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A associação entre síndrome de Guillain-Barré (SGB) e citomegalovírus (CMV) já é bem estabelecida na literatura, tendo sido primeiramente relatada em 1967. Porém, essa associação é rara em pacientes transplantados de órgãos sólidos, apesar da incidência de infecção sintomática por CMV ser maior nesta população. Devido ao seu potencial de gravidade, alta morbidade e mortalidade, a possibilidade de SGB não pode ser afastada em caso de complicação neurológica em pacientes transplantados. Neste relato, é descrito um caso de SGB secundária a CMV em um paciente transplantado renal de 8 anos de idade, na faixa etária pediátrica, intervalo com ainda maior escassez de relatos sobre essa associação. O paciente apresentava sorologia (IgG e IgM) negativa para CMV em exames pré-transplante, enquanto o doador possuía IgG positiva, havendo dessa forma alto risco de desenvolvimento da doença. A abertura do quadro clínico ocorreu cerca de dois meses após a realização do transplante, com sintomas e evolução clássicos de SGB. São discutidos os aspectos clínicos, diagnósticos, de tratamento e de evolução da doença, além da relação com as evidências presentes na literatura mundial.

Se presenta el caso de un adolescente con Lupus Eritematoso Sistémico (LES) e infección Virus BK y Citomegalovirus, que se trató con reducción de inmunosupresión, inmunoglobulina humana intravenosa, ciprofloxacina y valganciclovir, con lo que presentó remisión completa del cuadro clínico. Este proceso infeccioso en este tipo de pacientes representa un reto en especial en países de bajos recursos.

RESUMO Objetivo: O objetivo deste estudo foi revisar os aspectos clínicos e patológicos da catarata congênita secundária às infecções por sífilis, toxoplasmose, rubéola, citomegalovírus e herpes simples. Métodos: Trata-se de uma revisão de literatura, na qual foram incluídos artigos de periódicos indexados às bases de dados PubMed®, Cochrane, Lilacs, Embase e SciELO de 2010 a 2023. Resultados: Foram encontrados 45 artigos, e, após seleção, restaram 9 artigos. Além disso, foram adicionados artigos para enriquecer a discussão. A infecção por sífilis está relacionada a alterações corneanas. O citomegalovírus e a toxoplasmose estão relacionados com a coriorretinite e/ou microftalmia. A rubéola é responsável por causar catarata, glaucoma, microftalmia e retinite em sal e pimenta. Conclusão: Foram abordadas as principais etiologias infecciosas e seu quadro clínico na CC. O melhor tratamento para CC é cirúrgico associado a acompanhamento clínico, mas a prevenção é a maneira mais eficaz de combater a CC de etiologia infecciosa. O diagnóstico precoce e o tratamento efetivo previnem alterações e sequelas visuais irreversíveis. Nesse contexto, mostram-se importantes as ações de políticas públicas para o melhor desfecho clínico e melhor qualidade de vida.

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Objective: Toxoplasma gondii (T. gondii), Rubella and Cytomegalovirus (CMV) infections can cause severe morbidity in the fetus when transmissed during pregnancy. In our study, it was aimed to examine the seropositivity rates for T. gondii, Rubella and CMV infections in women of childbearing age who applied to our hospital. Methods: Anti-Toxoplasma IgG, anti-Toxoplasma IgM, anti-Rubella IgG, anti-Rubella IgM, anti-CMV IgG and anti-CMV were studied in women of childbearing age (18-49 years old) who applied to our hospital’s outpatient clinics between January 2018 and December 2020. The tests were performed in our microbiology laboratory using the ELISA method on Architect i2000 (Abbott, USA) and COBAS e601 (Roche, Germany) devices. Results: As a result of the data obtained, the percentages of IgM and IgG positivity for anti-Toxoplasma were calculated as 1.4% and 30.9%, respectively. Anti-Rubella IgM positivity was 0.7%, anti-Rubella IgG positivity was 91%, anti-CMV IgG positivity was 98.8%, and anti-CMV IgM positivity was 2%. Conclusion: Having its own seroprevalence for each region has is important in terms of planning pregnancy screenings. The seropositivity rates in our region are in line with other studies in the country. Since CMV seropositivity is very high in the population and there is no effective treatment or vaccine, screening may not be not necessary. T. gondii and Rubella screenings can be recommended due to the lower immunity rates and the availability of vaccine and treatment options.

