Evaluation of Ganciclovir for Cytomegalovirus Disease

Cytomegalovirus (CMV) infections are a common cause of morbidity and mortality in immunosuppressed patients. Ganciclovir is an acyclic deoxyguanosine analog structurally similar to acyclovir but with superior activity against CMV. The median ganciclovir concentration required to inhibit viral replication by 50 percent is 2.15 μmol versus 72 μmol for acyclovir. Pharmacokinetic properties of ganciclovir include biexponential decay with a terminal half-life of 2.5 hours, tissue uptake, cerebrospinal fluid penetration, and renal dependence for elimination. CMV treatment approaches have commonly used dosages of 3–15 mg/kg/d. In uncontrolled trials, the response rate of CMV retinitis is approximately 80 percent. The overall response rate for CMV pneumonitis has been approximately 50 percent. However, AIDS (acquired immunodeficiency syndrome) and other immunosuppressed patients appear to respond more favorably (~ 70 percent) than do marrow transplant recipients. Relapse is common once ganciclovir is stopped and maintenance therapy may be required for sustained benefit. Neutropenia appears to be the drug-limiting adverse reaction. Although the development of ganciclovir-resistant CMV, risk factors for neutropenia, and alternative administration strategies all need further study, ganciclovir appears to have a role in the treatment of cytomegalovirus disease.

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Correlation between cytomegalovirus disease and antiviral resistance

Microbiology Australia ◽

10.1071/ma05014 ◽

2005 ◽

Vol 26 (1) ◽

pp. 14

Author(s):

Gillian M Scott ◽

Jenna M Iwasenko ◽

Zubair M Waliuzzaman ◽

David H Miles ◽

William D Rawlinson

Keyword(s):

Immunosuppressive Therapy ◽

Human Cytomegalovirus ◽

Acquired Immunodeficiency Syndrome ◽

Morbidity And Mortality ◽

Antiviral Resistance ◽

Transplant Recipients ◽

Significant Morbidity ◽

Cytomegalovirus Disease ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome

Disease resulting from human cytomegalovirus (CMV) infections leads to significant morbidity and mortality in patients with Acquired Immunodeficiency Syndrome (AIDS), transplant recipients undergoing immunosuppressive therapy, and neonates.

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Gastric Toxoplasmosis as the Presentation of Acquired Immunodeficiency Syndrome

Archives of Pathology & Laboratory Medicine ◽

10.5858/2005-129-e87-gtatpo ◽

2005 ◽

Vol 129 (4) ◽

pp. e87-e90 ◽

Cited By ~ 33

Author(s):

Mihai Merzianu ◽

Steven M. Gorelick ◽

Voltaire Paje ◽

Donald P. Kotler ◽

Corazon Sian

Keyword(s):

Acquired Immunodeficiency Syndrome ◽

English Literature ◽

Human Immunodeficiency Virus Status ◽

Old West ◽

Immunosuppressed Patients ◽

The Central Nervous System ◽

Acquired Immunodeficiency ◽

High Index Of Suspicion ◽

Immunodeficiency Syndrome ◽

Disseminated Disease

Abstract We report a case of a 39-year-old West African man with unknown human immunodeficiency virus status diagnosed with gastric toxoplasmosis as the presenting manifestation of acquired immunodeficiency syndrome. Toxoplasma gondii is common in severely immunosuppressed patients and most frequently involves the central nervous system, followed by the eye, myocardium and skeletal muscle, lungs, bone marrow, and peripheral blood. For unclear reasons, gastrointestinal involvement is exceedingly rare and occurs in the context of severe immunosuppression and disseminated disease. To our knowledge, this is the first report in the English literature of a patient with isolated, manifest gastric toxoplasmosis without evidence of concomitant cerebral or extracerebral involvement. It is important for both the clinician and the pathologist to maintain a high index of suspicion for toxoplasmosis in immunosuppressed patients presenting with nonspecific symptoms of gastritis and radiologic and endoscopic presence of thickened gastric folds with or without ulceration.

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Treatment of Severe Cryptosporidium-Related Diarrhea with Octreotide in a Patient with AIDS

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002808802200206 ◽

1988 ◽

Vol 22 (2) ◽

pp. 134-136 ◽

Cited By ~ 27

Author(s):

Michael D. Katz ◽

Brian L. Erstad ◽

Cathryn Rose

Keyword(s):

Gastrointestinal Hormones ◽

Somatostatin Analog ◽

Secretory Diarrhea ◽

Inhibitory Effects ◽

Severe Diarrhea ◽

Immunosuppressed Patients ◽

Acquired Immunodeficiency ◽

Antiparasitic Drugs ◽

Long Acting ◽

Immunodeficiency Syndrome

Cryptosporidiosis commonly causes severe diarrhea in immunosuppressed patients. There currently are no antiparasitic drugs consistently effective for this infection. This case describes a 26-year-old hemophiliac patient with acquired immunodeficiency syndrome and cryptosporidiosis whose diarrhea improved with continuous intravenous administration of a long-acting somatostatin analog, octreotide. Somatostatin has a variety of inhibitory effects on gastrointestinal hormones as well as a possible nonspecific effect on gastrointestinal mucosal fluid and electrolyte secretion. The somatostatin analog should be considered for patients with secretory diarrhea refractory to other forms of therapy.

