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1.
Rev. méd. Chile ; 148(6): 778-786, jun. 2020. tab, graf
Article in English | LILACS | ID: biblio-1139371

ABSTRACT

ABSTRACT Background: Cytomegalovirus (CMV) is an opportunistic infection (OI) in immunosuppressed patients. However, there are no clear cut-off values available for quantitative plasmatic CMV measures (viral load [VL]) to discriminate those with CMV illness from those infected suffering a transient viral reactivation. Aim: To estimate a CMV VL cut-off point that discriminates infected patients and those with CMV related diseases, and to clinically characterize AIDS patients with this OI. Patients and Methods: Retrospective analysis of AIDS patients admitted by any reason between years 2017 and 2019 and who had a positive plasma CMV VL at any titer. Cases were categorized with illness or infected using accepted criteria and the cut-off value was obtained by receiver operating characteristic curve (ROC) analysis. Results: Twelve patients were identified as having a CMV-associated illness and seven with CMV infection. A CMV VL of 3,800 copies/mL had a sensitivity of 91.6% and 100% specificity to discriminate both states. Of the 12 patients with CMV illness, all were in AIDS stage and only five were receiving HIV therapy. Predominant clinical presentations were gastrointestinal (50%), followed by liver involvement (25%) and CMV disease (25%). All patients were treated with ganciclovir or valganciclovir. Ten patients had a favorable response (83.3%), one patient only had a laboratory improvement (8.3%) and one died during treatment (8.3%). Drug toxicity was recorded in nine patients but in only three cases, a dose adjustment was necessary. Conclusions: The predominant clinical manifestation in our series was gastrointestinal. A CMV VL cutoff level of CMV VL of 3,800 copies / mL is useful to discriminate infected patients from those with CMV related disease.


Antecedentes: Citomegalovirus (CMV) es una infección oportunista (IO) en pacientes inmunosuprimidos. Sin embargo, se requieren puntos de corte de carga viral (CV) para discriminar a aquellos con enfermedad por CMV de aquellos infectados que sufren una reactivación viral transitoria. Objetivos: Estimar un punto de corte de la CV de CMV que discrimine a los enfermos de los infectados y, además, caracterizar clínicamente a los pacientes con sida que presentan esta IO. Pacientes y Métodos: Análisis retrospectivo de pacientes con sida hospitalizados por cualquier motivo entre los años 2017 y 2019, y que presentaron un CV de CMV plasmática positiva a cualquier título. Los casos se clasificaron como enfermos utilizando criterios aceptados y el valor de corte se obtuvo mediante análisis de una curva ROC. Resultados: Durante el período de estudio, 12 pacientes fueron identificados con enfermedad asociada al CMV y siete con infección. Una CV de 3.800 copias/ml logró una sensibilidad de 91,6% y una especificidad de 100% para discriminar ambos estados. De los 12 pacientes enfermos, todos estaban en etapa de sida y solo 5 recibían terapia contra el VIH. La presentación clínica predominante fue gastrointestinal (50%) seguida del compromiso hepático (25%) y de la enfermedad por CMV (25%). Todos los pacientes fueron tratados con ganciclovir o valganciclovir. Diez pacientes tuvieron una respuesta favorable (83,3%), uno solo tuvo mejoría de laboratorio (8,3%) y otro paciente falleció durante el tratamiento (8,3%). Nueve pacientes evolucionaron con toxicidad farmacológica, pero en solo 3 casos fue necesario ajustar las dosis. Conclusiones: La forma predominante de presentación de la enfermedad fue gastrointestinal. Un punto de corte de 3.800 copias/ml discrimina pacientes infectados de aquellos con la enfermedad.


Subject(s)
Humans , Acquired Immunodeficiency Syndrome/complications , Acquired Immunodeficiency Syndrome/drug therapy , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Antiviral Agents/therapeutic use , Ganciclovir/therapeutic use , Retrospective Studies , Viral Load , Cytomegalovirus
2.
Rev. Soc. Bras. Med. Trop ; 51(2): 141-145, Mar.-Apr. 2018. tab, graf
Article in English | LILACS | ID: biblio-897064

