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Cytomegalovirus infection: treatment
Last reviewed: 23.04.2024
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Medicamental treatment of cytomegalovirus infection
Treatment of cytomegalovirus infection is medication, the effectiveness of which has been proven by controlled studies: ganciclovir, valganciclovir, sodium foscarnet, cidofovir. Interferon drugs and immunocorrectors in cytomegalovirus infection are not effective. With active cytomegalovirus infection (the presence of cytomegalovirus DNA in the blood) in pregnant women, the drug of choice is the human immunoglobulin anticytomegalovirus (neocytotect). To prevent vertical infection with the fetus virus, the drug is prescribed 1 ml / kg per day intravenously drip 3 injections at intervals of 1-2 weeks. In order to prevent the manifestation of the disease in neonates with active cytomegalovirus infection or in the manifest form of the disease with minor clinical manifestations, neocytotect at 2-4 ml / kg per day 6 injections (after 1 or 2 days) is shown. In the presence of children in addition to cytomegalovirus infection of other infectious complications, instead of neocytotec, Pentaglobin can be applied at a dose of 5 ml / kg daily for 3 days, with a repeat, if necessary, course or other immunoglobulins for intravenous administration. The use of neocytotec as monotherapy in patients suffering from manifest, life-threatening or severe consequences of cytomegalovirus infection is not shown.
Ganciclovir and valganciclovir are the drugs of choice for the treatment, secondary prevention and prevention of manifest cytomegalovirus infection. Treatment of a manifest cytomegalovirus infection with ganciclovir is carried out according to the following scheme: 5 mg kg intravenously twice a day with an interval of 12 hours for 14-21 days in patients with retinitis: 3-4 weeks - with lung or digestive tract injury; 6 weeks or more - in the pathology of the central nervous system. Valgantsiklovir is used inside at a therapeutic dose of 900 mg 2 times a day for the treatment of retinitis, pneumonia, esophagitis, enterocolitis cytomegalovirus etiology. The duration of administration and efficacy of valganciclovir are identical to parenteral therapy with ganciclovir. Criteria for the effectiveness of therapy are the normalization of the patient's condition, distinct positive dynamics from the results of instrumental studies, the disappearance of cytomegalovirus DNA from the blood. The effectiveness of ganciclovir in patients with cytomegalovirus lesions of the brain and spinal cord is less, primarily because of the late setting of the etiological diagnosis and untimely initiation of therapy, when there are already irreversible changes in the central nervous system. The effectiveness of ganciclovir, the frequency and severity of side effects in the treatment of children suffering from cytomegalovirus disease. Are comparable with those for adult patients. When a child develops a life-threatening manifest cytomegalovirus infection, ganciclovir is necessary. For treatment of children with a manifest neonatal cytomegalovirus infection, ganciclovir is given at a dose of 6 mg / kg intravenously every 12 hours for 2 weeks, then, in the presence of an initial effect of therapy, the drug is used at a dose of 10 mg / kg every other day for 3 months.
If the condition of immunodeficiency persists, relapses of cytomegalovirus are inevitable. HIV-infected patients treated with cytomegalovirus infection are prescribed maintenance therapy (900 mg / day) or ganciclovir (5 mg / kg / day) to prevent recurrence of the disease. Supportive treatment in patients with HIV infection who have transferred cytomegalovirus retinitis is performed against the background of HAART until the amount of CD4-lymphocytes is increased by more than 100 cells in 1 μl, which lasts at least 3 months. The duration of the maintenance course for other clinical forms of cytomegalovirus infection should be at least one month. If the disease recurs, a repeat therapeutic course is prescribed. Treatment of uveitis, which developed during the restoration of the immune system, involves systemic or periocular steroids.
At present, in patients with active cytomegalovirus infection, a strategy of "preemptive" etiotropic treatment is recommended to prevent the manifestation of the disease. The criteria for prescribing preventive therapy is the presence of deep immunosuppression in patients (in the case of HIV infection, the amount of CD4-lymphocytes in the blood is less than 50 cells per 1 μl) and cytomegalovirus DNA determination in whole blood at a concentration of more than 2.0 lgl0 gene / ml or detection of cytomegalovirus DNA in plasma. The drug of choice for the prevention of a manifest cytomegalovirus infection is valganciclovir, used at a dose of 900 mg / day. The duration of the course is at least a month. The criterion for cessation of therapy is the disappearance of cytomegalovirus DNA from the blood. In the recipients of the organs, preventive therapy is performed for several months after transplantation. Side effects of ganciclovir or valganciclovir: neutropenia, thrombocytopenia, anemia, increased serum creatinine. Skin rash, itching, dyspepsia, reactive pancreatitis.
The standard of treatment of cytomegalovirus infection
Therapeutic course: ganciclovir 5 mg / kg 2 times a day or valganciclovir 900 mg 2 times a day, the duration of therapy is 14-21 days or more until the disappearance of symptoms of the disease and cytomegalovirus DNA from the blood. If the disease recurs, a second treatment course is performed.
Supportive treatment of cytomegalovirus infection: valganciclovir 900 mg / day for at least a month.
Preventive treatment of cytomegalovirus infection in immunosuppressive patients to prevent the development of cytomegalovirus disease: valganciclovir 900 mg / day for at least a month before the absence of cytomegalovirus DNA in the blood.
Preventive treatment of cytomegalovirus infection during pregnancy in order to prevent vertical infection of the fetus: neocytotect 1 ml / kg per day intravenously 3 injections with an interval of 2-3 weeks.
Preventive treatment of cytomegalovirus infection in newborns, young children to prevent the development of the manifest form of the disease: neocytotect 2-4 ml / kg per day intravenously 6 administrations under the control of the presence of cytomegalovirus DNA in the blood.
Diet and diet
Special regime and diet for patients with cytomegalovirus infection is not required, restrictions are established based on the patient's condition and localization of the lesion.
Approximate terms of incapacity for work
The disability of patients with cytomegalovirus disease is disrupted for at least 30 days.
Clinical examination
Women during pregnancy undergo a laboratory examination to exclude active cytomegalovirus infection. Young children infected with cytomegalovirus infection antenatal are observed by a neurologist, otolaryngologist and ophthalmologist. Children who have suffered a clinically expressed congenital cytomegalovirus infection are on dispensary records with a neurologist. Patients after bone marrow transplantation, other organs in the first year after transplantation should undergo at least 1 time per month a check for the presence of cytomegalovirus DNA in whole blood. Patients with HIV infection. Having the number of CD4-lymphocytes less than 100 cells in 1 μl, should be inspected by an ophthalmologist and examined for quantitative content of cytomegalovirus DNA in blood cells at least once every 3 months.
The implementation of recommendations, the use of modern diagnostic methods and the use of effective therapeutic agents can prevent the development of a manifest cytomegalovirus infection or minimize its consequences.
[10], [11], [12], [13], [14], [15], [16], [17],
Prevention of cytomegalovirus infection
Prevention of cytomegalovirus infection should be differentiated depending on the risk group. It is necessary to advise pregnant women (especially seronegative) on the problem of cytomegalovirus infection and advice on the use of barrier contraceptives in sexual intercourse, observing the rules of personal hygiene when caring for young children. It is desirable to temporarily transfer pregnant seronegative women working in children's homes, children's in-patient departments and nursery schools, to work not related to the risk of their infection with cytomegalovirus. An important measure of preventing cytomegalovirus infection in transplantology is the selection of a seronegative donor if the recipient is seronegative. Patented anti-cytomegalovirus vaccine currently does not exist.