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Immune thrombocytopenia (ITP) is an acquired cause of thrombocytopenia characterized by the presence of autoantibodies against platelets. It may be primary or secondary to several conditions. We present the case of a 63-year-old woman with a diagnosis of immune thrombocytopenia refractory to conventional therapy. After she was tested for secondary causes of ITP, a diagnosis of acute cytomegalovirus (CMV) infection was made. She was treated with ganciclovir and presented normalization of platelet count. CMV-related Immune Thrombocytopenia should always be considered in certain cases of refractory ITP. If the diagnosis of ITP secondary to acute CMV infection is made, specific antiviral therapy with ganciclovir should be considered. In these cases, immunosuppressive agents, such as steroids, may worsen the ITP and should be tapered or withdrawn as rapidly as feasible.
A Púrpura Trombocitopênica Imune (PTI) é uma causa de trombocitopenia adquirida caracterizada pela presença de autoanticorpos contra plaquetas. A doença pode ser primária ou secundária a diversas condições. Apresentamos o caso de uma mulher de 63 anos com diagnóstico de PTI refratária à terapêutica convencional. A investigação de causas secundárias evidenciou infecção aguda por citomegalovírus (CMV). A paciente foi tratada com ganciclovir e evoluiu com normalização no nível de plaquetas. A PTI relacionada ao CMV deve sempre ser investigada em pacientes com PTI refratária, sendo a terapia antiviral específica com ganciclovir o tratamento de escolha. Nestes casos, os agentes imunossupressores, como os corticosteroides, podem piorar a PTI e devem ser reduzidos gradualmente ou retirados o mais rapidamente possível.
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Humans , Female , Middle AgedABSTRACT
Objective:To observe the changes of varicella zoster virus (VZV)-DNA load in aqueous humour samples in VZV-induced acute retinal necrosis (ARN) in the early stages of antiviral treatment.Methods:A retrospective observational clinical study. From April 2016 to April 2018, 24 patients with 24 eyes of VZV-induced ARN who were diagnosed by Department of Ophthalmology, Eye and ENT Hospital of Fudan University and received complete aqueous humor sampling were included in the study. Among them, there were 13 males with 13 eyes, 11 females with 11 eyes; 12 left eyes and 12 right eyes; the age was 52.0±9.5 years old (39-71 years old). The time from the onset of ocular symptoms to the diagnosis of ARN was 16.6±6.1 days (7-30 days). Best-corrected visual acuity (BCVA) and ultra-wide-field fundus imaging were performed in all affected eyes. The BCVA examination was carried out using the Snellen visual acuity chart, which was converted into the logarithm of the minimum angle of resolution (logMAR) visual acuity. All patients were given intravitreal injection of 40 mg/ml ganciclovir 0.1 ml (including 4 mg of ganciclovir), 2 times a week, until the active necrotizing retinal lesions subsided, at most after the diagnosis 4 weeks, with a maximum of 9 injections. The follow-up period was 12.8±5.6 months. The aqueous humor samples were collected at presentation and 4, 7, 14, 21, 28 days after the initiation of antiviral therapy, and the VZV-DNA load was detected by real-time quantitative polymerase chain reaction. A plateau phase and a logarithmic reduction phase of the DNA load changes were observed after antiviral treatment began. Wilcoxon rank sum test was used to compare and analyze the differences in BCVA between the eyes at baseline and last follow-up.Results:The mean viral load at presentation was 8.6×10 7±1.3×10 8 copies/ml. The initial plateau phase last for an average of 7.4±2.4 days. In the following logarithmic reduction phase, the mean slope of the decline in viral load was -0.13±0.04 log/day, and the expected time for half reduction of the initial viral load was 2.5±0.7 days. After 28 days antiviral treatment, the viral load decreased to 1.7×10 5±1.8×10 5 copies/ml. In the course of the disease, rhegmatogenous retinal detachment occurred in 16 eyes. Before treatment and at the last follow-up, the logMAR BCVA of the affected eye was 1.1±0.6 and 0.8±0.7, respectively. The results of correlation analysis showed that the logMAR BCVA at the last follow-up was correlated with the initial VZV-DNA load ( r=0.467, P=0.033). Conclusion:The VZV-DNA load in the aqueous humor of eyes with VZV-induced ARN is significantly decreased after antiviral treatment, which is closely related to the clinical process of ARN.
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Objective:To investigate the clinical manifestations of Epstein-Barr virus infection in children and the efficacy of interferon combined with ganciclovir.Methods:A total of 252 children with Epstein-Barr virus infection who received treatment in Liaocheng Maternal and Child Health Hospital from June 2018 to February 2020 were included in this study. They were randomly assigned to undergo treatment either with ganciclovir alone (control group, n = 126) or interferon combined with ganciclovir (experimental group, n = 126). General condition, clinical manifestation, clinical outcomes, and clinical efficacy were compared between the two groups. Results:The 252 children with Epstein-Barr virus infection were divided into four groups according to different age brackets: infancy (3.97%), early childhood (53.57%), preschool (28.97%), school age (13.49%). Children at the early childhood and preschool ages accounted for high proportions. Their clinical manifestations included fever, pharyngeal congestion, cervical lymph node swelling, and pharyngeal pain. Children with hepatosplenomegaly accounted for the highest proportion (44.12%) among those at the school age, and children with binocular edema accounted for the highest proportion (10.37%) among those at the early childhood age. The time to defervesce, eyelid edema, and lymph node regression in the experimental group were (3.55 ± 1.58) hours, (3.82 ± 1.17) hours, and (9.55 ± 1.60) hours respectively, which were significantly shorter than those in the control group [(4.40 ± 1.80) hours, (5.33 ± 1.58) hours, (10.44 ± 1.66) hours, t = 3.64, 2.47, 2.67, P < 0.001, P = 0.024, 0.009]. The total response rate was significantly higher in the experimental group than in the control group [96.03% (107/126) vs. 84.92% (121/126), χ2 = 9.03, P = 0.003]. Conclusion:Epstein-Barr virus infection has different clinical manifestations in children at different ages. Interferon combined with ganciclovir is more effective on Epstein-Barr virus infection than ganciclovir alone.