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Introduction: Infection by cytomegalovirus (CMV) is one of the most common congenital infections, with a global prevalence of 0.3%–2.4%. In Spain, CMV screening is not performed during pregnancy, but rather in neonates with risk factors, and, in many hospitals, in those born small for gestational age (SGA). Screening is usually performed by measurement of the viral load in urine by polymerase chain reaction (PCR) and/or head ultrasound in search of compatible features.The aim of the study was to assess the yield of the CMV PCR test in urine and head ultrasound examination in asymptomatic neonates born SGA after 34 weeks’ gestation. The secondary objective was to assess the cost-effectiveness of this strategy. Design and methods: We conducted an observational and retrospective study between January and December 2019 in a tertiary care hospital. It included neonates delivered after 34 weeks, SGA and without additional risk factors assessed with a CMV PCR test in urine and/or head ultrasound. Results: The sample included 259 patients. It was divided in 2 groups: group 1, patients with a head circumference, weight and length below the 10th percentile (53 patients; 20.5%), and group 2, patients in whom only the weight was below the 10th percentile (206 patients; 79.5%). The incidence of late preterm birth, twin pregnancy, neonatal admission and exposure to illicit drugs during gestation was higher in group 1. A total of 186 urine PCR tests and 223 head ultrasounds were performed overall, and both tests were performed more frequently in group 1 (P = .002). There was only 1 positive CMV PCR test result in the sample (0.54%), corresponding to a patient in group 2 with no abnormal sonographic findings who remained asymptomatic throughout the follow-up. Two head ultrasound examinations yielded abnormal findings, in both cases unrelated to congenital CMV infection. We performed a cost-effectiveness analysis and determined that the cumulative cost of head ultrasound examinations and urine CMV PCR tests in our sample amounted to Є17 000 for the detection of a single asymptomatic positive case. Conclusion: In our population, screening for congenital CMV infection in asymptomatic late preterm and term newborns whose only risk factor is SGA does not seem to be cost effective. It would be necessary to expand the sample to other populations. Resumen: Introducción: El citomegalovirus (CMV) es una de las infecciones congénitas más frecuentes, con una prevalencia del 0.3–2.4%. En España, al no formar parte del cribado gestacional, se realiza screening de los recién nacidos con factores de riesgo, y, en muchos centros, de los que presentan bajo peso para la edad gestacional (BPEG). Para ello se realiza, generalmente, determinación de PCR (Polymerase Chain Reaction) del virus en orina y/o ecografía transfontanelar en busca de imágenes compatibles.El objetivo del estudio es evaluar el rendimiento de la PCR de CMV en orina y ecografía transfontanelar, en recién nacidos > 34 semanas asintomáticos, sin factores de riesgo, con BPEG. El objetivo secundario es evaluar el coste-efectividad. Material y métodos: Estudio observacional, descriptivo y retrospectivo, entre enero y diciembre de 2019, en un hospital de tercer nivel (IIIC). Incluye recién nacidos >34 semanas, sin factores de riesgo con BPEG, con PCR de citomegalovirus en orina y/o ecografía transfontanelar realizada. Resultados: Se incluyeron en el estudio 259 pacientes. Se dividió la muestra en grupo 1 (pacientes con percentil menor de 10 para talla, peso y perimétro cefálico (53 pacientes, 20.5%)) y grupo 2 (percentil menor de 10 para peso (206 pacientes, 79,5%)). En el grupo 1 se objetivó mayor incidencia de prematuridad tardía, embarazo gemelar, ingreso y consumo de drogas ilegales durante el embarazo. Se realizaron 186 PCR de citomegalovirus en orina y 223 ecografías transfontanelares, siendo más frecuente la realización de ambas pruebas en el grupo 1 (p = 0.002). Se obtuvo un único resultado positivo en orina en el total de la muestra (0.54%) (grupo 2), sin alteraciones en la ecografía y sin sintomatología a lo largo de su evolución. Se encontraron 2 ecografías transfontanelares alteradas con hallazgos no relacionados con infección congénita por CMV. Se realizó un estudio de coste-efectividad, en el cual el coste del total de ecografías transfontanelares y CMV en orina realizadas en nuestra muestra ascendió a 17000Є, para detección de un caso positivo asintomático. Conclusiones: En nuestra población no parece coste efectivo realizar pruebas de cribado de infección congénita por CMV a recién nacidos a término y casi a término asintomáticos, cuyo único factor de riesgo es BPEG. Sería necesario ampliar la muestra a otras poblaciones.

Cytomegalovirus (CMV) and BK polyoma virus (BKV) coinfection is a severe and uncommon complication, manifested as tubulointerstitial nephritis in kidney grafts. Viral reactivations (CMV/BKV) cause renal dysfunction and are mainly related to the intensity of immunosuppression. We present 2 cases of renal transplant patients with CMV/BKV coinfection documented in renal biopsy. The gold standard for diagnosis is the identification of specific BKV/CMV inclusions by immunohistochemistry on histopathology. [ABSTRACT FROM AUTHOR]

A continuación, se presenta un paciente de 66 años con alteración en los movimientos oculares, asociado a mioclonías, disartria y ataxia cerebelosa, secundario a un proceso parainfeccioso por citomegalovirus. Posteriormente, se revisa la fisiopatología del síndrome de opsoclonus - mioclonus- ataxia, las etiologías del mismo y las opciones terapéuticas disponibles. Esta es una etiología poco frecuente del síndrome, pues sólo se encontró un caso reportado de opsoclonus mioclonus ataxia asociado a citomegalovirus.

