Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- 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
Outros fatores diagnósticos
- neonato: hepatoesplenomegalia
- neonato: petéquias ou púrpura
- dor e fraqueza
Fatores de risco
- 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
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- 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
Investigações a serem consideradas
- 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
Algoritmo de tratamento
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
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.
References
Key articles
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. Abstract
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].Full text
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].Full text
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Mononucleose infecciosa
- vírus da imunodeficiência humana (HIV)
- Toxoplasmose
More DifferentialsGuidelines
- Prevention and treatment of opportunistic infections in children with and exposed to HIV
- Prevention of cytomegalovirus infection and disease after hematopoietic cell transplantation
More GuidelinesPatient information
Infecção por citomegalovírus
More Patient information
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