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1.
Invest Ophthalmol Vis Sci ; 60(6): 1853-1862, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-31042791

RESUMO

Purpose: To evaluate risk factors for severity of cytomegalovirus (CMV) retinitis lesion whitening (opacity), using a standardized scoring system. Methods: We performed a cross-sectional, observational investigation of all individuals with newly diagnosed AIDS-related CMV retinitis in three randomized clinical trials and one prospective observational study. Opacity was scored by masked readers, using a prospectively defined ordinal 6-point scale. Demographic factors, laboratory data (CD4+, CD8+ T-lymphocyte counts, human immunodeficiency virus [HIV] blood levels), and lesion characteristics (location, size) were compared to the highest opacity score assigned to either eye. Among eyes with active lesions (scores ≥3), factors associated with severe opacity (scores 5, 6) were identified. Results: There were 299 participants (401 eyes with CMV retinitis). In one or more comparisons, increased opacity was associated with lower CD4+ and lower CD8+ T-lymphocyte counts, higher HIV blood level, lack of antiretroviral therapy, male sex, race/ethnicity, and bilateral disease. In eyes with active disease, severe opacity was associated with lower CD4+ T-lymphocyte count, higher HIV blood level, older age, Karnofsky score, lesion size, and bilateral disease. No relationship was identified between opacity and lesion location. Conclusions: Lesion border opacity (resulting from CMV activity) reflects level of immune function; as immunodeficiency becomes worse, CMV activity (and opacity) increases. The positive relationship between opacity and HIV blood level may reflect both immunodeficiency and increased CMV activity caused by transactivation of CMV by HIV. Scoring of opacity may be a useful, standard measure for continued study of CMV retinitis across different settings and populations. (Clinicaltrials.gov number for the HPMPC CMV Retinitis Trial: NCT00000142; Clinicaltrials.gov number for the Monoclonal Antibody CMV Retinitis Trial: NCT00000135; Clinicaltrials.gov number for the Ganciclovir-Cidofovir CMV Retinitis Trial: NCT0000014; Clinicaltrials.gov number for the Longitudinal Study of the Ocular Complications of AIDS: NCT00000168.).


Assuntos
Síndrome de Imunodeficiência Adquirida/diagnóstico , Retinite por Citomegalovirus/diagnóstico , HIV/genética , Retina/patologia , Síndrome de Imunodeficiência Adquirida/sangue , Síndrome de Imunodeficiência Adquirida/virologia , Adulto , Estudos Transversais , Retinite por Citomegalovirus/sangue , Retinite por Citomegalovirus/virologia , Feminino , Seguimentos , Humanos , Masculino , Estudos Prospectivos , RNA Viral/sangue , Índice de Gravidade de Doença
2.
Mymensingh Med J ; 28(2): 465-469, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31086168

RESUMO

We report three cases of acute lymphoblastic leukemia (ALL) those were suffered from cytomegalovirus retinitis (CMVR) during maintenance phase therapy. Ophthalmologic examination for loss of vision prompted diagnosis of cytomegalovirus retinitis. Administration of anticytomegalovirus drugs led to complete regression of active retinitis. CMVR should be in mind for children with ALL on maintenance of medical aid, even in those without hematopoietic stem cell transplantation state.


Assuntos
Retinite por Citomegalovirus/diagnóstico , Olho/virologia , Leucemia-Linfoma Linfoblástico de Células Precursoras/complicações , Doença Aguda , Antineoplásicos/efeitos adversos , Antivirais/administração & dosagem , Antivirais/uso terapêutico , Criança , Citomegalovirus , Retinite por Citomegalovirus/tratamento farmacológico , Retinite por Citomegalovirus/virologia , Humanos , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Acuidade Visual
3.
Transpl Infect Dis ; 21(4): e13099, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31033155

RESUMO

Cytomegalovirus (CMV) retinitis in hematologic malignancies in the absence of hematopoietic cell transplant (HCT) is uncommon. We report a case of a 54-year-old woman with peripheral T-cell lymphoma who develops CMV retinitis and subsequently undergoes an autologous HCT, with eventual development of immune reconstitution uveitis. We further reviewed the PubMed literature on CMV retinitis in patients with lymphoma. We describe that CMV retinitis in patients with lymphoma has variable clinical presentations, may occur at any time during the course of the disease and chemotherapy, and is associated with significant morbidity.