ABSTRACT

Abstract INTRODUCTION: Human cytomegalovirus is one of the causes of opportunist infections in immunocompromised patients, and is triggered by factors such as state of viral latency, weakened immune responses, and development of antiviral resistance to ganciclovir, the only drug offered by the public health system in Brazil to treat the infection. The goal of this study was to identify mutations that may be associated with antiviral resistance in immunocompromised patients. METHODS: Molecular analysis was performed in 82 blood samples and subjected to genomic DNA extraction by a silica-based method. Three sequences of the HCMV UL97 gene, which encodes a phosphotransferase protein required for activation of ganciclovir, were amplified by polymerase chain reaction. Pyrosequencing methods were applied to one external 2096-bp segment DNA and two internal sequences between nucleotides 1087 to 1828 to detect mutations in this gene. RESULTS: Approximately 10% of sequences contained mutations between nucleotides 377 and 594, in conserved regions of the UL97 gene, leading to amino acid changes. Eleven coding mutations were identified, including changes leading to amino acid substitutions, E596K and S604F, which were observed in 100% of samples and are described for the first time in Brazil. In addition, one mutation (A594V) that is associated with ganciclovir resistance was detected in a kidney transplant patient. CONCLUSIONS: Further studies to detect mutations associated with HCMV resistance to antiviral drugs are required to demonstrate the need to increase the variety and availability of drugs used to treat viral infections in the public health care system in Brazil.


Subject(s)
Humans , Antiviral Agents/therapeutic use , Phosphotransferases/genetics , Immunocompromised Host , Cytomegalovirus Infections/drug therapy , Cytomegalovirus/enzymology , Drug Resistance, Viral/genetics , Mutation/genetics , Antiviral Agents/pharmacology , Case-Control Studies , Polymerase Chain Reaction , Cross-Sectional Studies , Cytomegalovirus/drug effects , Cytomegalovirus/genetics , Drug Resistance, Viral/drug effects , Genotype
3.
Arch. argent. pediatr ; 113(3): e145-e148, jun. 2015. graf
Article in Spanish | LILACS, BINACIS | ID: lil-750472

ABSTRACT

La infección posnatal o adquirida por citomegalovirus en el recién nacido se transmite por secreciones cervicales maternas en el parto, lactancia materna o transfusión de hemoderivados. La leche materna es la principal fuente de infección. Las manifestaciones clínicas dependen de la edad gestacional y el peso de nacimiento. Son más vulnerables los nacidos prematuros y de bajo peso. La infección posnatal, generalmente, es asintomática y suele resolverse de manera espontánea sin necesidad de tratamiento antiviral; el riesgo de secuelas a largo plazo es menor que en la infección congénita. Describimos el caso de un niño de 45 días de vida; nacido de término con peso adecuado para su edad gestacional; con un cuadro clínico muy poco frecuente caracterizado por plaquetopenia grave; secundario a una infección posnatal por citomegalovirus. Detallamos su forma de presentación; evolución clínica; diagnóstico y la terapéutica empleada.


Postnatal infection or acquired cytomegalovirus in the newborn is transmitted by maternal cervical secretions at birth, breastfeeding, blood transfusion or biological fluids. Breast milk is the main source of infection. Clinical manifestations depend on the gestational age and birth weight, premature and low birth weight newborn being more vulnerable. Postnatal infection usually resolves spontaneously without antiviral treatment; the risk of long-term sequelae is lower than in congenital infection. We describe the case of a 45 days old male patient, term newborn appropriate for gestational age, with a very rare condition characterized by severe thrombocytopenia secondary to postnatal cytomegalovirus infection. We detail its symptoms, clinical evolution, diagnosis and treatment employed.


Subject(s)
Humans , Male , Infant , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Milk, Human , Infant
5.
Med. infant ; 22(1): 16-19, Marzo 2015. tab
Article in Spanish | LILACS | ID: biblio-905085

ABSTRACT

La prevención de la enfermedad por CMV en los receptores de trasplante de células progenitoras hematopoyéticas se basa en la terapia temprana de la reactivación viral. La Antigenemia y el estudio de la carga viral por PCR son las dos técnicas diagnósticas actualmente vigentes. Se siguió una cohorte de 35 pacientes con estudios semanales con ambos métodos desde la recuperación de la neutropenia hasta el día 100 días postrasplante. Se inició tratamiento empírico con antivirales (Ganciclovir o Foscarnet) con un resultado positivo (antigenemia > 1 cel/200.000 o carga viral > 500 copias / ml) y se mantuvo 3-6 semanas. La serología previa fue positiva en R y D en 66% de los casos, en R o D en 20%, negativa en 3% y no evaluable en 11%. Se detectó infección por CMV en el 50% de los pacientes. En 15 ptes el diagnóstico fue por PCR, en 2 ambas pruebas fueron positivas y en uno solo la antigenemia. Un paciente presentó neumonía por CMV y falleció dentro de los 100 días de seguimiento. En 11,4% de los casos se detectó reactivación viral luego de los 100 días y dos ptes presentaron neumonía por CMV tardía que fue causa de muerte. Conclusión: Con los umbrales utilizados la carga viral precedió a la antigenemia en el diagnóstico de reactivación de CMV. La terapia temprana previene la enfermedad temprana por CMV en la mayoría de los casos pero la enfermedad tardía es un problema pendiente de resolución (AU)


