Cytomegalovirus (Cmv)

cytomegalovirus

Cytomegalovirus (CMV, HHV-5) infection can cause a widely varying severity. There is often a syndrome resembling an infectious mononucleosis, but without severe pharyngitis. In HIV patients, rarely in organ transplant recipients and other immunocompromised patients, it can lead to severe focal disease, including retinitis. In newborns and immunocompromised patients, a severe systemic disease can develop. The laboratory diagnosis, helpful in severe diseases may include a cultural virus isolation, serological tests, biopsy, or the detection of antigen or nucleic acid. For the treatment of serious diseases, particularly retinitis is ganciclovir and other antiviral substances are suitable.

Cytomegalovirus (CMV, HHV-5) infection can cause a widely varying severity. There is often a syndrome resembling an infectious mononucleosis, but without severe pharyngitis. In HIV patients, rarely in organ transplant recipients and other immunocompromised patients, it can lead to severe focal disease, including retinitis. In newborns and immunocompromised patients, a severe systemic disease can develop. The laboratory diagnosis, helpful in severe diseases may include a cultural virus isolation, serological tests, biopsy, or the detection of antigen or nucleic acid. For the treatment of serious diseases, particularly retinitis is ganciclovir and other antiviral substances are suitable.

(Congenital and perinatal cytomegalovirus (CMV).) Cytomegalovirus (CMV, HHV-5) may cause infections with a widely varying severity. There is often a syndrome resembling an infectious mononucleosis, but without severe pharyngitis. In HIV patients, rarely in organ transplant recipients and other immunocompromised patients, it can lead to severe focal disease, including retinitis. In newborns and immunocompromised patients, a severe systemic disease can develop. The laboratory diagnosis, helpful in severe diseases may include a cultural virus isolation, serological tests, biopsy, or the detection of antigen or nucleic acid. For the treatment of serious diseases, particularly retinitis is ganciclovir and other antiviral substances are suitable. CMV (HHV-5: human herpes virus type 5) is transmitted by blood, body fluids or transplanted organs. The infection can be acquired perinatally or placenta. The Prävelanz increases with age; 60-90% of adults have a CMV infection (resulting in a lifelong latent infection). Socioeconomic less well-off groups tend to have a higher prevalence. Congenital infection may be asymptomatic or cause miscarriage, stillbirth or postnatal death. Complications are for. B. pronounced hepatic and central nervous injuries. Acquired infections are often asymptomatic. An acute febrile disease, called CMV mononucleosis can lead to hepatitis with elevated aminotransferases and atypical lymphocytes similar to infectious (mononucleosis due to Epstein-Barr virus. 2-4 weeks after a transfusion with CMV-positive blood products can a Postperfusions – / develop post-transfusion syndrome It causes fever that lasts 2-3 weeks, and at the same manifestations as a CMV mononucleosis in immunocompromised patients is CMV is a major cause of increased morbidity and mortality is the disease is often based on… a reactivation of latent viral infection. the lungs, the gastrointestinal tract or the central nervous system may be involved. CMV caused in end-stage AIDS infection until the late 1990s up to 40% of patients retinitis with fundoskopisch visible retinal changes may also. to ulcerative diseases of the colon (with abdomen Neuropathic Pain and gastrointestinal bleeding) or the esophagus come with odynophagia. Diagnosis Usually clinical assessment detection of CMV antigen or DNA urine culture in infants In immunocompromised patients often biopsy Serological tests CMV infection is suspected in healthy people with mononucleosis-like syndromes immunosuppressed patients with GI, CNS, or retinal symptoms newborn with systemic disease A CMV mononucleosis can from an infectious mononucleosis (EBV) can be distinguished by the absence of pharyngitis, a negative test for heterophile antibodies and serologic tests occasionally. CMV infection can be differentiated from a viral hepatitis by hepatitis serology. A clinical laboratory confirmation of a primary CMV infection is only necessary to distinguish them from others, partially treatable conditions or serious diseases. Seroconversion can be detected by the development of CMV antibodies and points to a new CMV infection. However, many of CMV disease resulting from