Assuntos
Retinite por Citomegalovirus/diagnóstico , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Síndrome Inflamatória da Reconstituição Imune/etiologia , Linfoma/virologia , Uveíte/etiologia , Citomegalovirus/imunologia , Retinite por Citomegalovirus/imunologia , Feminino , Humanos , Linfoma/complicações , Pessoa de Meia-Idade
5.
Niger J Clin Pract ; 22(3): 293-297, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30837414

RESUMO

Background: Cytomegalovirus (CMV) retinitis is one of the most important opportunistic infections in HIV-infected patients in developing countries before the introduction of highly active antiretroviral therapy. In Nigerian and African HIV populations, CMV retinitis is under-reported. Patients and Methods: In a cross-sectional study, 250 HIV-infected adults ≥18 years were recruited by systematic random sampling from March to August 2013. Using a structured questionnaire, information was obtained on socio-demographic characteristics and symptoms of visual impairment. HIV disease was staged according to the WHO clinical staging, and CD4+ T-lymphocyte count was measured. Participants with symptoms of impaired vision and/or CD4+ T-lymphocyte count <50 cells/µL had indirect ophthalmoscopic examination of the retina to detect CMV related eye lesions. Results: Two hundred and fifty adults were HIV-infected, out of which 114 (46%) were males and 136 (54%) were females. The mean age of study participants was 35 years. History of impaired vision was reported by 21 (8.4%) of participants. The right eye was involved in 7 (33%), the left eye in 4 (19%), and both eyes in 10 (48%) of participants. The predominant symptoms were blurred vision 9 (43%), floaters 9 (43%), and blindness 3 (14%). Among participants who had indirect ophthalmoscopy, 3 (1.2%) had characteristic retinal changes suggestive of CMV retinitis. Two (67%) of patients with CMV retinitis were females and 1 (33%) was male. Mean CD4+ count was 25.33 ± 14.19 and all were WHO HIV clinical stage 4 with death occurring within 6 months of diagnosis. Conclusion: CMV retinitis though rare is associated with advanced HIV disease and attendant morbidity and mortality. We recommend integration of CMV diagnostic services and ophthalmological services as routine in HIV care and treatment programs in Nigeria targeted toward high-risk patients.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/epidemiologia , Linfócitos T CD4-Positivos/patologia , Retinite por Citomegalovirus/epidemiologia , Infecções por HIV/complicações , Transtornos da Visão/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Adulto , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/imunologia , Estudos Transversais , Retinite por Citomegalovirus/diagnóstico , Feminino , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Prevalência , Transtornos da Visão/epidemiologia , Transtornos da Visão/etiologia
7.
Br J Ophthalmol ; 103(2): 157-160, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30196272

RESUMO

Patients with AIDS-related cytomegalovirus (CMV) retinitis receiving combined antiretroviral therapy (cART), but not specific anti-CMV therapy, consistently showed active retinitis for several months. Delayed diagnosis and treatment of CMV retinitis may have severe consequences. Patients first entering care with advanced HIV infection and vulnerability to reactivation of latent CMV infection should be screened immediately for CMV retinitis by dilated indirect ophthalmoscopy and treated with specific anti-CMV therapy without delay, in addition to cART.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Antivirais/uso terapêutico , Retinite por Citomegalovirus/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Infecções Oportunistas Relacionadas com a AIDS/imunologia , Adulto , Terapia Antirretroviral de Alta Atividade , Contagem de Linfócito CD4 , Linfócitos T CD4-Positivos/imunologia , Estudos Transversais , Retinite por Citomegalovirus/tratamento farmacológico , Retinite por Citomegalovirus/imunologia , Feminino , Humanos , Masculino , Oftalmoscopia , Estudos Retrospectivos , Acuidade Visual/fisiologia
9.
Eur J Ophthalmol ; 29(1): NP10-NP12, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-29747535

RESUMO

We here report a case of cytomegalovirus retinitis in a diabetic patient that occurred after intravitreal ranibizumab injection. A 75-year-old woman was treated with intravitreal ranibizumab injections for diabetic macular edema. During this period, a retinitis occurred in her left eye along with increased IgG and later IgM cytomegalovirus antibody titers. Ocular and intravenous ganciclovir was administered. Cytomegalovirus retinitis subsided post treatment with residual areas of retinal atrophy. Ophthalmologists should be aware of the incidence of cytomegalovirus retinitis, in diabetic patients, after ranibizumab injection.