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Objective:To explore safe dosage of single intravitreal injection of ganciclovir (IVG) in healthy rabit eyes, and to explore retinal toxicity of different dosage of ganciclovir after continues intravitreal injection into the vitreous cavity of healthy albino rabbit eyes.Methods:Ten healthy New Zealand albino rabbits were divided into 5 groups with 2 rabbits in each group. Each group was injected with 1 mg/0.025 ml,2 mg/0.025 ml, 5 mg/0.025 ml, 10 mg/0.025 ml ganciclovir or 0.025 ml saline (control group). After 1 week of intervention, rabbits were examined by ultra-wide-angle fundus photography, optical coherence tomography (OCT) and full field electroretinogram (ERG). The maximum mixed response of rod and cone cells (Max-R) was measured under dark adaption conditions, cone response (Cone-R) and 30 Hz flicker response (30 Hz-R) were measured under light adaption conditions. Twenty-four healthy New Zealand albino rabbits were randomly divided into a low-dose experimental group, a low-dose control group, a high-dose experimental group, and a high-dose control group, with 6 rabbits in each group, with the right eye as the experimental eye. The rabbits in the high-dose experimental group were continuously injected with ganciclovir 2 mg/0.025 ml, once a week, for a total of 4 times. The rabbits in the low-dose experimental group were injected with 1 mg/0.025 ml ganciclovir, the induction period was 2 times/week, a total of 4 times; the maintenance period was 1 time/week, a total of 2 times. The rabbits in the high-dose control group and the low-dose control group were injected with 0.025 ml normal saline into the vitreous cavity respectively. Full-field ERG examination was performed 1 day before each injection and 1 week after the last injection. Max-R was measured under dark-adapted conditions, and Cone-R and 30 Hz-R were measured under light-adapted conditions. OCT was recorded before the first injection and one week after the last injection. One week after the last injection, the experimental rabbits in each group were sacrificed for hematoxylin-eosin staining, and the retinal structure was observed under a light microscope. The comparison of a-wave and b-wave amplitude of Max-R, Cone-R and 30 Hz-R amplitude at different time was performed by two independent sample nonparametric test.Results:There were no abnormal results of fundus photography, OCT and ERG after single intravitral injection of 1 mg or 2 mg ganciclovir. One week after single 5 mg IVG, fundus photography of rabbits showed vascular occlusion and preretinal hemorrhage and ERG showed slight decrease of amplitude of Max-R, Cone-R and 30 Hz-R. One week after single 10 mg IVG, retinal necrosis and exudative changes were also observed. OCT showed edema and unclear retinal structure in the necrotic area. ERG showed significant decrease of amplitude of Max-R, Cone-R and 30 Hz-R. After continuous IVG in high dose and low-dose experimental group, the amplitude of Max-R a wave ( Z=-0.160, 0.000) and b wave ( Z=-0.321, 0.000), Cone-R a wave ( Z=-0.641,-0.641) and b wave ( Z=-0.321, -0.160), and 30 Hz-R ( Z=-0.321,-0.160) showed no difference compared to control group. No histologic evidences of retinal microstructure abnormalities were found in both groups. OCT and fundus photography before and after the intervention did not show any difference, either. Conclusion:There was no retinal toxicity of continuous 1 mg or 2 mg IVG recorded in albino rabbits.
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Objective:To observe the ocular clinical features of infantile cytomegalovirus (CMV) infection.Methods:A retrospective clinical study. From March 2019 to July 2021, 876 eyes of 438 children with CMV infection who visited Department of Ophthalmology of Henan Provincial Children's Hospital were included in the study. Among them, there were 254 males and 184 females; the age ranged from 3 days to 11 months; the gestational weeks were 28 to 42 weeks; the birth weight was 1 120 to 8 900 g. There were 384 and 54 full-term and premature infants, respectively. Fundus examination was performed in 385 cases (770 eyes) after medical consultation; 53 cases (106 eyes) of premature infants were routinely screened. CMV retinitis (CMVR) was divided into granular type and fulminant type. Patients with CMV-related diseases with moderate to severe symptoms were given intravenous drip and/or oral ganciclovir; patients with severe fundus vasculitis were combined with intravitreal injection of ganciclovir. The follow-up period was from 4 to 28 months, and the characteristics of eye lesions, systemic comorbid diseases and treatment outcomes were observed.Results:There were 516 eyes of 258 cases with normal fundus (58.9%, 258/438); 291 eyes of 180 cases with CMVR (41.1%, 180/438), of which binocular and monocular were 111 (61.7%, 111/180) and 69 (38.3%, 69/180) cases. Among the 291 eyes of CMVR, 281 eyes (96.6%, 281/291) of granular type; yellow-white point-like opacity and/or retinal hemorrhage; 10 eyes (3.4%, 10/291) of fulminant type; fundus Showed a typical "cheese ketchup-like" and vascular white sheath-like changes. Among the 180 children with CMVR, 72 patients (118 eyes) were given systemic intravenous drip and/or oral ganciclovir; 5 patients (10 eyes) were given intravitreal ganciclovir, all of which were fulminant CMVR. At the last follow-up, fundus lesions regressed significantly in 100 eyes of 61 cases; 18 eyes of 11 cases had old lesions or uneven retinal pigment; 108 cases were not treated.Conclusion:The most common fundus manifestation of CMV infection in infants is granular retinitis, and fulminant retinitis is more severe, and the lesions can be significantly regressed after timely antiviral treatment.
