1. Cytomegalovirus  

 
Source:                                Asymptomatic infection extremely common
Infection at birth or in childhood commonest route
Sexual contact
IVDU
Infected blood products  

 
Clinical presentation:

Retinitis:                            

                        

 

 Loss of vision, distorted vision, fever        
Fundoscopy shows white, haemorrhagic 
exudates following retinal blood vessels. Damage irreversible.                           
Retinal detachment common  
Oesophagitis:                     Pain on swallowing, fever 
Endoscopy shows large ulcer  
Colitis:       Diarrhoea, weight loss, fever, abdominal pain
High risk of perforation
Endoscopy shows  widespread ulceration 

 
Encephalitis:                   Rapid onset of confusion and personality change. LP often normal; sually follows CMV disease elsewhere                                 
Diagnosis:

CD4<100

CMV serology +ve but not usually helpful

 
Retinitis:                            By fundoscopy

 

Oesophagitis and colitis: Endoscopic biopsy shows ‘owl’s eye’ inclusion bodies  

 

Encephalitis:  Clinical  

 

Treatment: 

iv Ganciclovir 5mg/kg bd. for 14-21d (adjusted for renal function)

                                                         

                                                      

 
Neutropaenia
Thrombocytopaenia

Or

iv Foscarnet 90mg/kg bd. for 14-21d (adjusted for renal function)  

 

Renal failure
Hypocalcaemia
Genital Ulcers  

 

Complications:  see above; encephalitis usually terminal event: treatment commonly      unsuccessful  

 
Infectious risk to others: No risk to other patients or staff
Pregnant women should avoid intimate (kissing) contact  

 
Prevention: 

Treatment to prevent recurrence not required for colitis/

For retinitis:

Oral ganciclovir 1g tds daily (but only after first episode of peripheral retinitis and in if patient does not have diarrhoea)

Or

iv Ganciclovir 6mg/kg o.d. for 5days/ week (adjust for renal function)

Or

iv Foscarnet 120mg/kg o.d. for 14d then for 5days/ week (adjusted for renal function)