Physiology and metabolism in isolated viral septicemia. Further evidence of an organism-independent, host-dependent response
C. S. Deutschman, F. N. Konstantinides, M. Tsai, R. L. Simmons and F. B. Cerra
The hypothesis has been advanced that the human systemic septic response is
a function of the host and not of the type of infecting organism. Metabolic
and physiologic data from five immunosuppressed transplant recipients with
isolated cytomegaloviral sepsis and viremia were prospectively evaluated.
Serial cultures obtained from lung, sputum, urine, wound, blood, and
invasive lines were positive for virus and negative for bacterial or fungal
pathogens. The results were compared with two data banks derived from
either victims of multiple trauma without sepsis or surgical patients with
early bacterial or fungal sepsis. Statistically significant differences
between the patients and the nonseptic reference group were noted for
cardiac index, total peripheral resistance, arteriovenous oxygen content
difference, oxygen consumption, and levels of triglycerides, proline,
phenylalanine, tyrosine, alpha-aminobutyrate, and alanine. No such
differences were present for these data compared with the septic reference
group. Physiologic data obtained just before death in three patients
indicated a failure of oxygen transport. It appears that the systemic
septic response to viral agents is indistinguishable by physiologic and
metabolic criteria from that resulting from bacterial or fungal agents.