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Fungal Mastoiditis in AIDS Patients: Reported Cases

Arquivos Internacionais de Otorrinolaringologia ◽

10.1590/s1809-48722011000200019 ◽

2011 ◽

Vol 15 (02) ◽

pp. 245-248

Author(s):

Flavia Silveira ◽

Gabriel Bijos Faidiga ◽

Tassiana do Lago ◽

Camila Carrara Yassuda ◽

Eduardo Tanaka Massuda ◽

...

Keyword(s):

Case Report ◽

Facial Nerve ◽

Antifungal Therapy ◽

Acquired Immunodeficiency Syndrome ◽

Aids Patients ◽

Aspergillus Fumigates ◽

Immunosuppressed Patients ◽

Acquired Immunodeficiency ◽

Immunodeficiency Syndrome ◽

Fatal Complications

Summary Introduction: Fungal mastoidits by Aspergillus fumigates predominantly occurs in immunosuppressed patients. Diagnosis is usually hard and disease is potentially fatal. Treatment is comprised of antifungal therapy, surgical debridement and immunosuppression correction. Case Report: This article reports a case of fungal mastoiditis in a patient with acquired immunodeficiency syndrome (AIDS). The treatment performed was that of surgery associated with antifungal therapy. The patient's facial nerve was not affected, what does not exclude potentially fatal complications of mastoiditis.

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BK Virus Renal Infection in a Patient With the Acquired Immunodeficiency Syndrome

Archives of Pathology & Laboratory Medicine ◽

10.5858/1999-123-0807-bvriia ◽

1999 ◽

Vol 123 (9) ◽

pp. 807-811 ◽

Cited By ~ 4

Author(s):

Manuela Nebuloni ◽

Antonella Tosoni ◽

Renzo Boldorini ◽

Guido Monga ◽

Luca Carsana ◽

...

Keyword(s):

Acquired Immunodeficiency Syndrome ◽

Renal Damage ◽

Bk Virus ◽

Transplant Patients ◽

Immunosuppressed Patients ◽

Acquired Immunodeficiency ◽

Polymerase Chain ◽

Immunodeficiency Syndrome ◽

Inflammatory Infiltrates ◽

Renal Infection

Abstract Background.—We describe herein a patient with the acquired immunodeficiency syndrome and renal failure due to biopsy-proven BK virus (BKV) infection. Three months after the diagnosis of the renal viral infection, his condition remained unchanged. Although BKV has previously been shown to be associated with ureteral stenosis and renal damage in renal transplant patients, to our knowledge, the literature contains only 3 cases describing the presence of BKV lesions in the kidneys of immunosuppressed patients who had not undergone transplantation. Methods.—The presence of BKV infection was demonstrated by means of histology, immunohistochemistry with polyclonal anti-SV40 antibody, immunoelectron microscopy, polymerase chain reaction, and enzymatic cleavage with BamHI. Results.—Histologic examination revealed interstitial inflammatory infiltrates and tubules with enlarged and eosinophilic nuclei. Conclusions.—The high frequency of latent BKV infection and its reactivation during immunosuppression suggest that the possibility of its involvement in renal damage should be considered in immunocompromised patients.

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Persistence and Clinical Outcome of Hepatitis G Virus Infection in Pediatric Bone Marrow Transplant Recipients and Children Treated for Hematological Malignancy

Blood ◽

10.1182/blood.v93.2.721.402k28_721_727 ◽

1999 ◽

Vol 93 (2) ◽

pp. 721-727 ◽

Cited By ~ 1

Author(s):

Maki Yamada-Osaki ◽

Ryo Sumazaki ◽

Masahiro Tsuchida ◽

Kazutoshi Koike ◽

Takashi Fukushima ◽

...

Keyword(s):

Bone Marrow ◽

Pediatric Patients ◽

Hematological Malignancy ◽

Marrow Transplant ◽

Transplant Recipients ◽

Hepatitis G Virus ◽

Persistent Viremia ◽

Immunosuppressed Patients ◽

Hepatitis G ◽

Initial Blood

The natural course and the clinical significance of hepatitis G virus (HGV) infection were investigated in 106 pediatric patients who received chemotherapy for hematological malignancy or underwent bone marrow transplantation (BMT) using HGV-RNA and antibodies to the HGV-E2 protein (anti-E2). HGV markers were detected in 21 patients (19.8%; HGV-RNA in 19 and anti-E2 in 2). Longitudinal analysis of these HGV-infected patients showed that 1 had anti-E2 before the initial blood transfusion, 14 had persistent viremia, and 6 became clear of circulating HGV-RNA after completion of therapy, although 5 of the 6 HGV-cleared patients never developed anti-E2. Reactivation of HGV infection during chemotherapy was observed in two anti-E2–positive, HGV-RNA–negative patients; the reappearance of the same HGV strain was confirmed by phylogenetic analysis. Among BMT survivors without other known causes of liver dysfunction, HGV-RNA–positive patients had a higher peak serum alanine amino transferase (ALT) value than negative patients. Contrary to previous reports, immunosuppressed patients can apparently recover from HGV infection without detectable anti-E2 and some patients who supposedly recovered from HGV infection can nonetheless suffer exacerbation when subsequently immunosuppressed.

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