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La proctocolectomía total con reservorio ileal es el procedimiento quirúrgico de elección para la colitis ulcerativa refractaria (CUR) al tratamiento médico y la reservoritis es la complicación más frecuente y puede afectar hasta al 50% de los pacientes en los primeros 5 años del procedimiento. Aunque la etiología no está bien establecida, su presentación podría estar relacionada con disbiosis como resultado de la estasis fecal en individuos genéticamente susceptibles y con una respuesta inmunitaria alterada. Los síntomas típicos de reservoritis como diarrea, dolor abdominal, tenesmo, urgencia, incontinencia fecal y, menos frecuentemente, sangrado rectal no son específicos y el diagnóstico debe confirmarse mediante una evaluación endoscópica e histológica. La infección por citomegalovirus es infrecuente como causa de reservoritis; sin embargo, debe considerarse en pacientes con reservoritis refractaria al manejo antibiótico inicial. Las pruebas diagnósticas incluyen pruebas serológicas como la medición de anticuerpos, antigenemia y proteína C-reactiva (PCR) en sangre. El tratamiento de elección es el ganciclovir, medicamento de administración endovenosa que puede inducir complicaciones graves como mielosupresión, neutropenia y trombocitopenia. Se recomienda el seguimiento endoscópico posterior al tratamiento para asegurar la cicatrización mucosa, especialmente cuando hay sospecha de enfermedad de Crohn o compromiso del asa aferente en la endoscopia inicial.

Total proctocolectomy with ileal pouch is the surgical procedure of choice for ulcerative colitis refractory to medical treatment, and pouchitis is the most frequent complication. It can affect up to 50% of patients in the first five years of the procedure. Although the etiology is not well established, its manifestation could be related to dysbiosis resulting from fecal stasis in genetically susceptible individuals with altered immune responses. Typical symptoms of pouchitis, such as diarrhea, abdominal pain, tenesmus, urgency, fecal incontinence, and, less commonly, rectal bleeding, are nonspecific, and the diagnosis must be confirmed by endoscopic and histologic examination. Cytomegalovirus infection is an infrequent cause of pouchitis; however, it should be considered in patients with pouchitis refractory to initial antibiotic management. Diagnostic tests include serological tests such as the measurement of antibodies, antigenemia, and C-reactive protein (CRP) in blood. The treatment of choice is ganciclovir, an intravenous drug that can induce severe complications such as myelosuppression, neutropenia, and thrombocytopenia. Post-treatment endoscopic follow-up is recommended to ensure mucosal healing, especially when there is suspicion of Crohn's disease or involvement of the afferent loop on initial endoscopy. [ABSTRACT FROM AUTHOR]

A infeção por citomegalovírus é a infeção congénita mais frequente no mundo, com uma prevalência de 1,1% em Portugal Continental. A infeção fetal pode cursar com alterações importantes, sendo a principal causa de perda auditiva neurossensorial não hereditária na infância e podendo cursar com alterações congénitas de múltiplos sistemas de órgãos. A proposta de um rastreio universal pré-concecional é debatida há vários anos, não existindo ainda consenso sobre o tema. Dados recentes sugerem que o valaciclovir pode ser um tratamento eficaz e seguro, o que poderá trazer mais um argumento a favor da realização do rastreio universal do citomegalovírus. Este artigo de revisão procura sistematizar a mais recente informação sobre a infeção materna e fetal por citomegalovírus, o seu diagnóstico e possíveis tratamentos, bem como refletir acerca da pertinência da realização de um rastreio pré-concecional e ao longo da gravidez.

