[Gastrointestinal cytomegalovirus infections in organ transplant patients].
Cytomegalovirus (CMV) is a major pathogen of immunocompromised organ transplant patients. 80-90% of all transplant patients are infected by the virus; however, the incidence of CMV disease is 30-40%. Gastrointestinal CMV disease occurs in 10% of all transplants involving any part of the gastrointestinal tract. Mucosal injury, ulcerations, erosions, hemorrhage, gastrointestinal dysmotility, rarely gastrointestinal masses, perforations are the most common pathological findings of the CMV disease. The method of specific diagnostics is endoscopy with mucosal biopsy. The biopsy samples must be investigated histopathologically for specific cytomegalic cells with intranuclear ("owl's eye") and intracytoplasmatic inclusions. Different microbiological, immunohistochemical and molecular biological assays can be performed to detect CMV in the mucosa. In case of gastrointestinal CMV disease, both gastroenterological and antiviral treatment are needed by ganciclovir i.v. and/or valganciclovir orally. The prevention of the disease should be achieved by general prophylaxis in high-risk patients (oral valganciclovir, in special cases hyperimmune globulin), and by preemptive therapy using microbiological surveillance in middle-risk patients.
Péter
Antal
A
Semmelweis Egyetem, Altalános Orvostudományi Kar, Transzplantációs és Sebészeti Klinika, Budapest. antalpeter@freemail.hu
Telkes
Gábor
G
Varga
Marina
M
Járay
Jeno
J
D000212:Acyclovir / Q000627:therapeutic use; D000998:Antiviral Agents / Q000627:therapeutic use*; D001706:Biopsy; D000077404:Cidofovir; D003587:Cytomegalovirus / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology* / Q000517:prevention & control; D003596:Cytosine / Q000031:analogs & derivatives / Q000627:therapeutic use; D016099:Endoscopy, Gastrointestinal; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000031:analogs & derivatives / Q000627:therapeutic use; D005753:Gastric Mucosa / Q000821:virology; D005767:Gastrointestinal Diseases / Q000209:etiology* / Q000821:virology; D041981:Gastrointestinal Tract / Q000821:virology*; D006801:Humans; D016867:Immunocompromised Host; D007136:Immunoglobulins / Q000627:therapeutic use; D016219:Immunotherapy, Adoptive; D007413:Intestinal Mucosa / Q000821:virology; D016377:Organ Transplantation / Q000009:adverse effects*; D063065:Organophosphonates / Q000627:therapeutic use; D011322:Primary Prevention / Q000379:methods; D000077562:Valganciclovir
D000998:Antiviral Agents; D007136:Immunoglobulins; D063065:Organophosphonates; D017245:Foscarnet; D003596:Cytosine; D000077562:Valganciclovir; D000077404:Cidofovir; D015774:Ganciclovir; D000212:Acyclovir