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Introducción: La infección por citomegalovirus es muy frecuente en pacientes sometidos a trasplante de progenitores hematopoyéticos, debido a tratamientos mieloablativos de acondicionamiento, disparidad genética y al tratamiento inmunosupresor, y ocurre fundamentalmente después de la toma del implante. Objetivos: Actualizar el diagnóstico, manejo y seguimiento de la infección por citomegalovirus en pacientes trasplantados. Métodos: Se realizó revisión bibliográfica en los idiomas español e inglés, utilizando los motores de búsqueda de Pubmed, Google Académico y Scielo sobre el diagnóstico y manejo del citomegalovirus en pacientes receptores de trasplante hematopoyético. Análisis y síntesis de la información: Se recolectó y organizó la información obtenida siguiendo cronológicamente el surgimiento de técnicas para diagnóstico y la aparición de nuevos medicamentos en los últimos años. Se seleccionaron artículos recientes de expertos en el tema en revistas prestigiosas, donde se evidencia la importancia del diagnóstico adelantado y el inicio del tratamiento. Conclusiones: En la actualidad se cuenta con nuevas formas de diagnóstico y medicamentos novedosos para el citomegalovirus, pero la mortalidad puede llegar a ser alta, si el paciente no es tratado antes de que aparezcan los síntomas de la enfermedad e incluso a pesar del tratamiento. En ocasiones, no es posible erradicar el virus, lo que lleva a complicaciones importantes y a la muerte. La enfermedad citomegálica continúa siendo una complicación frecuente en estos pacientes a pesar de las medidas para evitar su reactivación(AU)
Introduction: Cytomegalovirus infection is very common in patients undergoing hematopoietic progenitor transplantation, due to myeloablative conditioning treatments, genetic disparity, and immunosuppressive treatment, and occurs mainly after the engrafment. Objective: A review and update of the diagnosis and management of cytomegalovirus is made in hematopoietic transplant recipients. Method: A bibliographic review was carried out in Spanish and English, using the search engines of Pubmed, Scholar Google and Scielo about the diagnosis and management of cytomegalovirus in hematopoietic transplant recipients. Development: The information obtained was collected and organized chronologically about the emergence of techniques for diagnosis and the appearance of new drugs in recent years. Recent articles by experts in prestigious journals were reviewed and the importance of early diagnosis and initiation of treatment is evidenced. Conclusions: There are currently new forms of diagnosis and novel medications, but mortality can be high, if the patient is not treated before the symptoms of the disease appear and even despite treatment, sometimes it is not possible to eradicate the virus, leading to major complications and death. Cytomegalic disease continues to be a frequent complication in these patients despite measures to prevent virus reactivation(AU)
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Humans , Male , Female , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnosis , Hematopoietic Stem Cell Transplantation/adverse effects , Cytomegalovirus , Early Diagnosis , Transplant RecipientsABSTRACT
Objective To evaluate the diagnostic value of quantitative detection of cytomegalovirus (CMV) DNA from different sources [plasma, sputum and bronchoalveolar lavage fluid(BALF)] for CMV pneumonia after allogeneic hematopoietic stem cell transplantation. Methods Clinical data of 405 recipients undergoing allogeneic hematopoietic stem cell transplantation were retrospectively analyzed. Among them, 19 recipients diagnosed with CMV pneumonia were assigned into the CMV pneumonia group, and 229 recipients with CMV viremia alone, 11 recipients without CMV pneumonia who received fiberoptic bronchoscopy and 16 recipients diagnosed with bacterial or fungal pneumonia based on pathogenic evidence receiving sputum culture were assigned into the control A, B and C groups, respectively. The incidence of CMV pneumonia was summarized. The CMV DNA load of specimens from different sources (plasma, sputum and BALF) of recipients with CMV pneumonia was analyzed. The clinical prognosis of recipients with CMV pneumonia was evaluated. Results Among 405 recipients undergoing allogeneic hematopoietic stem cell transplantation, 19 cases developed CMV pneumonia, and the overall incidence of CMV pneumonia was 4.7%(19/405). The CMV DNA load in the plasma, sputum and BALF of recipients with CMV pneumonia was higher than those in the control A, B and C groups (all P < 0.05). In the 19 recipients, 12 cases were cured after antiviral treatment and 7 died from treatment failure(3 cases abandoned treatment). The fatality was 37%(7/19). Conclusions Quantitative detection of CMV DNA in the plasma, sputum and BALF may increase the diagnostic rate of CMV pneumonia, thereby improving clinical prognosis of recipients undergoing allogeneic hematopoietic stem cell transplantation.