Prevention of CMV disease in hematopoietic stem-cell transplantation recipients is based on the early management of viral reactivation. Antigenemia assay and PCR viral load detection are the current diagnostic techniques of choice. We followed a cohort of 35 patients with weekly studies using both methods from recovery from neutropenia to day 100 post-transplant. Empirical viral treatment (Ganciclovir or Foscarnet) was started after a positive result (antigenemia > 1 cell/200,000 or viral load > 500 copies / ml) and maintained for 3-6 weeks. Previous serology was positive in R and D in 66% of the cases, in R or D in 20%, negative in 3%, and not evaluable in 11%. CMV infection was detected in 50% of the patients. In 15 patients the diagnosis was made using PCR, in 2 both tests were positive, and in one only the antigenemia assay was positive. One patient presented with pneumonia due to CMV and died within the 100 days of follow-up. In 11.4% of the cases viral activation was detected after 100 days and two patients developed late pneumonia due to CMV and consequently died. Conclusion: Using these thresholds viral load detection preceded antigenemia assay in the diagnosis of CMV reactivation. Early treatment prevents early disease due to CMV in the majority of cases, but late disease remains a problem to be solved (AU)


Subject(s)
Humans , Infant , Child, Preschool , Child , Adolescent , Antigens, Viral/blood , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/blood , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Cytomegalovirus Infections/prevention & control , Hematopoietic Stem Cell Transplantation/adverse effects , Polymerase Chain Reaction/methods , Viral Load/methods , Comparative Study , Pneumonia, Viral/etiology , Pneumonia, Viral/virology , Prospective Studies
6.
Article in English | WPRIM | ID: wpr-34568

ABSTRACT

BACKGROUND: Quantitation of cytomegalovirus (CMV) DNA using real-time PCR has been utilized for monitoring CMV infection. However, the CMV antigenemia assay is still the 'gold standard' assay. There are only a few studies in Korea that compared the efficacy of use of real-time PCR for quantitation of CMV DNA in whole blood with the antigenemia assay, and most of these studies have been limited to transplant recipients. METHOD: 479 whole blood samples from 79 patients, falling under different disease groups, were tested by real-time CMV DNA PCR using the Q-CMV real-time complete kit (Nanogen Advanced Diagnostic S.r.L., Italy) and CMV antigenemia assay (CINA Kit, ArgeneBiosoft, France), and the results were compared. Repeatedly tested patients were selected and their charts were reviewed for ganciclovir therapy. RESULTS: The concordance rate of the two assays was 86.4% (Cohen's kappa coefficient value=0.659). Quantitative correlation between the two assays was a moderate (r=0.5504, P<0.0001). Among 20 patients tested repeatedly with the two assays, 13 patients were transplant recipients and treated with ganciclovir. Before treatment, CMV was detected earlier by real-time CMV DNA PCR than the antigenemia assay, with a median difference of 8 days. After treatment, the antigenemia assay achieved negative results earlier than real-time CMV DNA PCR with a median difference of 10.5 days. CONCLUSIONS: Q-CMV real-time complete kit is a useful tool for early detection of CMV infection in whole blood samples in transplant recipients.


