Cytomegalovirus

Last Updated: 2019-08-27

Author(s): Anzengruber, Navarini

Cytomegalievirus, CMV, HCMV, human herpesvirus 5, HHV-5

Viral infectious disease with human herpes virus 5.

Worldwide, about 50-80% of the population is infected.

Prevalence regressing.

  • Transmission through droplet, smear infections, transplants and transfusions.
  • After the virus has settled in the mucosa of the oropharynx, it replicates the virus and spreads via leukocytes.
  • CMV infection is usually asymptomatic.
  • Can lead to rejection reactions after bone marrow or organ transplants.
  • Intrauterine infections can lead to microcephaly, cataract, optic atrophy and intracerebral calcifications.
  • Mononucleosis-like clinic.
  • PCR Viral.
  • CMV chorioretinitis
  • pneumonia
  • Skin ulceration in HIV patients.
  • In case of eye infestation, ophthalmological consil.
     
  • Ganciclovir (Cymevene®) intravenously, initial: (over 1h) 5 mg/kg bw 2x daily for 2-3 weeks. Maintenance therapy: 6mg/kg bw/week.
     
  • Foscarnet (Foscavir®) intravenously, initial: 60 mg/kg bw 3x daily for 2-3 weeks. Maintenance therapy: 7x/week 90-120 mg/kg bw.
     
  • For immunosuppression and acyclovir resistance: valganciclovir (Valganciclovir®) p.o., initial: 900 mg 2x daily for 21 days, maintenance therapy: 1x 900 mg p.o./d.
     
  • Cidofovir: no longer available

 

  • Specific immunoglobulins:
  • for CMV prophylaxis in immunosuppressive therapy.
  • Human cytomegaly immunoglobulin
  • Cytotect® (1000 U/ 5000 U) intravenously
  • Adults: 50 I/kg over 1-4 hours
  • Children: 50-1000 I/kg over 1-4 hours
  • Running speed: initial 0.08 ml/kg/h, after 10-15 minutes slow increase to 0.8 ml/kg/h
  • Contraindication: IgA deficiency with IGA antibodies.

 

  • Congenital infection:
  • Ganciclovir
  • Cymeven® intravenously 6 mg/kg bw every 12 hours for 6 weeks.
  • Efficient vaccines are not available.
  • Cave! Ganciclovir is bone market toxic, therefore cooperation with special centres is recommended
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