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Introduction: The infection due to cytomegalovirus is the most common congenital infection in developed countries, and one of the main causes of psychomotor impairment and neurosensory hearing loss of infectious origin.The present study has its objectives to describe the clinical-analytical and neuroimaging of patients with secondary neurological sequelae secondary to the congenital cytomegalovirus infection and then compare them with the group of patients with a congenital cytomegalovirus infection that did not have neurological symptoms during their follow-up. Material and methods: A retrospective, observational, cohort study was conducted that included all the cases of congenital cytomegalovirus infection from 2003 until 2018 and the short-medium term neurological sequelae were evaluated. Prenatal, perinatal, and postnatal data of patients with neurological sequelae were compared against those that did not present with any. Results: A total of 60 patients with congenital cytomegalovirus infection were recorded during the study period, with 65% having neurological involvement during their follow-up period (62.2% with psychomotor impairment, 61.5% with microcephaly, 46.2% loss of hearing, 27.8% motor disorders, 20.5% epilepsy, and 5.6% with chorioretinitis). In the patient group that had sequelae, the presence of clinical symptoms during the neonatal period, as well as changes in the neuroimaging study, were the most common, with both being statistically significant compared to the asymptomatic group. The patients with neurological involvement also had a higher score on the Noyola et alneuroimaging scale. Conclusions: The symptoms at birth, and certain findings in the neuroimaging, like the changes in the white matter or neuronal migration disorders, could predict neurocognitive sequelae in patients with congenital cytomegalovirus infection. Resumen: Introducción: La infección por citomegalovirus es la infección congénita más frecuente en los países desarrollados y una de las principales causas de retraso psicomotor y sordera neurosensorial de origen infeccioso.El presente estudio tiene como objetivos: describir las características clínico-analíticas y neuroimagen de los pacientes con secuelas neurológicas secundarias a la infección congénita por citomegalovirus y compararlas con el grupo de pacientes con infección congénita por citomegalovirus que no presentaron clínica neurológica durante su seguimiento. Material y métodos: Estudio de cohortes retrospectivo, observacional. Se incluyeron todos los casos de infección congénita por citomegalovirus desde 2003 hasta 2018 y se evaluaron las secuelas neurológicas a corto-medio plazo. Se compararon datos prenatales, perinatales y postnatales de los pacientes con secuelas neurológicas frente a los que no las presentaron. Resultados: En el periodo descrito se registraron 60 pacientes con infección congénita por citomegalovirus, presentando un 65% afectación neurológica durante su periodo de seguimiento (retraso psicomotor 62.2%, microcefalia 61.5%, hipoacusia 46.2%, trastornos motores 27.8%, epilepsia 20.5% y coriorretinitis 5.6%). En el grupo de pacientes que presentó secuelas, la presencia de clínica en el período neonatal así como las alteraciones en el estudio de neuroimagen fueron más frecuentes, siendo ambas estadísticamente significativas respecto al grupo asintomático. Los pacientes con afectación neurológica también presentaron mayor puntuación en la escala de neuroimagen según Noyola et al. Conclusiones: La sintomatología al nacimiento y ciertos hallazgos en la neuroimagen como la presencia de alteraciones de la sustancia blanca o trastornos de la migración neuronal podrían predecir las secuelas neurocognitivas en los pacientes con infección congénita por citomegalovirus.

Introduction: human immunodeficiency virus infection has gradually increased worldwide in recent years and has become a public health problem, mainly for developing countries. Objective: to carry out a review of the most frequent alterations of the posterior segment in these patients with the aim of updating the existing knowledge on the subject. Methods: review of scientific articles in Google Academic and other mega search engines for systematic review using Trip Database and Cochrane. Results: retinopathy associated to human immunodeficiency virus (non-infectious) is the most frequent posterior segment alteration in these patients and cotton wool exudates its most representative clinical finding. Cytomegalovirus retinitis is the most common opportunistic eye infection in patients with very low CD4 T-cell counts; it is seen in up to 40% and is the most frequent cause of blindness in these patients. Conclusions: Toxoplasma chorioretinitis presents in an atypical way in these patients and has a close relationship with cerebral toxoplasmosis, so a complete neurological study should be performed. Sometimes, it is a diagnostic challenge for the Ophthalmology Specialist.

A retocolite ulcerativa (RCU) é um distúrbio intestinal inflamatório crônico que acomete o cólon e o reto, com patogênese associada a distúrbios imunológicos e tratamento baseado em imunossupressão. O sistema imune de pacientes em hemodiálise (HD) é suprimido pelo meio urêmico e o uso de imunossupressores pode levar a infecções oportunistas, como citomegalovírus (CMV). A infecção por CMV pode levar a recaída ou alterar o curso da RCU. O presente artigo relata o caso de um paciente do sexo masculino, 42 anos, portador de doença renal crônica (DRC) sem etiologia definida, em HD há seis anos, sem nenhuma intercorrência clínica até então, que apresentou um quadro grave de pancolite, com diagnóstico endoscópico e histopatológico inicial de RCU, evoluiu com refratariedade ao tratamento clínico, sendo submetido à colectomia total e ileostomia, tendo a análise microscópica da peça cirúrgica revelado além de processo inflamatório crônico, a presença de atipias em células endoteliais sugestivas de infecção viral por CMV, confirmada por imunohistoquímica, com melhora clínica após tratamento com ganciclovir. Os achados desse paciente enfatizam a importância de considerar a possibilidade de RCU e colite por CMV como diagnóstico diferencial nos pacientes com DRC em HD que apresentam febre e diarreia sanguinolenta, especialmente naqueles que não respondem ao tratamento clínico inicial.

Las infecciones congénitas constituyen una de las causas principales de morbilidad y mortalidad fetal-neonatal. El objetivo del estudio fue analizar las infecciones por TORCH y Parvovirus B19 humano en embarazadas y sus implicaciones terapéuticas y de diagnóstico. Se utilizó un diseño documental mediante la búsqueda bibliográfica en base de datos científicas como: PubMed. Elsevier, Scielo, Redalyc, Google Académico, Microsoft Academic, Dialnet y DOAJ, utilizando como palabras clave: Toxoplasmosis, citomegalovirus, rubeola, sífilis, herpes simple, VIH, Parvovirus B19 humano. Se incluyeron artículos en inglés y español publicados a partir del 2015, seleccionados bajo criterios de inclusión y exclusión. Las infecciones congénitas siguen siendo comunes en países en desarrollo, con complicaciones significativas e incluso muerte; de allí la importancia de realizar monitoreo y diagnóstico en embarazadas. Es evidente que estas infecciones son un problema de salud pública siendo la de mayor frecuencia la causada por citomegalovirus. Se utilizan pruebas serológicas y moleculares de alta sensibilidad y especificidad para el diagnóstico certero. En las implicaciones epidemiológicas y terapéuticas se evidencia la prevención para rubeola, abordaje terapéutico y cesárea, a fin de disminuir las consecuencias perinatales como afectación del sistema nervioso central y malformaciones congénitas que representan un alto riesgo de aborto y muerte fetal

