jurnal infeksi ccmv dw

8/10/2019 Jurnal Infeksi CCMV Dw

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EVIDENCE BASED MANAGEMENT GUIDELINES

FOR THE DETECTION AND TREATMENT OF

CONGENITAL CMV

a Paediatric Infectiou Dieae Unit! St Geor"e# Uni$erit% of London! Cran&er Terrace! London S'() *RE! United

+in"do&

, Ro%a- Victoria In.r&ar% Ho/ita-! 0ueen Victoria Road! Ne1cat-e u/on T%ne NE( 2LP! United +in"do&

c Uni$erit% Co--e"e London! Di$iion of Infection and I&&unit%! Ro%a- Free Ho/ita-! Ro1-and Hi-- Street! London N'3

4PF! United +in"do&

S5 +ada&,ari a!6! E575 'i--ia& ,!(! S5 Luc8 c! P5D5 Gri9t: c! M5 S:ar-and a

I-a&&i%a: De1i ;unianti

Pe&,i&,in"

Dr5 MMDEAH Ha/ari! S/A+

Dr5 Na:1a Ar8:aei! Mi Med! S/A


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Currently no universal screeningprogramme for CMV.

The annual costs of CMV dieae to t:e US :ea-t: care

%te& 1ere eti&ated in t:e (


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ABSTRACT

CMV i t:e most common con"enita- infection innewborns 1or-d1ide5

Con"enita- CMV caue sensori-neural hearing loss in a

i"ni.cant /ro/ortion of infected ne1,orn! 1:i-e t:e&a?orit% of ne1,orn are asymptomatic.

In t:e -at t:ree %ear t:ere :a$e ,een i"ni.cantad$ance in t:e dia"noi and treat&ent of con"enita-

CMV5

'e :a$e de$e-o/ed /ractica- e$idence ,aed "uide-ine fort:e &ana"e&ent of con"enita- CMV5


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Content of S-ide

(5 Introduction

45 Ma8in" t:e dia"noi 45(5 C-inica- feature

45(5(5 S%&/to&atic con"enita- CMV infection

45(545 A%&/to&atic con"enita- CMV infection

4545 La,orator% con.r&ation of infection 4545(5 Urine $ a-i$a CMV PCR

454545 Pro,-e& 1it: tetin" Dried B-ood S/ot @DBS

4535 Furt:er in$eti"ation reuired in a ,a,% 1it: con.r&edcCMV 4535(5 B-ood tet

453545 C:oice of neuroi&a"in"

453535 O/:t:a-&ic ae&ent

453525 Audio-o"ica- ae&ent

45355 Decidin" 1:et:er t:e ,a,% i S%&/to&atic or A%&/to&atic


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35 Treatin" and &onitorin" cCMV 35(5 Treatin" %&/to&atic or"an dieae

35(5(5 ':o to treat

3545 Gancic-o$ir GCV 3535 Va-"ancic-o$ir VGCV

3535(5 Treatin" o-der c:i-dren

3525 Monitorin" 3525(5 Safet% /ara&eter

352545 Vira- -oad

352535 Dru" -e$e-

352525 Reitance aa%

25 P-annin" -on" ter& fo--o1 u/ 25(5 Audio-o"%

2545 Neurode$e-o/&enta-

2535 O/:t:a-&o-o"%

2525 Fa&i-% u//ort

5 Mana"e&ent a-"orit:& for t:e treat&ent of con"enita- CMV

>5 Conc-uion


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INTRO!CTION -"#$TR"CT

':at! ':%! ':o! ':en! ':ere! Ho1


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Introduction

Con"enita- CMV @cCMV i t:e lea%ing ofnon-genetic cause of enorineura-

:earin" -o

'or-d1ide! t:e ,irt: /re$a-ence of cCMV i

eti&ated at)(***

(45) of infected ne1,orn are symptomaticat ,irt:

(35 of infant 1:o are a%&/to&atic t:en %evelopse&uelae inc-udin" enorineura- :earin" -o @SNHL inc:i-d:ood


