Cytomegalovirus Retinitis in HIV Negative Patients – Retrospective Study
Authors:
A. Beňová; M. Brichová; P. Svozílková; B. Kousal; D. Jeníčková; prof. MUDr. Jarmila Heissigerová, Ph.D., MBA; E. Říhová
Authors place of work:
Oční klinika, 1. lékařská fakulta, Univerzity Karlovy nemocnice v Praze a Všeobecná fakultní nemocnice, Praha, přednostka doc. MUDr. Bohdana Kalvodová, CSc.
Published in the journal:
Čes. a slov. Oftal., 69, 2013, No. 6, p. 227-234
Category:
Original Article
Práce byla prezentována na XXI. výročním sjezdu České oftalmologické společnosti Brně v roce 2013
Summary
Aim:
To evaluate own experience with the diagnosis and treatment of cytomegalovirus (CMV) retinitis in HIV negative patients with imunodeficiency.
Methods:
Retrospective study and case reports.
Results:
In the Centre for diagnosis and treatment of Uveitis 1869 patients with uveitis we have examined from June 2003 to June 2012. CMV retinitis was diagnosed in 7 patients (1 woman and 6 men) according to the typical clinical findings and history of imunodeficiency. In 2 atypical findings was the diagnosis confirmed by determination of DNA pathogen in vitreous sample (a patient with non-Hodgkin lymphoma) or by positive serology (CMV in leukocytes – indolent form of CMV retinitis in a patient with systemic lupus erythematosus). In 8 cases we found fulminant form, in 1 case indolent form of CMV retinitis. The average age of patiens was 39,1 years (18-51 years old), ratio of men to women 6 : 3. In 6 of 9 cases we noticed bilateral retinitis. The average period of observation in our study was 15,8 months (1-48 months). Five of our patients underwent bone marrow transplantation, 2 patients were treated with systemic immunosuppressive drugs (colitis ulcerosa, systemic lupus erythematosus) and 2 patients had chemotherapy for lymphoma. The initiation or modification of treatment (gancyklovir p.o./i.v., foscarnet i.v.) was consulted and coordinated with others specialists. After initiation of treatment we followed-up 7 patients. In 4 eyes of 3 patients (31 %) the improvement of visual acuity was documented, in 5 eyes of 5 patients (38 %) the visual acuity was stabilized. The worsening of vision in 4 eyes of 3 patients (31 %) was caused by complications without any connection to virostatic therapy. All of our patients, who underwent bone marrow tranplantation, died within 12 months since the diagnosis of CMV retinitis was determined.
Conclusion:
The diagnosis of CMV retinitis only in 9 cases (0,48% of all uveitic patiens) confirms the rare occurrence of this retinitis. The important tool to the diagnosis of CMV retinitis is the history of imunodeficiency. In an atypical findings, the analysis of intraocular fluids or serological tests could help to the final diagnosis. The occurrence of CMV retinitis signify a very unfavourable prognosis for patients who underwent bone marrow transplantation and these patients died within 12 mounths since CMV retinitis has been diagnosed. The management of the therapy requires close interdisciplinary cooperation.
Key words:
cytomegalovirus, cytomegalovirus retinitis, gancyclovir, foscarnet, cidofovir, imunodeficiency
Zdroje
1. Altaweel, M., et al.: CMV retinitis [online]. July 11, 2012 [cit. 2012-08-13]. Dostupné z: http://emedicine.medscape. com/article/1227228-overview.
2. Banker, AS.: Posterior segment manifestations of Human Immunodeficiency Virus/ Acquired Immune Deficiency Syndrome. Indian J Ophthalmol. 2008; 56(5): 377–383.
3. Boguzsaková, J.: Oko a celková onemocnění. In: Kuchynka, P., et al. Oční lékařství. Praha: Grada Publishing, 2007.
4. Cihelková, I., Souček, P.: Atlas makulárních chorob. 1. vyd. Praha: Karolinum, 2005.
5. Eid AJ., Bakri, SJ., Kijipittayarit, S., et al.: Clinical features and outcomes of cytomegalovirus retinitis after transplantation. Transpl Infec Dis. 2008; 10(1): 13-18.
6. Freeman, WR., Friedberg DN., Berry C., et al.: Risk factors for development of rhegmatogenous retinal detachment in patients with cytomegalovirus retinitis. Am J Ophthalmol, 1993; 116(6): 713–720.
7. Foerster, HW. Pathology of granulomatous uveitis. Surv Ophthalmol. 1959; 4(3, Part 2): 283–326.
8. Gupta, AK., Mazumdar, S., Choudhry, S.: Practical approach to ophthalmoscopic retinal diagnosis. 1st edition.New Delhi: Jaypee Brothers Medical Publisher, 2010.
9. Hopkins, J., Gallant, J.: Johns Hopkins HIV guide 2012. 1st edition. Burlington: Jones&Bartlett Publishers, 2012.
10. Chung, H., Kim, K., Kim, J., et al.: Retinal complications in patients with solid organ or bone marrow transplantations. Transplantation, 2007; 83(6): 694-699.
11. Jabs, DA.: Ocular manifestations of HIV infection. Trans Am Ophthalmol Soc, 1995; 93: 623–683.
12. Kanski, JJ.: Clinical Ophthalmology - a systematic approach. 5th edition. Philadelphia: Butterworth Heinemann, 2003.
13. Kempen, JH., Jabs, DA., Wilson, LA., et al.: Risk of vision loss in patients with cytomegalovirus retinitis and the Acquired Immune Deficiency Syndrome. Arch Ophthalmol. 2003; 121: 466–476.
14. Kuchynka, P., et al.: Oční lékařství. Praha: Grada Publishing, 2007.
15. Kuo CI., Kempen, HJ., et al.: Clinical characteristics and outcomes of cytomegalovirus retinitis in persons without Human Immunodeficiency Virus infection. Am J Ophthalmol, 2004; 138(3): 338–346.
16. Reynolds, DJ.: Pediatric retina. New York: Springer, 2011.
17. Ryan, JS.: Retina. 3rd edition. Missoury: Mosby, 2001.
18. Říhová, E., et al.: Uveitidy. 1. vyd. Praha: Grada, 2009.
19. Viralzone. Cytomegalovirus [online]. July, 2012 [cit. 2012-08-16]. Dostupné z: http://viralzone.expasy.org/all_by_species/180.
20. Vlková, E., Pitrová, Š., Vlk, F.: Lexikon očního lékařství. 1. vyd. Brno: nakladatelství František Vlk, 2008.
21. Xhaard, A., Robin, M., Scieux, C., et al.: Increased incidence of cytomegalovirus retinitis after allogenic hematopoetic stem cell transplantation. Transplantation. 2007; 83(1): 80–83.
22. Zeicher, LS., Read, SJ.: Handbook of pediatric HIV care. Cambridge: Cambridge University Press, 2006.
Štítky
OphthalmologyČlánok vyšiel v časopise
Czech and Slovak Ophthalmology
2013 Číslo 6
Najčítanejšie v tomto čísle
- Vision Loss after Uncomplicated Pars Plana Vitrectomy
- Treatment Strategy of the Lacrimal Drainage System Inborn Obstruction. Part One – Conservative and Intervention Procedures
- Cytomegalovirus Retinitis in HIV Negative Patients – Retrospective Study
- Pars Plana Vitrectomy Due to the Intravitreal Hemorrhage Caused by Persistent Hyaloid Artery in Three Children