Subject(s)
Antiviral Agents/therapeutic use , Cytomegalovirus/genetics , Cytomegalovirus Infections/drug therapy , DNA, Viral/blood , Ganciclovir/therapeutic use , Humans , Immunoassay , Organ Transplantation , Phosphoproteins/genetics , Real-Time Polymerase Chain Reaction , Viral Matrix Proteins/genetics , Virology/methods
9.
Biomédica (Bogotá) ; 34(4): 521-527, oct.-dic. 2014. ilus, tab
Article in Spanish | LILACS | ID: lil-730935

ABSTRACT

El citomegalovirus es el agente de infección perinatal más frecuente y una de las principales causas de infecciones virales adquiridas. En la presentación del siguiente caso se describe el amplio espectro clínico de la infección por citomegalovirus. La clasificación correcta de la infección como congénita o adquirida y el tratamiento oportuno pueden evitar complicaciones y secuelas en los casos graves. Se describe el caso de un lactante menor que presentaba una infección por citomegalovirus con la manifestación poco frecuente de hemorragia cerebral. Después del tratamiento con ganciclovir, los síntomas clínicos evolucionaron favorablemente. La infección por citomegalovirus es muy frecuente en la edad pediátrica, tanto en la forma congénita como en la adquirida. La forma adquirida, como la de este caso, se caracteriza principalmente por el compromiso hematológico, al producirse una importante trombocitopenia, lo que puede originar, aunque infrecuentemente, sangrado del sistema nervioso central; la mayoría de las infecciones adquiridas, sin embargo, son de resolución espontánea y no requieren tratamiento. En este paciente no se presentaron repercusiones clínicas de importancia.


Cytomegalovirus is the most frequent causative agent of perinatal infection and a major cause of acquired viral infections. This case report aims to show the broad clinical spectrum of the presentation of cytomegalovirus infection. The correct classification of congenital or acquired infection and its prompt treatment can prevent complications and sequelae in severe cases. We report the case of an infant with acquired cytomegalovirus infection, which presented an unusual feature of cerebral hemorrhage. The patient was treated with ganciclovir, with a favorable evolution of the clinical symptoms. Cytomegalovirus infection is common in children, both in its congenital and acquired forms. Acquired infection, as portrayed in this case, is mainly characterized by hematological compromise given by the marked thrombocytopenia, which may rarely result in cases of bleeding in the central nervous system. In this patient, no important clinical implications occurred. In addition, most of the acquired infections are self-limited and require no treatment.


Subject(s)
Humans , Infant , Male , Cerebral Hemorrhage/etiology , Cytomegalovirus Infections/complications , Anemia/etiology , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Diagnosis, Differential , Erythrocyte Transfusion , Fetal Diseases/diagnosis , Ganciclovir/therapeutic use , Gastrointestinal Hemorrhage/etiology , Purpura/etiology , Thrombocytopenia/etiology
11.
Arch. pediatr. Urug ; 84(4): 275-280, dic. 2013. ilus
Article in Spanish | LILACS | ID: lil-754214

ABSTRACT

La infección congénita por citomegalovirus (CMV) es la principal etiología de hipoacusia neurosensorial de causa no genética. El uso de valganciclovir, un profármaco del ganciclovir con buena biodisponibilidad oral, es utilizado a nivel internacional como parte del tratamiento farmacológico. La indicación de tratamiento incluye a los recién nacidos sintomáticos con compromiso neurológico o con enfermedad órgano focal severa, dentro de los primeros 30 días de vida. El mayor beneficio del tratamiento en neonatos es la reducción del deterioro de la audición evitando la peoría de los umbrales auditivos, así como la mejoría en el neurodesarrollo. Un tratamiento inicial con ganciclovir, seguido de valganciclovir vía oral, ha demostrado mejor desempeño del desarrollo auditivo que el uso de terapia a corto plazo. Se reportan dos casos de citomegalovirus congénito, de diferente presentación clínica, en el período setiembre-octubre 2013. Se reporta mejoría sintomática tras el tratamiento con ganciclovir-valganciclovir en ambos casos. En el seguimiento con carga viral en orina, se observó una disminución mantenida de la misma durante el tratamiento. El principal efecto adverso fue la apariciónde anemia...


Subject(s)
Humans , Infant, Newborn , Infant , Ganciclovir/adverse effects , Ganciclovir/therapeutic use , Cytomegalovirus Infections/congenital , Cytomegalovirus Infections/drug therapy , Antiviral Agents/adverse effects , Antiviral Agents/therapeutic use
12.
Gastroenterol. latinoam ; 24(supl.1): S41-S44, 2013.
Article in Spanish | LILACS | ID: lil-763718

ABSTRACT

Cytomegalovirus (CMV) gastrointestinal infection in inflammatory bowel disease (IBD) is a diagnostic challenge with close relationship with clinical course and treatment response. This article summarizes biology, pathology, clinical manifestation and diagnosis of CMV disease and especially in IBD.


