Immunocompromised

Cytomegalovirus (CMV) is a herpesvirus, which causes an inapparent infection in immunocompetent persons. Worldwide, approximately 40% of people are infected with CMV. In immunocompromised patients, transplant recipients and neonates, CMV can cause serious and potentially lethal disease manifestations like pneumonia, retinitis and blindness, hepatitis, infections of the digestive tract, deafness or mental retardation. 

CMV, a virus of the herpes family, isa common viral infection. Healthy individuals may beoome infected yet have no symptoms. However, immunocompromised patients (such as those with HIV or cancer) may have the infection. Symptoms include malaise, fever, pneumonia, and super infection. Infants may acquire the virus from the mother while in the uterus, resulting in learning disabilities and mental retardation. CM V can infect the eye, causing retinitis. Symptoms of CMV retinitis are blurred vision and decreased visual acuity. Visual impairment is irreversible and can lead to blindness if untreated. 

RSV infection is highly contagious and infects mostly children, causing bronchiolitis and pneumonia. Infants younger than 6 months are the most severely affected. In adults, RSV causes colds and bronchitis, with fever, cough, and nasal congestion. When RSV affects immunocompromised patients, the consequences can be severe and sometimes fatal. 

Acyclovir (Zovirax) and penciclovir (Denavir) are the only topical antiviral dragp currently available These dragp inhibit viral replication. Acyclovir is used in the treatment of initial episodes of genital herpes, as well as heqies simplex virus infections in immunocompromised patients (patients with an immune system incapable of fighting infection). Penciclovir is used for the treatment of recurrent herpes labialis (cold sores) in adults. 

Antiviral drugp interfere with viral reproduction by altering DNA synthesis. These drug are used in the treatment of herpes simplex infections of the eye, treatment in immunocompromised patients with cytomegalovirus (CMV) retinitis, and for the prevention of CMV retinitis in patients undergoing transplant. 

These dru are contraindicated in patients with hypersensitivity to the drug or any component of the drug. These drugs are used cautiously in immunocompromised patients and during pregnancy and lactation. Some of these solutions contain boric acid and may result in a precipitate that causes irritation. 

Gubareva LV, Matrosovich MN, Brenner MK, Bethell RC, Webster RG (1998) Evidence for zanamivir resistance in an immunocompromised child infected with influenza B virus, J Infect Dis 178 1257-1262... 

Ison MG, Gubareva LV, Atmar RL, Treanor J, Hayden EG (2006a) Recovery of drug-resistant influenza virus from immunocompromised patients a case series, J Infect Dis 193 760-764 Ison MG, Mishin VP, Braciale TJ, Hayden EG, Gubareva LV (2006b) Comparative activities of oseltamivir and A-322278 in immunocompetent and immunocompromised murine models of influenza virus infection, J Infect Dis 193 765-772... 

To translate this approach into clinical scenarios, the risk-benefit assessment of chemotherapy administration in already immunocompromised patients would favor situations in which cytotoxic drugs are indicated anyhow, such as in AIDS-related lymphomas, where alkylating agents are part of the standard regimens. 

Cytomegalovirus (CMV) Enveloped, icosahedral particles 150nm in diameter CMV is generally acquired in childhood as a subclinical infection. About 50% of adults carry the virus in a dormant state in white blood cells. The virus can cause severe disease (pneumonia, hepatitis, encephalitis) in immunocompromised patients. Primary infections during pregnancy can induce serious congenital abnormalities in the fetus... 

Patients with diarrhea should be questioned about the onset of symptoms, recent travel, diet, source of water, and medication use. Other important considerations include duration and severity of the diarrhea along with an accounting of the presence of associated abdominal pain or vomiting, blood in the stool, stool consistency, stool appearance, stool frequency, and weight loss. Although most cases of diarrhea are self-limited, infants, children, elderly persons, and immunocompromised patients are at risk for increased morbidity. 

Antibodies against HCV (anti-HCV) in the blood indicate infection with the HCV. If the infection persists for more than 6 months and viral replication is confirmed by HCV RNA levels, then the person has chronic hepatitis C. Chronic disease may be due to an ineffective host immune system against the HCV. Cytotoxic T lymphocytes are ineffective in eradicating the HCV, thus allowing persistent damage to hepatic cells. Therefore, immunocompromised individuals are less likely to eliminate HCV.12... 

Several studies have evaluated dietary supplements such as isoflavones, which are found in soy products and red clover. A well-controlled trial in more than 400 postmenopausal women evaluating a specific isoflavone, ipriflavone, found no benefits on bone mineral density or fracture rates after 3 years.47 Nevertheless, because these therapies are available without prescription and are not regulated by the FDA, patients may choose to self-medicate with isoflavones. Lymphocytopenia appeared in several patients treated with ipriflavone in clinical trials. Additionally, ipriflavone should be used with caution in immunocompromised patients or those with renal disease. It may inhibit CYP1A2 and CYP2C9 and may interact with drugs metabolized by those pathways, such as warfarin. 

Connective tissue disease Substance abuse Stevens-Johnson syndrome Immunocompromised Atopic dermatitis Gonococcal infection Vitamin A deficiency... 

Immunocompromised, history of CNS disease, new onset seizure, papilledema, altered consciousness, or focal neurologic deficit or delay in performance of diagnostic lumbar puncture... 

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