0 |
|
|
bleeding or ulceration due to CMV (proven by biopsy) |
3 |
|
CNS changes |
none |
0 |
|
|
lethargy |
1 |
|
|
stupor |
2 |
|
|
coma |
3 |
|
renal |
creatinine < 2 times above best level after transplantation |
0 |
|
|
creatinine 2 - 4 times above best level after transplantation |
1 |
|
|
creatinine > 4 times above best level after transplantation |
2 |
|
|
nephrectomy |
3 |
|
|
permanent dialysis |
3 |
|
arthritis and/or muscle wasting |
absent |
0 |
|
|
present |
2 |
|
superinfection |
absent |
0 |
|
|
present |
3 |
where:
• There was also a value for death (4 points) but that seems to be beyond severe.
• I assume nephrectomy applies to the transplanted kidney.
total score =
= SUM(points for all of the parameters)
Interpretation:
• minimum score: 0
• maximum score: 25
• The higher the score the more severe the disease.
• A score >= 7 indicates moderate disease.
Purpose: To evaluate the severity of cytomegalovirus (CMV) infection in a renal transplant patient using the severity score of Plotkin et al.
Specialty: Infectious Diseases, Surgery, general
Objective: severity, prognosis, stage
ICD-10: B25.9,