La infección gastrointestinal por citomegalovirus (CMV) en paciente con enfermedad inflamatoria intestinal (EII) constituye un desafío diagnóstico importante y se encuentra íntimamente relacionada con la evolución y respuesta a tratamiento de la EII. El presente artículo resume las características biológicas del CMV, sus características patogénicas, sus manifestaciones clínicas y sus métodos diagnósticos. Se expone con mayor detalle la implicancia de esta infección en pacientes portadores con EII y su enfrentamiento clínico.


Subject(s)
Humans , Inflammatory Bowel Diseases/virology , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Antiviral Agents/therapeutic use , Cytomegalovirus/physiology , Colitis, Ulcerative/virology , Crohn Disease/virology , Ganciclovir/therapeutic use , Virus Activation
13.
Neumol. pediátr ; 7(1): 24-29, 2012. ilus, tab
Article in Spanish | LILACS | ID: lil-708226

ABSTRACT

Citomegalovirus (CMV), a herpesviridae, due to its high transmission rate, is endemic, with wide world distribution, especially in underdeveloped countries. CMV is an important pathogen agent during embryological period, being the commonest cause of TORCH syndrome. Due to its capability of infecting different organs, it can have a variety of clinical presentations. The more frequent and severe forms affect the respiratory, gastrointestinal, central nervous system and the retina. At the respiratory system CMV manifests in different ways, depending on age and immunological state of the patient. It produces interstitial pneumonias in immunocompromised host; but occasionally affects immunocompetent patients as a first trimester pneumonia, whooping cough like syndrome or chronic interstitial lung disease. The diagnostic method in use, the shell vial accelerated cultivation of samples obtain by bronchoalveolar lavage is both highly sensitive and specific. Treatment with ganciclovir has improved prognosis. The objective of this article is to show the different clinical presentations of CMV infection of the respiratory system in pediatric patients and the response to treatment.


Citomegalovirus (CMV) es un herpesviridae, endémico de amplia distribución mundial, debido a su alta tasa de transmisión, especialmente en países de bajo nivel socioeconómico. CMV es un importante agente patógeno en el período embrionario-fetal, siendo el principal agente etiológico del síndrome de TORCH. Por su capacidad de infectar diferentes órganos puede producir una variedad de cuadros clínicos, las formas más graves y frecuentes afectan al aparato respiratorio, gastrointestinal, sistema nervioso central y la retina. En el aparato respiratorio CMV se manifiesta de diversas maneras, dependiendo de la edad y del estado inmunológico del huésped. En inmunodeprimidos produce neumonías intersticiales graves; sin embargo, ocasionalmente afecta a individuos inmunocompetentes manifestándose como neumonía del primer trimestre, síndrome coqueluchoídeo o enfermedad pulmonar intersticial crónica. En la actualidad el método diagnóstico de elección es el cultivo acelerado de shell vial de muestra obtenida mediante lavado broncoalveolar, presenta alta sensibilidad y especificidad. El tratamiento con ganciclovir ha mejorado el pronóstico. El objetivo de este artículo es mostrar las diferentes formas de presentación clínica del CMV en el aparato respiratorio en pediatría y la respuesta al tratamiento utilizado.


Subject(s)
Humans , Male , Female , Infant , Child, Preschool , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Pneumonia, Viral/diagnosis , Pneumonia, Viral/drug therapy , Antiviral Agents/therapeutic use , Bronchoalveolar Lavage , Cytomegalovirus/isolation & purification , Ganciclovir/therapeutic use , Radiography, Thoracic , Tomography, X-Ray Computed
14.
Article in English | WPRIM | ID: wpr-102516

ABSTRACT

Hepatitis A virus (HAV) infections occur predominantly in children, and are usually self-limiting. However, 75-95% of the infections in adults are symptomatic (mostly with jaundice), with the illness symptoms usually persisting for a few weeks. Atypical manifestations include relapsing hepatitis, prolonged cholestasis, and complications involving renal injury. Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is a severe, drug-induced hypersensitivity reaction characterized by skin rash, fever, lymph-node enlargement, and internal organ involvement. We describe a 22-year-old male who presented with acute kidney injury and was diagnosed with prolonged cholestatic hepatitis A. The patient also developed DRESS syndrome due to antibiotic and/or antiviral treatment. To our knowledge, this is the first report of histopathologically confirmed DRESS syndrome due to antibiotic and/or antiviral treatment following HAV infection with cholestatic features and renal injury.