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PURPOSE: To report a case of retinal toxicity after an intravitreal ganciclovir injection to treat acute retinal necrosis in an eye filled with silicone oil.CASE SUMMARY: A 56-year-old male presented with ocular pain and visual loss in his right eye. His best-corrected visual acuity was 20/25, inflammatory cells in the anterior chamber, multiple retinitis lesions and retinal vessel occlusions in the peripheral retina and vitreous opacity were showed. Acute retinal necrosis was suspected, anterior chamber polymerase chain reaction (PCR) test was done. Aciclovir 2,400 mg/day intravenously and ganciclovir 2.0 mg were administered by intravitreal injection. After 4 days, retinitis was worsened and PCR test was positive for varicella zoster virus. Ganciclovir intravitreal injections were increased twice a week. After 16 days, retinal detachment occurred, so scleral encircling, vitrectomy, laser photocoagulation, and silicone oil tamponade were conducted. Ganciclovir 1.0 mg was injected at the end of surgery. The patient's visual acuity decreased to hand motion, and multiple crystal deposits with multiple retinal hemorrhages were observed in the right eye the next day. Visual acuity did not recover and optical coherent tomography showed that the macula was thinned.CONCLUSIONS: Visual loss seemed to be related with the retinal toxicity of ganciclovir. The increased local concentration due to the silicone oil tamponade is thought to have caused the toxicity.
Subject(s)
Humans , Male , Middle Aged , Acyclovir , Anterior Chamber , Ganciclovir , Hand , Herpesvirus 3, Human , Intravitreal Injections , Light Coagulation , Polymerase Chain Reaction , Retina , Retinal Detachment , Retinal Hemorrhage , Retinal Necrosis Syndrome, Acute , Retinal Vessels , Retinaldehyde , Retinitis , Silicon , Silicones , Visual Acuity , VitrectomyABSTRACT
@#AIM: To compare the clinical characteristics of cytomegalovirus positive and negative patients with Posner-Schlossman syndrome(PSS), and the clinical efficacy and short-term recurrence of 20g/L ganciclovir eye drops in local treatment of patients with CMV positive PSS were evaluated. <p>METHODS: Differences between CMV positive(86 cases, 86 eyes)and CMV negative(60 cases, 60 eyes)PSS patients were compared. General information, ocular parameters and distribution, IFN-γ and IL-4 levels in aqueous humor, clinical efficacy and recurrence within 1a were compared between the conventional group(30 cases, 30 eyes)and the experimental group(56 cases, 56 eyes).<p>RESULTS: Among the 146 PSS patients included, the CMV positive rate was 58.9%. The average intraocular pressure and the difference in the number of corneal endothelial cells between the onset eye and the contralateral eye in CMV positive patients were significantly increased, and the number of corneal endothelial cells in the onset eye was significantly decreased(<i>P</i><0.05). After treatment, all ocular parameters and distribution in the experimental group were significantly better than those in the conventional group(<i>P</i><0.05), IFN-γ level in the experimental group was significantly lower than that in the conventional group, and IL-4 level was significantly higher than that in the conventional group(<i>P</i><0.05). Compared with the conventional group, the experimental group had a high total effective rate, a short cure time, a low recurrence rate within 1a and a long recurrence interval, with statistically significant differences(<i>P</i><0.05).<p>CONCLUSION: Patients with CMV positive PSS had higher intraocular pressure and greater damage to corneal endothelial cells than PSS patients with CMV negative. 20g/L ganciclovir eye drops can effectively control intraocular pressure and inflammation by resisting CMV infection, with significant clinical efficacy and not easy to relapse in the short term.
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Resumen: Introducción: la citomegalovirosis es la infección connatal con mayor prevalencia y la causa más frecuente de sordera neurosensorial de origen no genético. Es una patología mayormente asintomática hasta en 90% de los casos. Existen en nuestro país escasos datos sobre la epidemiología de esta enfermedad. Objetivo: conocer el perfil epidemiológico de la citomegalovirosis connatal sintomática en el Centro Hospitalario Pereira Rossell. Material y método: estudio descriptivo, transversal, longitudinal. Fuente de datos: historias clínicas electrónicas del servicio. Criterios de inclusión: neonatos hospitalizados entre el 1/1/2010 y el 31/12/2018 con reacción en cadena de polimerasa (PCR) para citomegalovirus positiva en orina, saliva o sangre en las primeras tres semanas de vida y al menos una manifestación clínica o paraclínica. Resultados: 19 pacientes cumplieron los criterios establecidos. Incidencia 0,2/1000 nacidos vivos. Fallecieron dos pacientes. El diagnóstico fue realizado por PCR en sangre o en orina. Las manifestaciones clínicas más frecuentes fueron pacientes pequeños para la edad gestacional, microcefalia y hepatoesplenomegalia. Alteraciones paraclínicas: alteraciones imagenológicas del sistema nervioso central, alteraciones hematológicas y alteraciones del hepatograma. El tratamiento fue iniciado en todos los casos con ganciclovir, pero heterogéneo en la duración y continuación. Conclusiones: los hallazgos en cuanto a prevalencia de citomegalovirosis connatal sintomática, manifestaciones clínicas y paraclínicas son coincidentes con la bibliografía internacional. Es fundamental la creación de un protocolo de manejo del paciente con citomegalovirosis connatal.