reactivation of latent disease of the immunocompromised host. Reactivation of CMV can lead to virus in urine, other body fluids or tissues, but the presence of CMV in body fluids and tissues is not always indicative of a disease and can also represent only the eliminations. Therefore, often a biopsy that shows CMV-induced changes, necessary to prove invasive disease. Quantitative determination of CMV antigen or DNA in the peripheral blood can also be very helpful because often elevated or rising CMV antigenemia strongly suggestive of invasive disease. The diagnosis in newborns is provided by urine culture. Therapy In case of serious disease, antivirals (eg. As ganciclovir, valganciclovir, foscarnet, cidofovir) CMV retinitis, which usually occurs in AIDS patients is treated with systemic antivirals. Anti-CMV agents are also used to treat other serious diseases as retinitis, are here but less reliably effective than retinitis. CMV retinitis drugs for the treatment of CMV retinitis in induction and maintenance therapies include: ganciclovir or valganciclovir foscarnet with or without ganciclovir cidofovir Most patients receive induction therapy with either ganciclovir 5 mg / kg i.v. every 12 hours for 2-3 weeks or valganciclovir 900 mg po every 12 h for 21 days. When the induction therapy more than once failed, another substance should be used. After induction, patients 900 mg should be a maintenance or suppressive therapy po valganciclovir get 1 times a day, to prevent progression. And ganciclovir 5 mg / kg i.v. can be used as maintenance therapy to prevent relapse 1 times daily. Alternatively foscarnet can be given with or without ganciclovir. Foscarnet 60 mg / kg i.v. every 8 h applied over 2-3 weeks for induction, followed by 90-120 mg / kg i.v. 1 times daily as maintenance therapy. The adverse effects of i.v. Foscarnet are significant and include nephrotoxicity, symptomatic hypocalcemia, hypomagnesemia, hyperphosphatemia, hypokalemia, and CNS effects. Combination therapy with ganciclovir and foscarnet increases the effectiveness as well as the adverse effects. A Cidofovirtherapie with 5 mg / kg i.v. performed 1 time per week (induction) for 2 weeks, followed by a similar maintenance dose every other week. The efficacy similar to that of ganciclovir or foscarnet. Significant side effects such. B. kidney failure restrict the benefit of cidofovir a but. Cidofovir can iritis or ocular hypotension cause (intraocular pressure ? 5 mm Hg). The risk of nephrotoxicity may be reduced by the administration of probenecid and prewash before each dose. The side effects of probenecid, u. a. Rash, headache and fever, but may be so pronounced that must be apart from its use. In this case necessarily should also be dispensed with the gift of cidofovir, probenecid because not only reduces the nephrotoxicity of cidofovir crucial but also ensures that sufficient plasma levels of cidofovir are in the first place achieved. Even patients who received ocular injections, requiring systemic therapy to prevent CMV infection in the contralateral eye and extraocular tissues. Ultimately, an improvement in the number of CD4 + cells to> 100 cells / mm should reduce systemic antiretroviral therapy, the need for ocular implants and chemoprophylaxis. Prevention A secondary prophylaxis or “pre-emptive therapy” (ie, active monitoring of patients by monitoring the viral load and the administration of antiviral drugs to those with evidence of active infection) is effective to CMV disease or reactivation in recipients of solid organ to prevent or hematopoietic cell transplants who are infected with CMV and have the risk of CMV disease. Among the drugs used include ganciclovir, valganciclovir and foscarnet. Conclusion 60-90% of adults have a latent CMV infection CMV causes in healthy children and adults, if at all, only a weak, non-specific symptoms or sometimes a mononucleosis-like syndrome. A congenital infection can lead to stillbirth or severe, sometimes fatal postnatal complications including significant liver or nervous system damage. Highly immunocompromised patients can suffer from serious diseases that affect the retina, lungs, gastrointestinal tract or the central nervous system. Antiviral drugs can help as part of a reactivation of CMV in immunocompromised to behandlen retinitis, but are less effective if other organs are affected. Transplant patients at risk of CMV infection require prophylactic antivirals or close monitoring for early signs of infection.

Health Life Media Team

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