Forty-day fever. An epidemic of cytomegalovirus disease in a renal transplant population.

An epidemic of cytomegalovirus disease (CMV) occurred in 38 percent of 34 renal transplant recipients during an 18-month period. A characteristic clinical pattern was noted: 40 days following transplantation, daily fevers recurred for periods of four to six weeks. This fever in conjunction with a diffuse interstitial pneumonitis and impaired hepatic and renal function constituted a diagnostic tetrad. Of all the laboratory techniques, throat and urine cultures were the most consistent in confirming the diagnosis. Analysis of the epidemic implicated the communal hemodialysis unit as the source of exposure to the virus. CMV was not seen in the first 86 patients who received transplants in the program, but with increasing use of hemodialysis, the percentage of patients with positive serologic reaction for CMV increased dramatically.