Summary: Introduction: cytomegalovirus is a greatly prevalent connatal infection and it is the most common cause of non-genetic sensorineural hearing loss. Mostly, in up to 90% of the cases, is asymptomatic. There is few data in Uruguay regarding its epidemiology. Objective: to learn about the symptomatic connatal cytomegalovirus epidemiological profile at the Pereira Rossell Children Hospital. Materials and methods: descriptive transversal longitudinal study. Source of data: electronic medical records. Selection criteria: hospitalized newborns between Jan 1, 2010 and Dec 31,2018 showing a polymerase chain reaction (PCR) for positive cytomegalovirus in urine, saliva or blood during the first 3 weeks of life and at least one clinical or paraclinical reaction. Results: 19 patients met the criteria. Incidence: 0,2/1000 of live newborns. Two patients died. A blood or urine PCR test was carried out. The most common clinical symptoms were: small-sized babies for their gestational age, microcephaly, hepatosplenomegaly. Paraclinical alterations: imagological SNC alterations, hematological alterations and hepatogram alterations. Ganciclovir treatment was started in every case, but treatment duration and continuity were heterogeneous. Conclusions: the findings regarding symptomatic connatal cytomegalovirus prevalence and their clinical and paraclinical symptoms met the international literature findings. It is essential to create a patient management protocol for patients with connatal cytomegalovirus.
Resumo: Introdução: o citomegalovírus é uma infecção congênita muito prevalente e é a causa mais comum de perda auditiva neurossensorial não genética. É principalmente assintomático, em até 90% dos casos. Existem poucos dados no Uruguai sobre a sua epidemiologia. Objetivo: conhecer o perfil epidemiológico do citomegalovírus congênito sintomático no Hospital Pediátrico Pereira Rossell. Materiais e métodos: estudo longitudinal transversal descritivo. Fonte dos dados: prontuários eletrônicos. Critérios de seleção: recém-nascidos hospitalizados entre 1º de janeiro de 2010 e 31 de dezembro de 2018 que mostraram uma reação em cadeia da polimerase (PCR) para citomegalovírus positivo na urina, saliva ou sangue durante as primeiras 3 semanas de vida e pelo menos uma reação clínica ou para clínica. Resultados: 19 pacientes preencheram os critérios. Incidência: 0,2/1000 de recém-nascidos vivos. Dois pacientes morreram. Foi realizado um teste de PCR no sangue ou na urina. Os sintomas clínicos mais comuns foram: crianças de pequeno porte para a idade gestacional, microcefalia, hepatoesplenomegalia. Alterações para clínicas: alterações hematológicas, alterações no hepatograma e alterações imagiológicas do SNC. O tratamento com Ganciclovir foi iniciado em todos os casos, mas a duração e a continuidade do tratamento foram heterogêneas. Conclusões: os resultados referentes à prevalência de citomegalovírus congênito sintomático, assim como os sintomas clínicos e para clínicos concordaram com aquilos achados da literatura internacional. É essencial criar um protocolo de gerenciamento para pacientes com citomegalovírus congênito.
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Equid alphaherpesvirus 1 (EHV-1) is an important pathogen of horses, associated with respiratory, neurological disease and abortions. As vaccination is not always effective, anti-herpetic therapy may represent an alternative to prevent the losses caused by the infection. We herein investigated the activity of ganciclovir (GCV), an anti-herpetic human drug, in rabbits experimentally infected with EHV-1. Thirty-days-old New Zealand rabbits were allocated in three groups (6 animals each) and submitted to different treatments: G1 (non-infected controls), G2 (inoculated with EHV-1) - 107 TCID50 intranasally - IN) and G3 (inoculated IN with EHV-1 and treated with GCV - 5mg/kg/day for 7 days) and monitored thereafter. All animals of G2 developed systemic signs (moderate to severe apathy, anorexia), ocular discharge and respiratory signs (serous to mucopurulent nasal discharge), including mild to severe respiratory distress. Viremia was detected in all rabbits of G2 for up to 11 days (mean duration = 6.5 days). One animal died after severe respiratory distress and neurological signs (bruxism, opistotonus). In addition, these animals gained less weight than the control (G1) and GCV-treated rabbits (G3) from days 4 to 14pi (p<0.05). The clinical score of rabbits of G2 was statistically higher than the other groups from days 3 to 6pi (p<0.05), demonstrating a more severe disease. In contrast, G3 rabbits did not present systemic signs, presented only a mild and transient nasal secretion and gained more weight than G2 animals (p<0.05). In addition, viremia was detected in only 3 rabbits and was transient (average of 2.3 days). Thus, administration of GCV to rabbits inoculated IN with EHV-1 resulted in an important attenuation of the clinical disease as demonstrated by full prevention of systemic signs, maintenance of weight gain and by drastic reduction in viremia and in the magnitude of respiratory signs. These results are promising towards further testing of GCV as a potential drug for anti-herpetic therapy in horses.(AU)
O alfaherpesvírus equino 1 (EHV-1) é um importante patógeno de equinos, associado com doença respiratória, neurológica e abortos. Como a vacinação nem sempre é eficaz, a terapia anti-herpética pode representar uma alternativa para prevenir as perdas causadas pela infecção. Para tal, investigou-se a atividade do ganciclovir (GCV), uma droga anti-herpética de uso humano, em coelhos infectados experimentalmente com o EHV-1. Coelhos da raça Nova Zelândia com 30 dias de idade foram alocados em três grupos (6 animais cada) e submetidos a diferentes tratamentos: G1 (controles não infectados), G2 (inoculados com o EHV-1) - 107 TCID50 intranasal - IN) e G3 (inoculados IN com o EHV-1 e tratados com GCV - 5mg/kg/dia por 7 dias), e monitorados posteriormente. Todos os animais do G2 desenvolveram sinais sistêmicos (apatia moderada a grave, anorexia), secreção ocular e sinais respiratórios (secreção nasal serosa a mucopurulenta), incluindo dificuldade respiratória leve a grave. Viremia foi detectada em todos os coelhos do G2 por até 11 dias (duração média = 6,5 dias). Um animal morreu após dificuldade respiratória grave e sinais neurológicos (bruxismo, opistótono). Além disso, esses animais ganharam menos peso que os coelhos controle (G1) e tratados com GCV (G3) entre os dias 4 e 14pi (p<0,05). O escore clínico de coelhos do G2 foi estatisticamente maior que os demais grupos dos dias 3 a 6pi (p<0,05), demonstrando uma doença mais grave. Em contraste, os coelhos do G3 não apresentaram sinais sistêmicos, apresentaram apenas secreção nasal leve e transiente e ganharam mais peso que os animais do G2 (p<0,05). Além disso, a viremia foi detectada em apenas 3 coelhos e foi transitória (média de 2,3 dias). Assim, a administração de GCV a coelhos inoculados com EHV-1 resultou em uma importante atenuação da doença clínica, como demonstrado pela prevenção completa de sinais sistêmicos, manutenção do ganho de peso e pela redução drástica da viremia e da magnitude dos sinais respiratórios. Estes resultados são promissores para testes adicionais com o GCV para potencial terapêutico anti-herpética em equinos.(AU)
