RESUMO
OBJECTIVE: The use on ganciclovir for perinatal cytomegalovirus (CMV) infection is controversial. We aim to evaluate the use of ganciclovir treatment for neonatal CMV hepatitis. METHODS: We present five infants with perinatally-acquired CMV hepatitis as a single organ manifestation of CMV infection. The three more severely affected children, i.e. those with cholestasis and elevation of serum hepatic enzymes to more than twice the normal values, were treated for 15 days with intravenous ganciclovir. RESULTS: The three treated infants improved clinically and CMV DNA in the blood disappeared during treatment. After cessation of ganciclovir treatment all of the patients had a relapse of the infection. The two untreated patients recovered completely. CONCLUSION: The long-term outcome of infants with CMV hepatitis is unpredictable. Some patients have persistent liver injury despite ganciclovir therapy. Ganciclovir therapy did not prevent chronic liver disease in any of the patients in our study. Owing to the possible serious side-effects the cost-benefit of ganciclovir treatment should be carefully evaluated.
Assuntos
Antivirais/uso terapêutico , Infecções por Citomegalovirus/tratamento farmacológico , Ganciclovir/uso terapêutico , Hepatite Viral Humana/tratamento farmacológico , Alanina Transaminase/sangue , Fosfatase Alcalina/sangue , Aspartato Aminotransferases/sangue , Citomegalovirus/efeitos dos fármacos , Humanos , Lactente , Fígado/efeitos dos fármacos , Fígado/metabolismo , Fígado/patologia , Assistência Perinatal , Resultado do TratamentoRESUMO
The authors analyzed acute exacerbations of chronic hepatitis B in 24 chronic HBsAg carriers (20 with positive HBeAg, 4 with anti-HBe), more than half of whom were treated with glucocorticoids, by examining specific antigens and antibodies of the hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis delta virus (HDV), Epstein-Barr virus (EBV) and cytomegalovirus (CMV). Of 38 observed exacerbations of the disease they found in 7 (18%) deterioration after discontinuation of glucocorticoids, in 7 (18%) seroconversion of HBeAg to anti-HBe, in 9 (24%) spontaneous exacerbation of chronic hepatitis B, in 11 (29%) chronic activation, reactivation of EBV superinfection, in 3 (8%) CMV reactivation or superinfection and in one (3%) HDV superinfection. In no instance HAV superinfection was observed. Exacerbations were found five times more frequently in subjects in the stage of active viral replication (in HBeAg+ subjects) than in subjects with anti-HBe. In eight patients EBV reactivation was found after glucocorticoids withdrawal: in five patients after an average period of 5 months (range 3-7) and in three patients after an average period of 33 months (range 22-48). The results provide evidence that in addition to already known causes of acute exacerbations of chronic hepatitis B in our geographical area probably an important cause of deterioration of hepatitis is reactivation or superinfection with EBV and CMV in some patients in conjunction with previous glucocorticoid treatment.
Assuntos
Hepatite C/fisiopatologia , Doença Aguda , Adolescente , Adulto , Idoso , Anticorpos Antivirais/análise , Doença Crônica , Citomegalovirus/imunologia , Feminino , Anticorpos Anti-Hepatite/análise , Antígenos de Superfície da Hepatite B/análise , Hepatite C/imunologia , Hepatite C/virologia , Herpesvirus Humano 4/imunologia , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
A virus, identified as Tettnang virus, was isolated from the cerebrospinal fluid (CSF) of an 18 months old child with pharyngitis accompanied by an encephalitic reaction. The isolation of virus was followed by seroconversion. The aetiological role of the virus in the given disease is discussed.