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An accurate %iagnosis :a to ,e &ade1it:in the 'rst three wee(s of -ife $iro-o"ica- and ero-o"ica- tet ta8en after t:i

ti&e no -on"er c-ear-% ditin"ui: ,et1eencon"enita- and acuired infection5

Vertica- tran&iion of CMV infection canoccur t:rou": three main routes Intrauterine

Intrauterine tran&iion i the most importantroute a it &a% reu-t in &a?or neuro-o"ica- eue-ae

Intra/artu&

Potnata-


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Co&&on ource

T:e &ot common source of $irufor /re"nant 1o&en i fro& youngchil%ren

Pot/artu& acuiition &ain-%t:rou": ,reat &i-8 One tud% found infant 1:o breast

fee% from seropositive mothers:a$e an eti&ated rate of infection of u/

to 3=5


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M")IN* I"*NO$I$

An accurate %iagnosis :a to ,e &ade 1it:in the 'rstthree wee(s of -ife


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45(5 C-inica- feature

45(5(5 S%&/to&atic con"enita- CMVinfectionT:e t%/ica- /:%ica- i"n inc-ude

B-ue,err% &u9n ra:

Petec:iae

IUGR

Microce/:a-%

He/ato/-eno&e"a-%

7aundice


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La,orator% reu-t

are conitent 1it:hepatic an%reticuloen%othelial involvement + Con?u"ated

:%/er,i-iru,inae&iaT:ro&,oc%to/aenia

E-e$ated :e/atictrana&inae

S%&/to&aticne1,orn

SNHL! -earnin"di9cu-tie!&icroce/:a-% and

$iua- -o @rare-%


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45(545 A%&/to&atic con"enita- CMV infection Con"enita- CMV i most commonly

asymptomatic

A//roJi&ate-% (* 1i-- %evelop $N, over the'rst /0 years of -ife

1:i-t t:e incidence of hearing loss in the general

population is only 1.2/1.34 Hearin" -o can ,e ,i-atera-

On-% * of cae of SNHL caued ,% CMV are eJ/ected to ,edetected ,% neonata- :earin" creenin" /ro"ra&&e


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4545 La,orator% con.r&ation ofinfection

4545(5 Urine $ a-i$a CMV PCR Detection of CMV in t:e urine or a-i$a i relatively

easy ,ecaue ne1,orn she% high levels of the virus fro&t:ee

Kuid and ,ot: are a&ena,-e to ra/id tetin" uin" PCR

The gol% stan%ar% for t:e dia"noi of cCMVinfection in ne1,orn :a ,een io-ation of t:e $iru int:e urine 1it:in t:e .rt t:ree 1ee8 of -ife

Rea- ti&e PCR aa% of ,ot: li&ui% an% %rie% salivaa&/-e :ad sensitivities of 5604 an% 66.64


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454545 Pro,-e& 1it: tetin" Dried B-oodS/ot @DBS

T:e detection of CMV DNA on DBS uin" PCR :aenable% the retrospective %iagnosis of cCMVin o-der chil%ren who /reent 1it: co&/ati,-ec-inica- feature uc: a $N,.

#$ 7CR has low sensitivity for accurate%iagnosis of cCMV ,ecaue a//roJi&ate-% t1ot:ird of infection 1ere &ied uin" t:i &et:od


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4535 Furt:er in$eti"ationreuired

in a ,a,% 1it: con.r&ed cCMV 4535(5 B-ood tet

B-ood Count 89#C: and Li$er Function Tet 89Ts: areeentia-

Becaue CMV can caue /anc%to/enia and :e/atiti

Renal function :ou-d a-o ,e &eaured a a ,ae-ine /riorto co&&encin" treat&ent

453545 C:oice of neuroi&a"in" Manifet 1it:

Intracrania- ca-ci.cation

Mi"rationa- a,nor&a-itie @uua--% &icro"%ria and c%tic c:an"e

Ventricu-o&e"a-%

1:ite &atter -o


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Crania- u-traound:a ,een :o1n to

,e a "ood /redictor of outco&e in%&/to&atic ne1,orn 1it: cere,ra-a,nor&a-itie useful 'rst imaging investigation in

ne1,orn 1it: u/ected cCMV

Crania- u-traound can are eai-%

o,taina,-e and and o no1 :ou-d ,e ued a a primary screening

too- to ae for intracere,ra- a,nor&a-itieinc-udin" ca-ci.cation for a-- ,a,ie 1it:con.r&ed cCMV