Subject(s)
Acute Kidney Injury/diagnosis , Anti-Bacterial Agents/adverse effects , Cefotaxime/adverse effects , Cholestasis/complications , Cytomegalovirus/genetics , Cytomegalovirus Infections/drug therapy , DNA, Viral/analysis , Eosinophilia/etiology , Exanthema/chemically induced , Ganciclovir/therapeutic use , Hepatitis A/complications , Humans , Hydrocortisone/therapeutic use , Immunoglobulins/therapeutic use , Male , Syndrome , Young Adult
15.
Rev. Inst. Med. Trop. Säo Paulo ; 52(6): 305-310, Nov.-Dec. 2010. tab
Article in English | LILACS | ID: lil-570729

ABSTRACT

Neurological disorders caused by Cytomegalovirus (CMV) in patients with Acquired Immunodeficiency Syndrome (AIDS) are rarely reported in the Highly Active Antiretroviral Therapy (HAART) period. The objective of this study was to describe the main clinical and laboratory features of patients with CMV-related neurological complications in HIV-infected patients admitted to a referral center in São Paulo, Brazil. CMV disease requires the identification of the virus in the cerebrospinal fluid (CSF) using Polymerase Chain Reaction (PCR). Thirteen cases were identified between January, 2004 and December, 2008. The median age of patients was 38 years and nine (69 percent) were men. At admission all patients were aware of their HIV status and only four (31 percent) patients were on HAART. Patients who were not on antiretroviral therapy before admission received HAART while inpatients. CMV disease was the first AIDS-defining illness in eight (62 percent) patients. The neurologic syndromes identified were diffuse encephalitis (n = 7; 62 percent), polyradiculopathy (n = 7; 54 percent), focal encephalitis (rhombencephalitis) (n = 1; 8 percent), and ventriculo-encephalitis (n = 1; 8 percent). Seven (54 percent) patients presented extra-neural CMV disease and four (31 percent) had retinitis. The median of CD4+ T-cell count was 13 cells/µL (range: 1-124 cells/µL). Overall in-hospital mortality was 38 percent. Eight patients used ganciclovir or foscarnet (in-hospital mortality: 50 percent) and five patients used ganciclovir and foscarnet (in-hospital mortality: 20 percent). None of the patients fulfilled the diagnosis criteria of immune reconstitution inflammatory syndrome. Four patients were lost to follow-up, and three patients presented immune recovery and discontinued secondary prophylaxis. Although infrequent, distinct neurological syndromes caused by CMV continue to cause high mortality among AIDS patients. Survival depends upon the use of effective antiviral therapy against CMV and the early introduction of HAART.


As complicações neurológicas causadas pelo Citomegalovírus (CMV) em pacientes com aids são raramente relatadas na era HAART. O objetivo deste estudo foi descrever as principais características clínicas e laboratoriais de pacientes com complicações neurológicas associadas ao CMV em pacientes com aids admitidos em centro de referência em Sao Paulo, Brasil. A doença citomegálica precisou da identificação do vírus no líquor mediante a reação em cadeia da polimerase (PCR). Treze casos foram identificados entre janeiro de 2004 e dezembro de 2008. A mediana da idade foi 38 anos e nove (69 por cento) eram homens. Na admissão, todos os pacientes sabiam do seu status sorológico para o HIV e apenas quatro (31 por cento) pacientes usavam HAART. A doença citomegálica foi a primeira doença definidora de aids em oito (62 por cento) pacientes. As síndromes neurológicas identificadas foram: encefalite difusa (n = 7; 62 por cento), polirradiculopatia (n = 7; 54 por cento), encefalite focal (romboencefalite) (n = 1; 8 por cento), e ventrículo-encefalite (n = 1; 8 por cento). Sete (54 por cento) pacientes apresentaram doença citomegálica fora do sistema nervoso e quatro (31 por cento) tiveram retinite. A mediana da contagem de células CD4+ foi 13 células/µL. A mortalidade global durante a internação foi 38 por cento. Oito pacientes usaram ganciclovir ou foscarnet (mortalidade: 50 por cento) e cinco pacientes usaram ganciclovir e foscarnet (mortalidade: 20 por cento). Nenhum paciente apresentou critérios diagnósticos da síndrome inflamatória de reconstituição imunológica. Quatro pacientes foram perdidos do acompanhamento ambulatorial e três pacientes apresentaram reconstituição imunológica e descontinuaram as profilaxias secundárias. Embora raras, as particulares síndromes neurológicas causadas pelo CMV continuam causando elevada mortalidade em pacientes com aids. A sobrevida depende do uso de terapia antiviral efetiva contra o CMV e a introdução oportuna do HAART.


