Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- malaise
- fever
- diarrhea
- nausea and vomiting
- visual floaters and blindness
- abnormalities on fundoscopy
- newborn: microcephaly
- newborn: poor tone and motor function and abnormal head lag
- newborn: hearing loss
Outros fatores diagnósticos
- newborn: hepatosplenomegaly
- newborn: petechiae or purpura
- pain and weakness
Fatores de risco
- CMV D+/R- status (donor CMV seropositive, recipient seronegative) in solid organ transplant recipients
- CMV R+ (recipient seropositive) in transplant recipients
- type of immunosuppressive drugs
- AIDS
- inflammatory bowel disease
- acute illness in intensive care setting
- newborn in CMV infection during pregnancy
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- CBC
- serum creatinine
- serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
- serum alkaline phosphatase
- serology
- pp65 antigenemia
- nucleic acid detection
- CD4 count
- chest x-ray
Investigações a serem consideradas
- chest CT scan
- histopathology of biopsy
- upper gastrointestinal endoscopy and colonoscopy
- serial fetal ultrasound examinations (congenital CMV infection)
- amniocentesis or fetal blood sampling (congenital CMV infection)
- brain ultrasound/brain MRI: newborns
Algoritmo de tratamento
acquired self-limited illness: immunocompetent
infection in transplant recipient: no known drug resistance
infection in patient with AIDS: no known drug resistance
refractory/resistant infection
congenital infection
Colaboradores
Autores
Matteo Mombelli, MD
Infectious Disease Service and Transplantation Center
University Hospital (CHUV)
University of Lausanne
Lausanne
Switzerland
Declarações
MM declares that he has no competing interests.
Oriol Manuel, MD
Infectious Disease Service and Transplantation Center
University Hospital (CHUV)
University of Lausanne
Lausanne
Switzerland
Declarações
OM has participated in Advisory Boards of MSD, Takeda, Astra-Zeneca, and Biotest.
Agradecimentos
Dr Matteo Mombelli and Dr Oriol Manuel would like to thank Dr Sandra Asner from the University Hospital of Lausanne, Switzerland for her careful review of congenital CMV in this topic. They would also like to gratefully acknowledge Dr Raymund R. Razonable and Dr Atul Humar, the previous contributors to this topic.
Declarações
RRR is an author of a number of references cited in this topic. AH has done consultancy work for Astellas, Chimerix, and Roche.
Revisores
Joseph Sassine, MD
Assistant Professor of Medicine
Transplant Infectious Diseases
University of Oklahoma Health Sciences Center
Oklahoma City
OK
Declarações
JS reports research grants paid to his institution from Ansun BioPharma, Cidara Therapeutics, Community Infusion Solutions, F2G, and Shionogi.
Simon Barton, MD, FRCOG, FRCPEd, FRCP
Clinical Director
HIV and Sexual Health
Chelsea and Westminster Hospital
London
UK
Declarações
SB has been funded by GlaxoSmithKline and Gilead for speaking at scientific meetings.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
Referências
Principais artigos
Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients - guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019 Sep;33(9):e13512. Resumo
HIV.gov, US National Institutes of Health. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Jul 2021 [internet publication].Texto completo
HIV.gov, US National Institutes of Health. Guidelines for the prevention and treatment of opportunistic infections in children with and exposed to HIV. Aug 2023 [internet publication].Texto completo
Kotton CN, Kumar D, Caliendo AM, et al; The Transplantation Society International CMV Consensus Group. The third international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation. 2018 Jun;102(6):900-31.Texto completo Resumo
Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017 Jun;17(6):e177-88. Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
Diagnósticos diferenciais
- Infectious mononucleosis
- HIV
- Toxoplasmosis
Mais Diagnósticos diferenciaisDiretrizes
- Prevention and treatment of opportunistic infections in children with and exposed to HIV
- Prevention of cytomegalovirus infection and disease after hematopoietic cell transplantation
Mais DiretrizesFolhetos informativos para os pacientes
Cytomegalovirus infection
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