La familia de los herpesvirus es una gran familia compuesta por varios integrantes, entre ellos el herpes simple tipo 1 y 2, varicela zóster, citomegalovirus, Epstein-Barr y herpesvirus humano 6, los cuales en los últimos años se ha puesto en evidencia que infectan todo el neuroaxis, por lo que es de vital importancia reconocer los síntomas iniciales y hacer exámenes apropiados para identificar y manejar de manera efectiva estas infecciones, evitando así secuelas neurológicas devastadoras e incapacitantes para los pacientes. En este apartado se revisará el virus de Epstein-Barr, para lo cual se abordará su fisiopatología, diagnóstico y tratamiento.

La atresia biliar asociada con inmunoglobulina M (IgM) positiva para citomegalovirus (CMV) es una entidad infrecuente que se caracteriza por la obliteración inflamatoria progresiva de los conductos intra- o extrahepáticos producida por una reacción autoinmune perinatal contra el CMV. El diagnóstico se realiza con IgM positiva para CMV y biopsia hepática con evidencia de atresia de las vías biliares. El conocimiento y la identificación temprana de esta patología conduce a un manejo quirúrgico temprano, mejorando considerablemente el pronóstico de estos pacientes. Se presenta un caso clínico de una paciente de 82 días de edad con un cuadro de acolia, coluria e ictericia de inicio tardío, asociado con hiperbilirrubinemia a expensas de la directa, elevación de perfil hepático e IgM positiva para CMV. La colangiorresonancia intraoperatoria confirmó el cuadro de atresia de las vías biliares. Se realizó una derivación biliodigestiva tipo Kasai y la toma de biopsia hepática que confirmó el cuadro clínico.

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Biliary atresia associated with positive cytomegalovirus IgM results is a rare condition characterized by progressive inflammatory obliteration of the intra- or extrahepatic ducts. It is caused by a perinatal autoimmune reaction against cytomegalovirus (CMV). Diagnosis is made based on positive IgM for CMV and liver biopsy with evidence of bile duct atresia. Knowledge and timely identification of this disease leads to early surgical management, considerably improving the prognosis of these patients. This is the clinical case of an 82-day-old female patient with late-onset acholia, choluria, and jaundice, associated with conjugated hyperbilirubinemia, elevated liver function tests and positive CMV IgM results. Intraoperative cholangioresonance confirmed bile duct atresia. The Kasai procedure was performed, and a liver biopsy was taken, confirming the diagnosis. [ABSTRACT FROM AUTHOR]

Congenital syphilis (CS) is a disease transmitted by Treponema pallidum to the fetus by transplacental circulation, usually from the 20th week of gestation. In 2019, Mexico reported 372 cases, on the other hand, infection by Congenital Cytomegalovirus (cCMV) is not considered mandatory notification. We report the first neonatal case of Coinfection by T. pallidum and CMV according to the medical literature in spanish and english. The clinical case is a premature newborn born in the Hospital de la Mujer in Mexico City, pregnancy 1, 21-year-mother without prenatal control, female product is obtained vaginally, weight 1570 g (

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Introducción: el citomegalovirus (CMV) es un virus de importante presencia a nivel mundial. La detección precoz y seriada de la carga viral para CMV ayuda a tratar precozmente la infección y evita la enfermedad que en muchos casos puede ser letal en pacientes inmunodeprimidos. Objetivo: determinar la prevalencia de CMV en niños inmunodeprimidos sometidos a trasplante de médula ósea, por medio de Reacción de Polimerasa en Cadena en tiempo real. Métodos: estudio retrospectivo, descriptivo y transversal. La carga viral fue determinada en muestras de plasma recolectadas entre 2009 y 2012 en niños que recibieron trasplante de médula ósea en el Hospital de la Sociedad de Lucha contra el Cáncer [SOLCA] en Guayaquil, Ecuador. Resultados: fueron analizadas 38 muestras. La edad promedio fue de 7.2 años siendo 57.9% (n=22) varones y 42.1% (n=16) mujeres, con una relación de masculino/femenino 1.4. Cinco pacientes presentaron resultados positivos por la técnica mencionada, siendo el 80% del género femenino. Y las provincias que obtuvieron el mayor número de casos con resultados positivos fueron Los Ríos, Guayas y Esmeraldas. Los pacientes que fueron trasplantados a causa de leucemia linfoblástica aguda y linfoma leucemizado a leucemia linfoblástica aguda tuvieron resultados positivos por infección activa por CMV, 80 y 20%, respectivamente. Conclusión: la prevalencia de CMV en niños sometidos a trasplante de médula ósea mediante PCR en tiempo real fue del 13%, mayor en el género femenino. Rev.cienc. biomed. 2015;6(1):53-59