Subject(s)
Adult , Humans , Male , Middle Aged , AIDS Dementia Complex/diagnosis , Cytomegalovirus Infections/diagnosis , AIDS Dementia Complex/drug therapy , Antiretroviral Therapy, Highly Active , Antiviral Agents/therapeutic use , Cytomegalovirus Infections/drug therapy , Foscarnet/therapeutic use , Ganciclovir/therapeutic use , Magnetic Resonance Imaging , Polymerase Chain Reaction , Tomography, X-Ray Computed
16.
Rev. bras. cir. cardiovasc ; 25(2): 149-153, abr.-jun. 2010. ilus
Article in English | LILACS | ID: lil-555858

ABSTRACT

OBJECTIVE: Cytomegalovirus (CMV) systemic disease and myocarditis in healthy persons is infrequently reported in the literature, although in increasing numbers in recent years. The importance of the recognition of the syndrome that usually has an initial picture of a mononucleosis like infection in an otherwise healthy person, is the available therapeutic agent, ganciclovir, that can cure the infectious disease. METHODS: We analyzed the clinical result of pulsotherapy with steroids in a patient with CMV myocarditis after 7 days of etiological treatment, with ganciclovir, intravenous vasodilators, and the conventional treatment for congestive heart failure. RESULTS: The clinical condition of the patient improved accordingly to the better function of the left ventricle, and the ganciclovir was kept for 21 days, most of it in an out patient basis. The patient was dismissed from the hospital, with normal myocardial function. CONCLUSION: Potentially curable forms of myocarditis, like M pneumoniae and CMV, for example, can have an initial disproportionate aggression to the myocardium, by the acute inflammatory reaction, that can by itself make worse the damage to the LV function. In our opinion, the blockade of this process by pulsotherapy with steroids can help in the treatment of these patients. We understand that the different scenario of immunosuppressive treatments for the possible auto immunity of the more chronic forms of the presumably post viral cardiomyopathy has been in dispute in the literature, and has stolen the focus from the truly acute cases.


OBJETIVO: Doença sistêmica por citomegalovírus (CMV) com miocardite em pessoas saudáveis é raramente referida na literatura, apesar de em maior número em anos recentes. A importância do reconhecimento da síndrome, que usualmente tem um quadro inicial "mononucleosis like" em uma pessoa sadia é a disponibilidade do agente terapêutico ganciclovir, que pode curar a infecção. MÉTODOS: Nós analisamos o resultado da pulsoterapia com esteróides em um paciente com miocardite por CMV, após 7 dias de tratamento etiológico com ganciclovir, vasodilatadores intravenosos e o tratamento convencional para insuficiência cardíaca congestiva. RESULTADOS: A condição clínica do paciente melhorou com a melhor função do ventrículo esquerdo e o ganciclovir foi mantido por 21 dias após alta hospitalar.A função miocárdica retornou ao normal. CONCLUSÃO: Formas curáveis de miocardites como M pneumonia e CMV, por exemplo, podem ter uma agressão grave ao miocárdio por uma ação inflamatória que pode piorar a função cardíaca. Em nossa opinião, o bloqueio deste processo pela pulsoterapia com esteróides pode auxiliar no tratamento destes pacientes. Entendemos que existe um cenário diferente de tratamento com imunossupressores para possível agressão auto-imune das formas mais crônicas de cardiomiopatias dilatadas e isso está em disputa na literatura, talvez mudando o foco dos casos realmente agudos.


Subject(s)
Adult , Humans , Male , Cytomegalovirus Infections/drug therapy , Myocarditis/drug therapy , Shock, Cardiogenic/drug therapy , Anti-Bacterial Agents/therapeutic use , Antihypertensive Agents/therapeutic use , Antiviral Agents/therapeutic use , Ganciclovir/therapeutic use , Glucocorticoids/therapeutic use , Injections, Intravenous , Myocarditis/virology , Prednisone/therapeutic use , Shock, Cardiogenic/etiology , Teicoplanin/therapeutic use
17.
Gastroenterol. latinoam ; 21(2): 205-207, abr.-jun. 2010.
Article in Spanish | LILACS | ID: lil-570006

