Medicine:Cytomegalovirus retinitis

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Cytomegalovirus retinitis
Other namesCMV retinitis
Fundus photograph-CMV retinitis EDA07.JPG
Fundus photograph of CMV retinitis
SymptomsBlurred vision[1]
CausesBone marrow transplant, HIV/AIDS[1]
Diagnostic methodOphthalmologic exam, blood test[1]
MedicationAntivirals (oral or intraocular injection)[2]

Cytomegalovirus retinitis, also known as CMV retinitis, is an inflammation of the retina of the eye that can lead to blindness.[1] Caused by human cytomegalovirus, it occurs predominantly in people whose immune system has been compromised, 15-40% of those with AIDS.[3]

Signs and symptoms

The typical "pizza pie" appearance of the fundus in CMV retinitis[4][5][6][7]

The symptoms of cytomegalovirus retinitis have it usually starting in one eye (and also have the possibility of retinal detachment), presenting as:[1]

Cause

Cytomegalovirus (a type of herpes virus) is what causes cytomegalovirus retinitis. Other types of herpes viruses include herpes simplex viruses and Epstein-Barr virus. Once an individual is infected with these viruses they stay in the body for life.[8] What triggers the virus to reactivate are the following (though CMV can also be congenital).[7]

  • Leukemia
  • AIDS
  • Immunosuppressive chemotherapy

Mechanism

Human cytomegalovirus (HCMV or CMV) is a DNA virus in the family Herpesviridae known for producing large cells with nuclear and cytoplasmic inclusions,[9] CMV infects around 40% of the population worldwide.[10]

Those areas infected by cytomegalovirus have cells evolve to necrosis, though inflammation within the retina is not great. Rhegmatogenous retinal detachments can occur following the development of holes in areas of healed retinitis (retina may be atrophic).[11][12] Proliferative vitreoretinopathy has been observed in cases of retinal detachment.[13]

Diagnosis

PCR result, Gel electrophoresis

The diagnosis of CMV retinitis can be done via the following:[7][14]

  • Ophthalmic screening frequency is based on CD4 count,(CD4 < 50 cells/mL, 0- 35% possibility of CMV retinitis)
  • BUN
  • CD8+ T-lymphocyte count
  • CMV DNA capture ( polymerase chain reaction (PCR) test)
  • DNA PCR ( ocular fluids)
  • Viral load
  • Complete blood count

Treatment

Ganciclovir

In terms of the treatment of cytomegalovirus retinitis, oral valganciclovir, intravenous ganciclovir, IV foscarnet, and IV cidofovir are all efficient in the treatment of this condition. Also intravitreal injections, an injection of medicine into the vitreous near the retina, of foscarnet in concomitance with oral valganciclovir can be used for treatment as well.[15][2][16]

Often individuals with CMV retinitis will need surgery for either retinal detachment or intravitreal instillation of ganciclovir. Retinal detachment occurs in up to 29% of affected eyes, repair being most effective with endolaser and silicone oil endotamponade. Intravitreal ganciclovir implant has the benefit of less systemic toxicity. An adverse effect of this is retinal detachment (and vitreous hemorrhage), also there is no systemic beneficial effect for cytomegalovirus organ disease.[7]

See also

References

  1. ↑ 1.0 1.1 1.2 1.3 1.4 "Cytomegalovirus retinitis". MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/000665.htm. Retrieved 2016-03-14. 
  2. ↑ 2.0 2.1 "Inflammatory Retinal Diseases." (in en-GB). Patient. Leeds, UK: Egton Medical Information Systems Limited. 12 March 2014. http://patient.info/doctor/inflammatory-retinal-diseases. 
  3. ↑ (in en) Principles and Practice of Vitreoretinal Surgery. JP Medical Ltd. 2014-05-30. p. 571. ISBN 978-9-351-52097-9. https://books.google.com/books?id=X7XTAwAAQBAJ. 
  4. ↑ "Cytomegalovirus retinitis". JAMA 262 (23): 3337. December 1989. doi:10.1001/jama.1989.03430230122038. ISSN 0098-7484. PMID 2555576. https://jamanetwork.com/journals/jama/article-abstract/379907. 
  5. ↑ "Current approach in the diagnosis and management of posterior uveitis". Indian Journal of Ophthalmology 58 (1): 29–43. January 2010. doi:10.4103/0301-4738.58470. ISSN 0301-4738. PMID 20029144. 
  6. ↑ "HIV-Related CMV Retinitis in the Developing World" (PDF). EyeNet Magazine - American Academy of Ophthalmology: 27–29. February 2014. https://www.aao.org/Assets/6b1e694e-62d6-4fa3-9691-dc7a2f7cb9dc/635559897697170000/february-2014-clinical-update-international-pdf. 
  7. ↑ 7.0 7.1 7.2 7.3 Cytomegalovirus (CMV) Retinitis~clinical at eMedicine. "Archived copy". https://emedicine.medscape.com/article/1227228-clinical. 
  8. ↑ "CMV | Overview | Cytomegalovirus and Congenital CMV Infection". U.S. Centers for Disease Control and Prevention. https://www.cdc.gov/cmv/overview.html. 
  9. ↑ "Human Cytomegalovirus Infection" (in en). Sexually Transmitted Infections (2nd ed.). Elsevier Health Sciences. February 2014. p. 399. ISBN 978-8-131-22978-1. https://books.google.com/books?id=kQ9tAwAAQBAJ. 
  10. ↑ Encyclopedia of Molecular Pharmacology (2nd ed.). Springer. 2008. pp. 437–438. ISBN 978-3-540-38916-3. https://archive.org/details/encyclopediamole12rose. 
  11. ↑ "Rhegmatogenous Retinal Detachment Clinical Presentation: History, Physical, Causes". Medscape. 8 October 2019. http://emedicine.medscape.com/article/1224737-clinical#b5. 
  12. ↑ "Neuropathogenesis of congenital cytomegalovirus infection: disease mechanisms and prospects for intervention". Clinical Microbiology Reviews 22 (1): 99–126, Table of Contents. January 2009. doi:10.1128/CMR.00023-08. ISSN 0893-8512. PMID 19136436. 
  13. ↑ "Proliferative vitreoretinopathy: current and emerging treatments". Clinical Ophthalmology 6: 1325–1333. January 2012. doi:10.2147/OPTH.S27896. ISSN 1177-5467. PMID 22942638. 
  14. ↑ (in en) Diagnosis & Treatment of Uveitis. JP Medical Ltd. 2013-03-30. p. 449. ISBN 978-9-350-25572-8. https://books.google.com/books?id=vZxqM6cuQI4C. 
  15. ↑ "Cytomegalovirus Disease | Adult and Adolescent OI Prevention and Treatment Guidelines". AIDSinfo. U.S. National Institutes of Health. https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/337/cmv. 
  16. ↑ "Intravitreal injection". MedlinePlus Medical Encyclopedia. U.S. National Library of Medicine. https://www.nlm.nih.gov/medlineplus/ency/article/007629.htm. Retrieved 2016-03-16. 

Further reading

External links

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