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Infecção por citomegalovírus

  • Overview
  • Theory
  • Diagnosis
  • Management
  • Follow up
  • Resources
Last reviewed: 16 八月 2025
Last updated: 03 九月 2024

Summary

定义

病史和体格检查

关键诊断因素

  • presença de fatores de risco
  • mal-estar
  • febre
  • diarreia
  • náuseas e vômitos
  • moscas volantes e cegueira
  • anormalidades na fundoscopia
  • neonato: microcefalia
  • neonato: tônus e função motora insuficientes e atraso anormal na sustentação da cabeça (head lag)
  • neonato: perda auditiva
完整详情

其他诊断因素

  • neonato: hepatoesplenomegalia
  • neonato: petéquias ou púrpura
  • dor e fraqueza
完整详情

危险因素

  • estado do citomegalovírus (CMV) D+/R- (doador soropositivo para CMV, receptor soronegativo) em receptores de transplante de órgão sólido
  • CMV R+ (receptor soropositivo) em receptores de transplante
  • tipo de medicamentos imunossupressores
  • síndrome da imunodeficiência adquirida (AIDS)
  • doença inflamatória intestinal
  • doença aguda em ambiente de cuidados intensivos
  • neonato em infecção por CMV durante a gravidez
完整详情

诊断性检查

首要检查

  • Hemograma completo
  • creatinina sérica
  • aspartato aminotransferase (AST) e alanina aminotransferase (ALT) séricas
  • fosfatase alcalina sérica
  • sorologia
  • antigenemia pp65
  • detecção do ácido nucleico
  • contagem de CD4
  • radiografia torácica
完整详情

需考虑的检查

  • tomografia do tórax
  • histopatologia da biópsia
  • endoscopia digestiva alta e colonoscopia
  • exames ultrassonográficos fetais seriados (infecção congênita por citomegalovírus [CMV])
  • amniocentese ou amostragem de sangue fetal (infecção congênita por CMV)
  • Ressonância nuclear magnética (RNM)/ultrassonografia cranioencefálica: neonatos
完整详情

治疗流程

急症处理

doença autolimitada adquirida: imunocompetente

infecção em receptor de transplante: sem resistência conhecida a medicamentos

infecção em paciente com síndrome de imunodeficiência adquirida (AIDS): sem resistência conhecida a medicamentos

infecção refratária/resistente

infecção congênita

撰稿人

作者

Matteo Mombelli, MD

Infectious Disease Service and Transplantation Center

University Hospital (CHUV)

University of Lausanne

Lausanne

Switzerland

利益声明

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

利益声明

OM has participated in Advisory Boards of MSD, Takeda, Astra-Zeneca, and Biotest.

鸣谢

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.

利益声明

RRR is an author of a number of references cited in this topic. AH has done consultancy work for Astellas, Chimerix, and Roche.

同行评议者

Joseph Sassine, MD

Assistant Professor of Medicine

Transplant Infectious Diseases

University of Oklahoma Health Sciences Center

Oklahoma City

OK

利益声明

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

利益声明

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.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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. 摘要

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].全文

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]​.全文

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.全文  摘要

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.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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