Immunocompromised patients cytomegalovirus infections

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... 

Buhles WC, Mastre BJ, Tinker AJ, et al. Ganciclovir treatment of life- or sight-threatening cytomegalovirus infection experience with 314 immunocompromised patients. Rev Infect Dis 1988 10 495. 

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. 

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. 

Valganciclovir Valcyte Treatment of cytomegalovirus (CMV] retinitis in immunocompromised patients also used to prevent CMV infection after organ transplants... 

The lack of effect of available nucleoside analogs on cytomegalovirus (CMV) infection led to the synthesis of the acyclovir analog, ganciclovir [gan SYE kloe ver] (9-[(1,3-dihydroxy-2-propoxy)methyl]guanine, DHPG). It is currently available for treatment of cytomegalic retinitis in immunocompromised patients. 

It is used in the treatment of cytomegalovirus infections in immunocompromised patients... 

Acyclovir is useful for treating infections caused by HSV, herpes zoster, and for VZV infections (Whitley and Roizman, 2001). Although HCMV is relatively resistant to acyclovir, some cytomegalovirus infections have responded marginally to large doses of acyclovir, and it seems to be effective for the prophylaxis of cytomegalovirus infections in immunocompromised patients. Epstein-Barr virus is not sensitive to acyclovir, and clinical infections do not respond to the drug. 

Ganciclovir is an acyclic nucleoside analogue of guanine that is structurally similar to acyclovir, but is more effective in the treatment and prophylaxis of severe cytomegalovirus infection in immunocompromised hosts. Ganciclovir is myelotoxic, but has no significant nephrotoxicity [22]. It does, however, require dose adjustment for patients with reduced kidney function. 

Famciclovir Cytomegalovirus infections in immunocompromised patients only... 

Foscamet is an antiviral agent that inhibits replication of all known herpes viruses, including cytomegalovirus (CMV), herpes simplex virus types 1 and 2 (HSV-1, HSV-2), human herpes virus 6 (HHV-6), Epstein-Barr virus (EBV) and varicella-zoster virus (VZV). It is indicated in the treatment of CMV retinitis in patients with AIDS treatment of acyclovir-resistant mucocutaneous HSV infections in immunocompromised patients and as combination therapy with ganciclovir for patients who have relapsed after monotherapy with either drug. 

The first antisense therapeutic agent to reach the market is fomivirsen (ISIS 2922) (19). Fomivirsen is a 21-mer phosphorothioate oligodeoxynucleotide (Fig. 8.5). It inhibits human cytomegalovirus (CMV), a ubiquitous herpesvirus that is the most common cause of viral retinitis in immunocompromised patients, especially those with FIIV infection. Cytomegalovirus infection is characterized by the progressive destruction of retinal cells and, if untreated, leads to retinal detachment and blindness. Even with treatment, some degree of visual loss occurs in nearly all patients with a diagnosis of CMV retinitis. It can affect one or both eyes. 

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