Assuntos
Inibidores da Angiogênese/efeitos adversos , Retinite por Citomegalovirus/etiologia , Retinopatia Diabética/tratamento farmacológico , Edema Macular/tratamento farmacológico , Ranibizumab/efeitos adversos , Idoso , Anticorpos Antivirais/sangue , Antivirais/uso terapêutico , Citomegalovirus/imunologia , Retinite por Citomegalovirus/diagnóstico , Retinite por Citomegalovirus/tratamento farmacológico , Retinite por Citomegalovirus/imunologia , Feminino , Angiofluoresceinografia , Ganciclovir/uso terapêutico , Humanos , Imunoglobulina G/sangue , Imunoglobulina M/sangue , Injeções Intravítreas , Fator A de Crescimento do Endotélio Vascular/antagonistas & inibidores
11.
Int Ophthalmol ; 39(8): 1709-1715, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30030661

RESUMO

PURPOSE: To study the characteristics and visual outcome of cytomegalovirus retinitis in patients of a tertiary referral ophthalmology center. METHODS: This retrospective cross-sectional study included 16 patients who presented with CMV retinitis between February 2014 and January 2017. Demographics, clinical signs, course of treatment, and visual and anatomical results were analyzed. RESULTS: Twenty five eyes of 16 patients were included. Eleven (68.8%) were females. The mean age was 29.37 ± 17.12 (range 11-73) years. Involvement was bilateral in 9 (56.2%) cases. HIV serology was negative in all patients. Best-corrected visual acuity was 0.57 ± 0.55 logarithm of the minimal angle of resolution (LogMAR) at the time of presentation and decreased to 0.69 ± 0.55 LogMAR on final visit (P = 0.332). None of the patients participating in this study was HIV-positive. CONCLUSION: CMV retinitis is a devastating complication in immunosuppressed. The visual acuity usually decreases despite aggressive appropriate treatment. This observation supports the increasing incidence of CMV infection in non-HIV patients.


Assuntos
Retinite por Citomegalovirus/diagnóstico , Infecções Oculares Virais/diagnóstico , Acuidade Visual/fisiologia , Adolescente , Adulto , Idoso , Antivirais/uso terapêutico , Criança , Estudos Transversais , Retinite por Citomegalovirus/tratamento farmacológico , Retinite por Citomegalovirus/fisiopatologia , Infecções Oculares Virais/fisiopatologia , Feminino , Seguimentos , HIV , Infecções por HIV , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos , Adulto Jovem
13.
Curr Opin Ophthalmol ; 29(6): 535-542, 2018 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30281031

RESUMO

PURPOSE OF REVIEW: This review highlights recent studies that have increasingly implicated cytomegalovirus (CMV) as a significant cause of keratouveitis and retinitis in immunocompetent hosts. RECENT FINDINGS: Molecular testing has identified that CMV infection is frequently present in cases of Posner-Schlossman and Fuchs, keratouveitis syndromes previously presumed to be idiopathic conditions. Ocular hypertension and endothelial cell loss are important complications of CMV keratouveitis and are likely mediated by viral invasion of the trabecular meshwork and corneal endothelium. Topical ganciclovir is a well tolerated, effective, and economical therapy. CMV retinitis is possible in the absence of HIV/AIDS. SUMMARY: CMV has long been considered an innocuous infection in the general population, though recent studies have found otherwise. Intraocular reactivation, replication, and invasion of the trabecular meshwork and endothelium lead to recurrent bouts of ocular hypertension and endothelial cell loss, the complications of which may be tempered with initiation of antivirals. Topical ganciclovir is a promising therapy that needs investigation. CMV retinitis, an entity previously believed isolated to the severely immunosuppressed population, has been reported on numerous occasions in presumably immunocompetent individuals, particularly following local steroid injections. Further studies may elucidate the pathogenesis of CMV in immunocompetent populations.


Assuntos
Doenças da Córnea/diagnóstico , Infecções por Citomegalovirus/diagnóstico , Retinite por Citomegalovirus/diagnóstico , Infecções Oculares Virais/diagnóstico , Hospedeiro Imunocomprometido , Uveíte Anterior/diagnóstico , Antivirais/uso terapêutico , Doenças da Córnea/tratamento farmacológico , Infecções por Citomegalovirus/tratamento farmacológico , Retinite por Citomegalovirus/tratamento farmacológico , Epitélio Posterior/patologia , Infecções Oculares Virais/tratamento farmacológico , Ganciclovir/uso terapêutico , Humanos , Uveíte Anterior/tratamento farmacológico
14.
Br J Ophthalmol ; 102(12): 1607-1610, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30206157

