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Cytomegalovirus infection

Última revisão: 15 Aug 2025
Última atualização: 28 Jan 2025

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
Detalhes completos

Outros fatores diagnósticos

  • newborn: hepatosplenomegaly
  • newborn: petechiae or purpura
  • pain and weakness
Detalhes completos

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
Detalhes completos

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
Detalhes completos

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
Detalhes completos

Algoritmo de tratamento

AGUDA

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

Nossas equipes internas de editoria e de evidências trabalham em conjunto com colaboradores internacionais especializados e pares revisores para garantir que forneçamos acesso às informações o mais clinicamente relevantes possível.

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.
  • Cytomegalovirus infection images
  • Diagnósticos diferenciais

    • Infectious mononucleosis
    • HIV
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  • Diretrizes

    • Prevention and treatment of opportunistic infections in children with and exposed to HIV
    • Prevention of cytomegalovirus infection and disease after hematopoietic cell transplantation
    Mais Diretrizes
  • Folhetos informativos para os pacientes

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    Mais Folhetos informativos para os pacientes
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