Cytomegalovirus

Cytomegalovirus, CMV, human herpesvirus 5, HHV 5.

Viral infectious disease. The human herpes virus 5 acts as the trigger.

• Worldwide, approx. 50-80% of the population is contaminated
• Prevalence regressive

• Transmission by droplet infection, smear infection, transplantation and transfusion
• After the virus has established itself in the mucosa of the oropharynx, viral replication and haematogenous spread via leucocytes
• occurs
• Most of the time, CMV infection is asymptomatic

• May cause rejection after bone marrow or organ transplantation
• Intrauterine infections may lead to microcephaly, cataract, optic atrophy and intracerebral calcifications
• Monucleosis-like clinic

• Viral PCR

• CMV chorioretinitis
• Pneumonia
• Skin ulceration in HIV patients

• In the case of eye infestation, ophthalmological consultation

• Ganciclovir i.v., initial: (over 1h) 5 mg/kg bw 2x daily for 2-3 weeks. Maintenance therapy: 6mg/kg bw/week

• Foscarnet i.v., initial: 60 mg/kg bw 3x/day for 2-3 weeks. Maintenance therapy: 7x/week 90-120 mg/kg bw

• In case of immunosuppression and aciclovir resistance: valganciclovir p.o., initial: 900 mg 2x tgl. for 21 days, maintenance therapy: 1x 900 mg p.o./d.

• Cidofovir: no longer available

• Specific immunoglobulins:
  • For CMV prophylaxis during immunosuppressive therapy.
  • Human cytomegalovirus immunoglobulin
  • (1000 U/ 5000 U) i.v.
  • Adults: 50 U/kg over 1-4 hrs
  • Children: 50-1000 E/kg over 1-4 hr.
  • Run rate: initially 0.08 ml/kg/h, slowly increasing to 0.8 ml/kg/h after 10-15 minutes
  • KI: IgA deficiency with IGA antibodies

• Connatal infection:
  • Ganciclovir
  • i.v. 6 mg/kg bw every 12 hrs for 6 weeks
  • Efficient vaccines are not available
  • Caution. Ganciclovir is bone marrow toxic, therefore collaboration with specialised centres is recommended

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