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453535 O/:t:a-&ic ae&ent :ou-d ,e /erfor&ed for a-- ne1,orn 1it: cCMV at t:e ti&e of dia"noi5

Retina- carrin"

Stra,i&u

Cortica- $iua- -o

453525 Audio-o"ica- ae&ent Hearin" -o can be progressive or late onset and o audio-o"ica- fo--o1 u/

i eentia-

45355 Decidin" 1:et:er t:e ,a,% i S%&/to&atic orA%&/to&atic

Fo--o1in" a fu-- c-inica-! radio-o"ica-! audio-o"% and o/:t:a-&o-o"% ae&ent1it: ,-ood in$eti"ation

A c-ear deciion :a to ,e &ade and docu&ented in t:e note! a to 1:et:ert:e ,a,% 1it: cCMV i A%&/to&atic! or i S%&/to&atic


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TR;"TIN* "NMONITORIN*

Cure and care


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35(5 Treatin" %&/to&atic or"andieae

35(5(5 ':o to treat

*anciclovir 8*CV:and valganciclovir 8V*CV:

i on-% reco&&ended for %&/to&atic ne1,orn 8inthe 'rst 1ee8 of IV GCV =mg>(g>%ose e$er% (4 :

Re%uce %evelopmental %elaysat > and (4 &ont: co&/ared to

untreated infant

T:ere are :o1e$er still onlylimite% %ata re"ardin"

T:e /:ar&aco8inetic!afet% /ro.-e and

ad$ere eect of GCV

3535 Va-"ancic-o$ir VGCV

2 mg>(g twice %aily re"i&en foriJ 1ee8

Neonate recei$in" > 1ee8 of GCV @>&"8" were similar to t:oerecei$in" VGCV


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352545 Vira- -oad ':o-e ,-ood CMV $ira- -oad @VL :ou-d ,e ta8en 1ee8-% durin"

t:e coure of treat&ent to ae treat&ent e9cac% and &onitor dieae /ro"reion

B-ood CMV $ira- -oad uua--% dro/ ,et1een ( and 4 -o" durin"treat&ent

352535 Dru" -e$e- Gancic-o$ir /ea8 -e$e- :ou-d ,e ta8en one hour after

ad&initration :ou-d ,e ,et1een ) < &"L

352525 Reitance aa% Uua--% due to mutations in gene !60 1:ic: encode t:e

$ira- /rotein 8inae or in t:e $ira- /o-%&erae "ene UL2

Treat&ent fai-ure and t:e e&er"ence of o&e reitance&utation :a$e ,een aociated 1it: t:e ue of $a-"ancic-oc$ir


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7"NNIN* ON* T;RM9OO? !7

Pri&u& non nocere


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3.2. "u%iology

T:e Nationa- Deaf C:i-dren# Societ% "uide-ine@:tt/1115ndc5or"5u8 reco&&end

,earing assessment for ,a,ie 1it: cCMV :ou-d ,e/erfor&ed e$er% 3> &ont: in t:e .rt %ear unti- a"e 3 andt:en %ear-% unti- > %ear o-d5

3.@. Neuro%evelopmental

C-inica- and neurode$e-o/&enta- fo--o1 u/ :ou-d ,eperforme% at = months and at -eat one %ear in

"enera- /aediatric c-inic5

A-- CNS %&/to&atic infant :ou-d :a$e aneurode$e-o/&enta- assessment at one year


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3.


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CONC!$ION

Get 1e-- oon c:i-d


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Conc-uion

In t:e a,ence of an% i&&inent $accine,eco&in" a$ai-a,-e and ne1 anti$ira- a"enton t:e &ar8et! treatment with *CV an%

V*CV will remain the only therapy foro&e ti&e

'e 8no1 $er% -itt-e ti-- a,out t:e -on" ter&

outco&e of t:ee dru"! so posttreatment surveillanceof ne1,orntreated 1it: GCVVGCV re&ain $er%i&/ortant

jurnal infeksi ccmv dw

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