La retinitis por CMV es la infección ocular oportunista más frecuente en los pacientes con SIDA. La necrosis retiniana aguda suele corresponder a infecciones por VVZ o VHS, y sólo en un pequeño porcentaje de casos es secundaria a infección por CMV. El tratamiento (dosis de mantenimiento) con valganciclovir no descarta completamente la posibilidad de desarrollo de enfermedad por CMV, además que se asocia a otras infecciones oportunistas, en este caso asociado a herpes zoster y molusco contagioso. Presentamos un Caso Clínico de un paciente VIH positivo, sin tratamiento, con necrosis retiniana aguda por CMV del ojo izquierdo como forma inicial de presentación de la etapa de SIDA y retinitis por CMV de su ojo derecho varios meses después, a pesar de estar en tratamiento con valganciclovir a dosis de mantenimiento.

Introdução: A reativação do citomegalovírus tem sido considerada um factor de agravamento nos doentes diagnosticados com sépsis nas unidades de Cuidados Intensivos. Os principais objetivos deste estudo consistiram na determinação da reativação do Cytomegalovirus em doentes internados numa unidade de Cuidados Intensivos com diagnóstico de sépsis, e se essa reativação estaria relacionada com a evolução do quadro clínico do doente. Material e Métodos: Na presente investigação foram estudados 22 doentes, internados com o diagnóstico de sépsis na Unidade de Cuidados Intensivos do Hospital da Luz. A deteção do ácido desoxirribonucleico do citomegalovírus foi realizada por técnica de polymerase chain reaction em tempo real e as concentrações de nove citocinas (IL-1α, IL-1β, IL-2, IL-4, IL-6, IL-8, IL-10, TNF-α, e INFγ) foram determinadas através de uma técnica de ELISA Multiplex. Resultados: A reativação ocorreu em oito doentes (36,3%). Não foram encontradas relações entre a reativação do citomegalovírus e o sexo, idade, tempo de permanência na unidade de Cuidados Intensivos, duração da ventilação mecânica e morte do doente. Também não foram encontradas diferenças significativas nas concentrações das citocinas nos doentes com e sem reativação. Contudo, os doentes com reativação do citomegalovírus apresentaram um maior tempo de internamento no hospital desde a entrada na unidade de Cuidados Intensivos até a alta hospitalar ou morte do doente (p = 0,025). Discussão: Apesar da amostra de pequena dimensão, o presente estudo indicia que a reativação é um evento frequente nos doentes diagnosticados com sépsis e que pode estar relacionada com o prolongamento do tempo de permanência no hospital destes doentes. Conclusão: A análise conjunta dos resultados obtidos e da revisão da literatura não apoiam o conceito de que a monitorização do citomegalovírus deva ser implementada na prática clínica, mas parece prudente aguardarem-se por mais ensaios randomizados utilizando profilaxia antiviral, antes de se assumir uma atitude definitiva relativamente ao papel do citomegalovírus na sépsis.

Introduction: Viral encephalitis is a well-known inflammatory process associated with neurological dysfunction that might derive into severe brain damage or a fatal outcome. In México there is no epidemiological data that describes the prevalence of viral agents responsible for acute encephalitis. Objective: To identify the main viral agents by real time PCR involved in acute encephalitis in Mexico. Materials and methods: We obtained cerebral spinal fluid (CSF) samples from all patients with suspected viral encephalitis admitted to the emergency service of the Hospital Civil de Guadalajara “Fray Antonio Alcalde”. To identify pathogens, we performed nucleic acid extraction using real-time PCR and RT-PCR. Results: Sixty-six patients were diagnosed with acute encephalitis from 2011 to 2014. A definitive viral etiological diagnosis was established in 16 patients (24%); the main causative agents were enteroviruses in 50% of the 16 positive samples, followed by herpes simplex virus (37%) and cytomegaloviruses (12.5%). Patients with encephalitis were predominantly male (63.3%) and a seasonal predominance was observed during autumn (37.5%). The main clinical characteristics in the acute encephalitis phase were fever (48.45) and cephalea (36.3), followed by seizures, disorientation, and muscular weakness (30.3%). Kerning sign was present in two cases (3%) and other two cases presented Brudzinski’s sign (3%). Conclusions: CSF PCR is a suitable diagnostic technique for the identification of viral encephalitis caused by viral infections that allows an appropriate antiviral therapeutic treatment.