Subject(s)
Animals , Rabbits , Ganciclovir/therapeutic use , Herpesvirus 1, Equid , Herpesviridae Infections/drug therapy , Respiratory Tract Diseases/veterinary , Models, AnimalABSTRACT
@#AIM:To study the effect of biological keratoconjunctivitis combined with Ganciclovir Pellicles in patients with infectious keratitis and the effect on serum levels of inflammatory factors.<p>METHODS: In this study, 54 patients with 54 eyes were selected as the research object and divided into the observation group and the control group according to the random number table method. All patients were treated with bioartificial corneal transplantation. The patients in the observation group were treated with Ganciclovir eye drops, and the control group was treated with Aciclovir eye drops. The changes of LogMAR visual acuity, corneal transparency, serum inflammatory factors and cytokines were analyzed.<p>RESULTS: The rates of getting rid of blindness in the observation group and the study group were 93% and 89% respectively(<i>P</i>=0.642). The LogMAR visual acuity of two groups were significantly improved in 1wk and 6mo after operation compared with that before operation(<i>P</i><0.05). At 7d after operation, the levels of IL-6, TNF-α, INF- γ, SOD, NO and MDA in the two groups were significantly improved, and the improvement of the indexes in the observation group was better than that of the control group(<i>P</i><0.05). The rate of adverse reaction rate between two groups showed no significant difference(<i>P</i>=0.556).<p>CONCLUSION: Biological keratoconus combined with Ganciclovir has a good effect on viral keratitis, which can improve vision, inflammation and reduce the level of MDA.
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PURPOSE: We report a case of cytomegalovirus (CMV) retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient diagnosed with non-infectious uveitis. CASE SUMMARY: A 60-year-old woman was referred to our hospital for recurrent anterior uveitis. Fundus examination and fluorescein angiography showed dense vitritis, but no definite retinal infiltration. After laboratory examinations, the patient was diagnosed with non-infectious panuveitis. Uveitis was much improved after the patient started taking oral steroid medication. However, the patient complained of systemic side effects from the oral steroids. Medication was stopped, and an intravitreal dexamethasone implant was fitted to address worsening inflammation. Two months later, perivascular retinal infiltration developed and vitritis recurred. Viral retinitis was suspected, and the patient underwent diagnostic vitrectomy adjunctive with intravitreal ganciclovir injection. Polymerase chain reaction of vitreous fluid confirmed the diagnosis of CMV retinitis. The patient has remained inflammation-free for more than 20 months after vitrectomy, single ganciclovir injection, and 2 months of oral valganciclovir medication. CONCLUSIONS: This is a case report of CMV retinitis following placement of an intravitreal dexamethasone implant in an immunocompetent patient without any risk factors or previous history of immunosuppression. Potential risk factors for CMV retinitis should be evaluated and careful follow-up should be performed when intravitreal dexamethasone injections are unavoidable for the treatment of non-infectious uveitis.
Subject(s)
Female , Humans , Middle Aged , Cytomegalovirus Retinitis , Cytomegalovirus , Dexamethasone , Diagnosis , Fluorescein Angiography , Follow-Up Studies , Ganciclovir , Immunosuppression Therapy , Inflammation , Panuveitis , Polymerase Chain Reaction , Retinaldehyde , Retinitis , Risk Factors , Steroids , Uveitis , Uveitis, Anterior , VitrectomyABSTRACT
Objective To compare the clinical effects of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis.Methods From March 2014 to March 2016,80 patients with acute idiopathic facial neuritis admitted in the department of neurology of Luzhong Hospital were randomly divided into treatment group and control group according to the admission sequence,with 40 cases in each group.The two groups were given basic treatment (mecobalamine intramuscular injection + clonazepam and continuous application for 15d),and the treatment group was excluded from the corticosteroid application.On this basis,ganciclovir combined with dexamethasone was applied in the treatment group,and ganciclovir was applied in the control group.Both two groups had a course of 15 days.All the patients were graded by Portmann simple scale before treatment and at 7 days and 15 days after treatment,and statistical significance of SPSS13.0 software was adopted.Results Intra-group comparison:after treatment of 7d,the score of the treatment group was (10.11 ± 3.62) points,which was significantly higher than (2.60 ± 2.22) points before treatment (t =1.432,P ＜ 0.05).The score had no statistically significant difference between 7d after treatment [(10.11 ± 3.62)points] and 15d after treatment [(11.82 ±3.02) points] in the treatment group (t =1.582,P ＞ 0.05).In the control group,the score had no statistically significant difference between 7 d after treatment [(3.22 ± 3.12) points] and before treatment [(2.70 ± 2.30) points](t =0.923,P ＞0.05).Comparison between the two groups:there was no statistically significant difference in pretreatment score between the two groups (P ＞ 0.05).The score of the treatment group at 7d after treatment [(10.11 ±3.62) points] was significantly different from that of the control group[(3.22 ± 3.12)points] (t =1.633,P ＜ 0.05).There was no statistically significant difference in scores between the two groups at 15d after treatment (P ＞ 0.05).Conclusion Ganciclovir combined with dexamethasone and ganciclovir alone are effective in the treatment of acute idiopathic facial neuritis.Although the improvement effect of the combined treatment is earlier than that of single use,there is no significant difference in the total effective rate between the two treatments.
