Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

462 Cytomegalovirus

tests

Nonspecific

■Moderate elevation of transaminases

■Lymphocytosis with atypical monocytes

■Negative heterophils

Specific

■Non-congenital: difficult due to increase number of asymptomatic

infection and relapsing infection. May need multiple methods for

accurate diagnosis:

➣4-fold rise IgG antibody in paired sera

➣IgM antibody may be helpful (but invariably present)

➣Recovery of virus from target organ is optimal

➣Peripheral blood antigenemia in immunocompromised

➣Nucleic acid amplification techniques commercially available

■Congenital; viral isolation best method – urine is excellent sample

differential diagnosis

Other causes of mononucleosis syndrome in immunocompetent pt;

acute rejection post lung transplant; overall differential broad in

immunocompromised host

management

If severe, immunosuppressive agents may need to be changed or dose

reduced.

specific therapy

■DHPG or Ganciclovir phosphonoformate has been used for

immunocompromised patients.

Valganciclovir (oral) – treatment of AIDS retinitis, prevention post-

transplant

■Foscarnet another option

Cidofovir in AIDS (cannot be given with CSA or tacrolimus in post-

transplant)

AIDS retinitis – ganciclovir intraocular implant

■CMV-IgG is available and may be beneficial in some settings.

follow-up

Full supportive care in severe disease in immunocompromised pt

complications and prognosis

■Symptomatic congenital; IUGR, jaundice, HSM, thrombocytopenia,

microcephaly, mild hepatitis