RESUMO

AIMS: To determine if early dilated fundus examination for cytomegalovirus (CMV) retinitis leads to better visual outcomes in areas with limited HIV care, where patients may have long-standing retinitis before they are diagnosed with HIV. METHODS: Twenty-four eyes of 17 patients with CMV retinitis who were seen at an urban HIV clinic in Chiang Mai, Thailand, were included in this retrospective cohort study. Participants were divided into two groups based on the amount of time from the first documented CD4 count below 100 cells/mm3 to the first eye examination for CMV retinitis. Average visual acuity in each group was calculated at the time CMV retinitis was first detected, and then at 3, 6 and 12 months after diagnosis. RESULTS: The group of patients who received an eye examination within approximately 4 months of the initial low CD4 count measurement had better baseline visual acuity (median 20/30,IQR 20/20 to 20/60) compared with patients who presented later (median 20/80, 20/60 to hand motion); p=0.03). Visual acuity did not change significantly during the 12-month study period in either the early group (p=0.69) or late group (p=0.17). CONCLUSION: In this study, patients who were examined sooner after a low CD4 count had better vision than patients who were examined later. Routine early screening of patients with CD4 counts under below 100 cells/mm3 may detect earlier disease and prevent vision loss.


Assuntos
Retinite por Citomegalovirus/diagnóstico , Diagnóstico Tardio , Diagnóstico Precoce , Oftalmoscopia/estatística & dados numéricos , Adulto , Retinite por Citomegalovirus/fisiopatologia , Diagnóstico Tardio/efeitos adversos , Diagnóstico Tardio/estatística & dados numéricos , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Tailândia , Acuidade Visual
15.
Indian J Ophthalmol ; 66(9): 1361-1363, 2018 09.
Artigo em Inglês | MEDLINE | ID: mdl-30127173

RESUMO

A 60-year-old diabetic patient, who had undergone a renal transplant 2 years earlier, presented with sudden decrease in vision in his left eye (LE). He had undergone phacoemulsification combined with intravitreal dexamethasone implant injection in his LE 2 months earlier, for coexistent cataract and diabetic macular edema. Examination revealed necrotizing retinitis with hemorrhages in the macula. A diagnosis of cytomegalovirus retinitis was made, which was confirmed on vitreous polymerase chain reaction. Intravitreal and systemic ganciclovir led to the resolution of retinitis and improvement of visual acuity over a follow-up of 9 months.


Assuntos
Retinite por Citomegalovirus/induzido quimicamente , Dexametasona/efeitos adversos , Retinopatia Diabética/tratamento farmacológico , Infecções Oculares Virais/induzido quimicamente , Edema Macular/tratamento farmacológico , Facoemulsificação/métodos , Retinite por Citomegalovirus/diagnóstico , Retinopatia Diabética/diagnóstico , Implantes de Medicamento , Infecções Oculares Virais/diagnóstico , Glucocorticoides/administração & dosagem , Glucocorticoides/efeitos adversos , Humanos , Edema Macular/diagnóstico , Masculino , Pessoa de Meia-Idade , Acuidade Visual
17.
J Trop Pediatr ; 64(3): 215-224, 2018 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-29873796

RESUMO

Background: Cytomegalovirus (CMV) results in significant morbidity and mortality in Human Immunodeficiency Virus (HIV)-infected individuals. There is paucity of literature on paediatric CMV disease, especially from developing countries. Methods: A retrospective review of records of all HIV-infected children with evidence of CMV disease was done. Results: A total of 15 children were found to have CMV disease (retinitis in all, pneumonia in two and invasive gastrointestinal disease in one). Median CD4+ T cell count and percentage at diagnosis of CMV disease was 64.5 cells/µl and 3.6%, respectively. Intravenous ganciclovir was used in patients with active CMV disease. Of the 15 children, three died while two were lost to follow-up. Symptomatic patients had poor visual outcome and almost all children who were diagnosed on active screening attained normal vision. Conclusion: Retinitis is the most common CMV disease in HIV-infected children. Early detection by active screening and initiation of systemic ganciclovir reduces the morbidity.


Assuntos
Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico , Antivirais/administração & dosagem , Infecções por Citomegalovirus/tratamento farmacológico , Citomegalovirus/isolamento & purificação , Ganciclovir/administração & dosagem , Infecções por HIV/complicações , Infecções Oportunistas Relacionadas com a AIDS/diagnóstico , Infecções Oportunistas Relacionadas com a AIDS/mortalidade , Administração Intravenosa , Terapia Antirretroviral de Alta Atividade , Antivirais/uso terapêutico , Contagem de Linfócito CD4 , Criança , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/mortalidade , Infecções por Citomegalovirus/virologia , Retinite por Citomegalovirus/diagnóstico , Retinite por Citomegalovirus/tratamento farmacológico , Retinite por Citomegalovirus/mortalidade , Retinite por Citomegalovirus/virologia , Feminino , Ganciclovir/uso terapêutico , Infecções por HIV/tratamento farmacológico , Infecções por HIV/epidemiologia , Humanos , Índia/epidemiologia , Masculino , Pneumonia por Pneumocystis/tratamento farmacológico , Taxa de Sobrevida
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