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Objective: Hematological toxicity, including neutropenia and thrombocytopenia, is a typical side effect of ganciclovir (GCV). We previously developed a risk-prediction model for GCV-induced neutropenia using decision tree (DT) analysis. By employing the DT model, which is a flowchart-like framework, users can predict the combination of factors that may increase neutropenia risk. However, a risk-prediction model for thrombocytopenia has not been established. Here, we aimed to identify the risk factors associated with GCV-induced thrombocytopenia and construct risk-prediction models.Method: We retrospectively evaluated the medical records of 386 patients who received GCV between April 2008 and March 2018 at Hokkaido University Hospital. Thrombocytopenia is defined as a decrease in the platelet count (PLT) to ＜50,000 cells/mm3 and to a ＜75% decrease. Risk factors of thrombocytopenia were extracted from the medical records using a multiple logistic regression analysis. Moreover, we employed chi-squared automatic interaction detection (CHAID) and classification and regression tree (CRT) algorithms to develop the DT models. The accuracies of the established models were evaluated to assess their reliability.Results: Thrombocytopenia occurred in 47 (12.2%) patients. In the multiple logistic regression analysis, data of patients with white blood cells ＜7,000 cells/mm3,PLT＜101,000 cells/mm3 and total bilirubin ≥ 0.8 mg/dL were extracted. Two risk-prediction models were constructed, and patients were divided into six and seven subgroups. In both algorithms, data on hematopoietic stem cell transplantations, PLT ＜101,000 cells/mm3, serum albumin ＜ 2.8 g/dL, total bilirubin ≥ 0.8 mg/dL, and residence in intensive care unit were extracted. The predictive accuracy of both the CHAID algorithm and the logistic regression models was 87.8% and that of the CRT algorithm was 88.3%, indicating they were reliable.Conclusion: We successfully identified the factors associated with GCV-induced thrombocytopenia and constructed useful flowchartlike risk-prediction models.
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Objective@#To compare the clinical effects of ganciclovir combined with dexamethasone and ganciclovir alone in the treatment of acute idiopathic facial neuritis.@*Methods@#From March 2014 to March 2016, 80 patients with acute idiopathic facial neuritis admitted in the department of neurology of Luzhong Hospital were randomly divided into treatment group and control group according to the admission sequence, with 40 cases in each group.The two groups were given basic treatment (mecobalamine intramuscular injection + clonazepam and continuous application for 15d), and the treatment group was excluded from the corticosteroid application.On this basis, ganciclovir combined with dexamethasone was applied in the treatment group, and ganciclovir was applied in the control group.Both two groups had a course of 15 days.All the patients were graded by Portmann simple scale before treatment and at 7 days and 15 days after treatment, and statistical significance of SPSS13.0 software was adopted.@*Results@#Intra-group comparison: after treatment of 7d, the score of the treatment group was (10.11±3.62)points, which was significantly higher than (2.60±2.22)points before treatment(t=1.432, P<0.05). The score had no statistically significant difference between 7d after treatment[(10.11±3.62)points] and 15d after treatment[(11.82±3.02)points] in the treatment group (t=1.582, P>0.05). In the control group, the score had no statistically significant difference between 7d after treatment[(3.22±3.12)points] and before treatment[(2.70±2.30)points] (t=0.923, P>0.05). Comparison between the two groups: there was no statistically significant difference in pre-treatment score between the two groups (P>0.05). The score of the treatment group at 7d after treatment[(10.11±3.62)points] was significantly different from that of the control group[(3.22±3.12)points](t=1.633, P<0.05). There was no statistically significant difference in scores between the two groups at 15d after treatment (P>0.05).@*Conclusion@#Ganciclovir combined with dexamethasone and ganciclovir alone are effective in the treatment of acute idiopathic facial neuritis.Although the improvement effect of the combined treatment is earlier than that of single use, there is no significant difference in the total effective rate between the two treatments.
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Adenovirus pneumonia is a common type of pneumonia in immunocompetent and immunocompromised patients, and its prognosis is poor.Antiviral therapy includs ganciclovir, valganciclovir, cidofovir, brincidofovir, ribavirin and so on.Among them, cidofovir and brincidofovir have obvious antiviral activity against adenovirus in vitro and in vivo, but further RCT results are still needed.Therefore, antiviral therapy of adenovirus pneumonia still needs further study.