ABSTRACT

La infección por citomegalovirus (CMV), en el contexto de la enfermedad inflamatoria intestinal (EII), se da principalmente en pacientes con colitis ulcerosa activa, generalmente asociado a corticoides e inmunosupresores. El rol patogénico de este agente, en este escenario en particular, no ha sido aclarado. Los métodos de diagnóstico para CMV son variados y no se ha definido un “gold standard”, sin embargo, aquellos que tienen mayor correlación con cambios en la evolución clínica son la demostración histológica o, eventualmente, la detección de ADN viral en las muestras de biopsias de mucosa colónica enferma. El diagnóstico oportuno y tratamiento eficaz de CMV con Ganciclovir intravenoso en pacientes seleccionados de colitis ulcerosa podría incidir en lograr remisión clínica y evitar una cirugía en pacientes potencialmente rescatables.


Cytomegalovirus (CMV) infection in inflammatory bowel disease (IBD) seems to play a role in patients with active ulcerative colitis (UC), generally associated to the use of corticoids and immunosupressive drugs. The pathogenicity of CMV is not clear and the diagnosis is not well standardized. Detection of with biopsies and DNA tests in tissue samples followed by treatment with Ganciclovir may induce clinical remission in patients without response to immunosuppressive drugs, and potentially avoid unnecessary colectomy. Prompt diagnosis and early treatment in a subset of UC patients with active colitis and CMV could change the clinical course.


Subject(s)
Humans , Inflammatory Bowel Diseases/complications , Cytomegalovirus Infections/complications , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Antiviral Agents/therapeutic use , Inflammatory Bowel Diseases/drug therapy , Ganciclovir/therapeutic use
18.
Gastroenterol. latinoam ; 21(2): 245-248, abr.-jun. 2010. tab
Article in Spanish | LILACS | ID: lil-570016

ABSTRACT

La infección por Citomegalovirus representa un desafío considerable tras el trasplante hepático, limitando la supervivencia del injerto a través de efectos directos, pero también a través de una modulación del sistema inmune, favoreciendo otras infecciones y el rechazo al injerto. La identificación de la condición serológica del donante y el receptor permite establecer el riesgo posterior de contraer la infección, además de la administración juiciosa de la profilaxis antiviral, lo cual limita ostensiblemente el riesgo de desarrollar una infección por Citomegalovirus tras el trasplante hepático. Hoy en día se cuenta con terapias antivirales efectivas pero que, lamentablemente también tienen efectos adversos importantes, lo cual hace aún más relevante la administración de profilaxis en los casos que lo ameritan y estar alerta al desarrollo de la infección en el post trasplante.


Cytomegalovirus infection is an important challenge to liver transplant clinicians, because it can be life threatening and because of its indirect effects on the immune system and the graft. Identification of the serologic condition of the donor and the receptor and risk factors to develop this condition allow us to establish a rational prophylaxis and to rapidly detect the infection. Currently there are effective antiviral treatments; which unfortunately also have important adverse effects. This emphasizes the importance of antiviral prophylaxis after liver transplantation.


Subject(s)
Humans , Cytomegalovirus Infections/epidemiology , Cytomegalovirus Infections/prevention & control , Liver Transplantation/adverse effects , Antibiotic Prophylaxis , Antiviral Agents/therapeutic use , Ganciclovir/analogs & derivatives , Ganciclovir/therapeutic use , Immunocompromised Host , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy
20.
Braz. j. infect. dis ; 14(2): 180-182, Mar.-Apr. 2010. ilus
Article in English | LILACS | ID: lil-548470

ABSTRACT

A case of severe and irreversible pancytopenia secondary to acute primary cytomegalovirus infection in an immunocompetent woman is described. The patient presented with thrombocytopenia, lymphopenia, anemia, and abnormal liver function tests. Treatment with corticosteroids and intravenous immunoglobulin was ineffective in reconstituting hemopoiesis. The patient developed severe sepsis and eventually expired.


Subject(s)
Female , Humans , Middle Aged , Cytomegalovirus Infections/complications , Immunocompetence , Pancytopenia/etiology , Sepsis/etiology , Cytomegalovirus Infections/diagnosis , Cytomegalovirus Infections/drug therapy , Fatal Outcome , Glucocorticoids/therapeutic use , Immunoglobulins, Intravenous/therapeutic use , Pancytopenia/drug therapy , Prednisolone/therapeutic use , Severity of Illness Index
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