Introduction: Cytomegalovirus (CMV) is the most frequent opportunistic infection after renal transplantation. There are two strategies for its prevention: Universal prophylaxis, with valganciclovir for 90 days, and anticipated therapy, using weekly viral load surveillance, and therapy only if positive. Meta-analysis directly comparing both strategies have shown them to have similar effectiveness. Objective: To determine which strategy is more cost-effective in intermediate risk patients in Colombia. Materials and methods: We designed a third-party payer perspective decision tree, considering only direct medical costs in 2014 Colombian pesos (COP) (USD$ 1=COP$ 2,000) and a time horizon of one year. The target population was intermediate CMV risk patients (positive receptor). Transition probabilities were extracted from clinical studies, validated with a Delphi expert panel method; procedural costs were obtained from the ISS 2001 manual with a 33% increment based on the Consumer Price Index for 2014, while medication costs were obtained from the official Ministry of Health information system. Results: Universal prophylaxis with valganciclovir was dominant, with lower costs and less probability of infection. The average cost of the first year in anticipated therapy would be COP$ 30,961,290, whereas in the case of universal therapy the cost would be COP$ 29,967,834 (incremental cost of COP$ 993,456). Conclusions: For Colombian renal transplant patients at intermediate risk for CMV infection, universal prophylaxis strategy is the best option.

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Background: Cytomegalovirus (CMV) is able to cause serious and even deadly diseases in immunocompromised patients. It is important to have a sensitive, specific and molecular viral tests for its detection, using as targets, key genes for viral replication. The following genes have been used in the molecular detection of CMV: UL122 (replication) and UL83 (most abundant protein of the tegument). Objective: Detect and quantify CMV, by real-time duplex PCR, from a minimum amount of plasma. Material and methods: The UL122 and UL83 genes were amplified with different fluorophores, by real-time duplex PCR. To quantify CMV, curves were generated, starting with DNACMV (1.0-0.0000001 ng). Results: The dynamic range of "master" duplex straight had a pendent (m) -3.0, the amplification efficiency was 115.44% plasmas from patients with HIV viral load = 100,000 copies/mL, 11.36% were true positive for CMV and 88.64% had no amplifications or they were outside of the linear range of molecular detection. Conclusions: This test identified two important CMV genes (UL122 and UL83) in a single reaction (FAM:VIC), viral detection was confirmed from a minimum amount of plasma. This mean a smaller amount of biological sample required and would add a tool to the clinical area, as well as a lower consumption of reagents and materials. [ABSTRACT FROM AUTHOR]

Introduction. Cytomegalovirus is the most common cause of infections in the post-transplantation period. A reliable and timely laboratory diagnosis of cytomegalovirus infection in patients on dialysis and in the post-transplantation period is significant because of the possibility of preventing or mitigating the effects of cytomegalovirus disease. The main objective of this study was to compare serological and molecular polymerase chain reaction methods to determine the presence of cytomegalovirus in the blood of dialysis patients. Material and Methods. The study included 28 dialysis patients, potential renal transplant recipients. All patients were evaluated for the presence of cytomegalovirus in the blood by a quantitative polymerase chain reaction method as well as in the serum for the presence of anti-cytomegalovirus Immunoglobulin G and Immunoglobulin M antibodies. Results. According to the comparative enzyme-linked immunosorbent assay for detecting antibodies in dialysis patients, 96.4% were once exposed to the virus, while 7.1% showed current infection not confirmed by polymerase chain reaction test. No statistically significant association was found between the positive finding of anti-cytomegalovirus Immunoglobulin M antibodies and the findings of the polymerase chain reaction cytomegalovirus method when Chi-square (χ 2) and Fisher's correlation tests were conducted (p > 0.05). Conclusion. Due to 7.1% false positives results for the presence of anti-cytomegalovirus Immunoglobulin M antibodies in the serum of immunocompromised dialysis patients, not confirmed by polymerase chain reaction test, serological techniques are not reliable in detecting active cytomegalovirus infection causing positive finding of anti-cytomegalovirus Immunoglobulin M, so confirmation of cytomegalovirus deoxyribonucleic acid by polymerase chain reaction method is required. [ABSTRACT FROM AUTHOR]

Niño de 1 año 10 meses de edad, originario de Irapuato, Guanajuato, sin antecedentes de importancia para el padecimiento actual. Inició dos meses previos a su ingreso con crisis convulsivas tónico-clónicas generalizadas de 15 segundos de duración durante el sueño. Se realizó electroencefalograma que reportó actividad epileptiforme, por lo que se dio tratamiento con ácido valproico. Una semana previa al ingreso se agregó ataxia troncal impidiendo la marcha, por lo que se realizó una tomografía axial computarizada de cráneo en la que se observó un tumor en fosa posterior con densidad heterogénea y áreas de necrosis central que obliteraba el cuarto ventrículo, ocasionando efecto de masa y desplazamiento ventral del tallo cerebral. Por tal motivo, fue referido a nuestra institución.