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Adenovirus pneumonia is a common type of pneumonia in immunocompetent and immu-nocompromised patients,and its prognosis is poor. Antiviral therapy includs ganciclovir,valganciclovir,cido-fovir,brincidofovir,ribavirin and so on. Among them,cidofovir and brincidofovir have obvious antiviral activ-ity against adenovirus in vitro and in vivo,but further RCT results are still needed. Therefore,antiviral therapy of adenovirus pneumonia still needs further study.
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La infección por Citomegalovirus (CMV) se considera la infección viral más frecuente en la gestante, el feto y el recién nacido. Con el objetivo de describir el perfil clínico de la infección congénita por Citomegalovirus en pacientes que ingresaron al Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga durante el lapso 2012-2016, se realizó un estudio retrospectivo seleccionando un total de 33 historias clínicas para su evaluación; 60,6% de pacientes presentaron infección congénita por CMV mientras que 39,3% fueron diagnosticados con síndrome de TORCH. El mayor porcentaje de pacientes tenían una edad menor a 7 días (63,6%), con predominio del sexo masculino (63,6%), edad gestacional menor de 36 semanas (69,7%) y un peso al nacer entre 2501-3000 grs (51,5%). La edad promedio del diagnóstico fue de 17,9 ± 10,4 días. El 96,9% de los pacientes presentaron ictericia, petequias (42,4%), enteritis y hepatoesplenomegalia (27,2%, respectivamente). Entre los resultados paraclínicos, 96,9% de los pacientes presentó hiperbilirrubinemia, leucocitosis (72,7%), trombocitopenia (81,8%), aumento de las transaminasas glutámico oxalacética y pirúvica (78,7% y 42,4%, respectivamente). El 96,9% de los pacientes reportaron PCR positivo en sangre, mientras que en 18,1% de los casos el PCR fue positivo en orina y 3% presentaron IgM positiva. Sólo 12,1% de los pacientes recibieron inmunoglobulina humana y 6% recibieron ganciclovir. El tiempo de evolución promedio fue de 25,2 ± 12,5 días y 90,9% de los pacientes evolucionaron satisfactoriamente. En conclusión, este estudio aporta información relevante sobre el perfil clínico de la infección congénita por CMV con el fin de contribuir a mejorar la atención de este tipo de casos en nuestro centro de salud(AU)
Cytomegalovirus (CMV) infection is considered the most common cause of viral infection in pregnant women, the fetus and newborn. With the aim of describing the clinical profile of congenital cytomegalovirus infection in patients admitted in the Servicio Desconcentrado Hospital Pediátrico Dr. Agustín Zubillaga during the 2012-2016 period, we conducted a retrospective study selecting 33 clinical histories to review; 60.6% of patients had congenital CMV infection while 39.3% had TORCH syndrome. 63.6% of patients were < 7 days at the moment of diagnosis, predominantly male (63.6%), with a gestational age < 36 weeks (69.7%) and a birth weight between 2501-3000 grs (51.5%). The average age of diagnosis was 17.9 ± 10.4 days; 96.9% of patients had jaundice, petechial rash (42.4%), enteritis and hepatosplenomegaly (27.2%, respectively). Hyperbilirubinemia was found in 96,9% of patients, leukocytosis in 72,7%, thrombocytopenia in 81.8% and high glutamic oxalacetic and pyruvic transaminase levels in 78.7% and 42.4% of cases. 96.9% of cases reported positive blood PCR, 18.1% positive PCR in urine and 3% positive IgM. Only 12.1% of patients received human immunoglobulin and 6% received ganciclovir. The average hospital stay was 25.2 ± 12.5 days and 90.9% of patients responded satisfactorily. This study provides relevant information on the clinical profile of congenital CMV infection in order to help improve the management of this type of cases in our hospital(AU)
Subject(s)
Humans , Male , Female , Infant, Newborn , Polymerase Chain Reaction , Cytomegalovirus Infections , Clinical Laboratory Techniques , Pregnant Women , Fetus , Antiviral Agents , Diagnostic Imaging , Ganciclovir/therapeutic use , Cerebrospinal FluidABSTRACT
Cytomegalovirus(CMV) infection may be acquired congenitally, perinatally or postnatally in babies. Congenital and perinatal CMV infection can be diagnosed by viral culture or detection and quantitation of CMV DNAby Real Time Quantitative PCR (RT-qPCR) in blood ,urine and body fluids. The objective of this study was to diagnose and determine CMV load in infants presenting with clinical features suggestive of cytomegalovirus infection by RT-qPCR of urine. This descriptive study was done on babies admitted to the Departments of Neonatology and Paediatrics Govt Medical College, Kozhikode from January 2015 to December 2017. Urine samples from 142 babies were received and processed in the Microbiology Department. DNA isolation and amplification was performed using commercial DNA extraction kit and PCR kit for detection and quantification of CMV. Serum samples of the babies with CMV viruria were tested for CMV IgM antibodies. Of 142 babies suggestive of CMVinfection CMV-DNAwas detected and quantitated in urine of 25 (17.60%) (mean age 3.36 months). . CMVIgM was positive in 15/25(60%) babies with viruria .Twenty two had congenital CMV infection (cCMV) and 3 had perinatal infection.The most common clinical presentation was jaundice 13( 52%). Of 8 babies started on Ganciclovir 7 responded to treatment. RT-qPCR helps in diagnosing and quantitating CMVload which helps in deciding on therapy and assessing response to treatment,and can predict risk for long term sequelae.