INTRODUCCIÓN: las infecciones pulmonares son comunes en los pacientes inmunocomprometidos. La carga viral de citomegalovirus se utiliza de rutina para determinar en qué momento se debe iniciar la terapia preventiva en hospederos inmunocomprometidos, diagnosticar enfermedad activa y supervisar la repuesta a una terapia implementada. OBJETIVO: describir el valor de la carga viral de citomegalovirus en líquido de lavado bronquioalveolar vs. sangre periférica en población pediátrica con signos de infección respiratoria. MATERIALES Y MÉTODOS: estudio descriptivo, observacional de 16 pacientes pediátricos y 19 episodios, a quienes se les realizó, de manera simultánea, la carga viral de citomegalovirus en sangre y lavado bronquioalveolar. RESULTADOS Y CONCLUSIONES: todas las cargas virales de citomegalovirus realizadas en lavado bronquioalveolar fueron positivas y en general se obtuvieron valores más elevados que en sangre, lo que sugiere una mayor sensibilidad de la prueba cuando se realiza en este tipo de muestra, en pacientes con sospecha clínica de infección respiratoria por citomegalovirus, lo cual la convierte en una ayuda diagnóstica importante según lo muestran los resultados obtenidos.

Copyright of Cirugía y Cirujanos is the property of Publicidad Permanyer SLU and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In vitro studies on the pathogenesis of the human cytomegalovirus (HCMV) are conducted regularly using laboratory adapted strains that lose some characteristics during the adaptation process. Since HCMV is excreted from bodily fluids during infection or reactivation, this work aimed to isolate and culture HCMV from the MRC-5 human cells found in the urine, bronchoalveolar lavage, saliva, and plasma samples of pediatric patients with probable or confirmed infection. The samples were inoculated on cell cultures either for 14 days or until a cytopathic effect (CPE) of 80 % was observed. The cell lysates and supernatants were used to perform successive viral passages. Besides HCMV, the herpes simplex virus was detected from all the saliva samples. Inoculation of the HCMV positive sera induced cell clustering and immediate monolayer damage that restricted their use. One sample of bronchoalveolar lavage induced a CPE after inoculation like that of the HCMV reference strains (Towne and Merlin), which was consequently propagated and titrated. A second viral isolate derived from the urine sample of a patient with congenital infection did not demonstrate a CPE, although presence of the virus had been confirmed using PCR. The viral isolates were examined and found to be negative for adenoviruses or enteroviruses. Despite the evident difficulty encountered for the isolation and harvesting of the HCMV, this work shows that it was possible to obtain a low passage viral strain using a modified shell vial method and inoculation protocol with extended follow-up and confirmation. [ABSTRACT FROM AUTHOR]

O citomegalovírus pertence à família do Herpes vírus, e está presente na maior parte da população. A citomegalovirose no período neonatal pode estar associada à transmissão intra-útero por via transplacentária, ou ainda, perinatal. No caso apresentado, destaca-se a demora no diagnóstico e na efetivação da conduta terapêutica visto que, no Brasil, o rastreamento de infecção por citomegalovírus em gestante não faz parte da rotina de pré-natal. O diagnóstico da citomegalovirose neonatal é obtido por meio da realização da cultura do vírus na urina entre o terceiro e o quinto dia de vida, ou ainda, pela realização da Reação em Cadeia de Polimerase. No relato de caso, o tratamento utilizado para a citomegalovirose baseou-se no uso de Ganciclovir (500 mg/10ml por via endovenosa durante três semanas). A dificuldade de estabelecer um diagnóstico precoce da citomegalovirose neonatal ainda representa um dos principais desafios para se alcançar um melhor prognóstico da doença.

ABSTRACT Introduction: In contrast to organ transplantation, few studies correlate the monitoring of pp65 antigenemia with a diagnosis of cytomegalovirus (CMV) in patients with systemic lupus erythematosus (SLE). Objective: To highlight the importance of CMV outside transplantation, we monitored pp65 antigenemia in a series of SLE patients. Methods: From March 2015 to March 2016, SLE patients presenting kidney involvement, fever, and an unclear infection at hospital admission were monitored through pp65 antigenemia. The pp65 antigenemia assay, revealed by immunofluorescence, was correlated with clinical and laboratory findings. Results: We included 19 patients with a suspected unclear infection. A positivity for pp65 antigenemia was found in seven patients (36.8%). The mean age was 33.5 ± 11.2 years, 16 (84%) were females, and 16 (84%) were black. Lymphopenia, anemia, and higher scores of SLEDAI were significantly more common in pp65-positive patients. Five patients received antiviral therapy with ganciclovir. Although receiving specific CMV treatment, one patient died because of suspected CMV disease. Conclusions: Pp65 antigenemia might be relevant in SLE patients, and studies with a greater number of patients are needed in order to establish sensitivity and specificity of pp65 antigenemia in different clinical contexts of SLE patients.

ABSTRACTCongenital cytomegalovirus (CMV) infection is the leading cause of infectious congenital defects and disabilities. Its transmission can occur in primary and non-primary infections; however the transmission rate is considerably higher in primary infections. The diagnosis of congenital infection is complex, and there is a discussion concerning serological evaluation during pregnancy. This article aims to review the literature concerning CMV infection, its diagnosis and epidemiology.