Vancíková Z, Dvorák P
1st Department of Paediatrics, 2nd Medical School, Charles University, University Hospital Motol, V Uvalu 84, 150 06 Praha 5, Motol, Czech Republic.
Curr Drug Targets Immune Endocr Metabol Disord. 2001 Aug;1(2):179-87.
This review summarizes the state-of-the-art knowledge on diagnosis, pathogenesis, immune response to, clinical picture, treatment and prevention of cytomegalovirus (CMV) infection in humans. CMVs are ubiquitous betaherpesviruses that infect animals as well as humans. Primary infection with human cytomegalovirus (HCMV) is followed by persistence of the virus in a latent form. During life, the virus can reactivate, resulting in renewed shedding of the virus or development of disease. Redundant molecular mechanisms have been identified by which CMVs interfere with the host immune control, but finally, the infection is held in check by the host's immune response. As a consequence, CMV disease is restricted to the immunocompromised or immunologically immature host. HCMV is the leading cause of congenital infections, with an incidence of 1-2.4% of live births, with possible severe classic "cytomegalovirus inclusion disease" in 10% of them. Congenital CMV infection is the leading infectious cause of brain damage and hearing loss in children and also a relevant health issue to transplant recipients and human immunodeficiency virus (HIV)-infected patients. Significant progress has been made in the last few years in detecting CMV, but in the immunocompromised patients, establishing the diagnosis of CMV infection can still be problematic. The most sensitive molecular amplification methods such as polymerase chain reaction (PCR) should be used. The decision how to treat the infection depends mainly on the immune status of the host. In immunocompetent patients only symptomatic treatment is recommended, while in immunocompromised patients antiviral therapy and immunotherapy should be used. The most commonly used antivirotics are: ganciclovir, foscarnet, cidofovir, valganciclovir, valaciclovir.
本综述总结了关于人类巨细胞病毒(CMV)感染的诊断、发病机制、免疫反应、临床表现、治疗和预防的最新知识。CMV是普遍存在的β疱疹病毒,可感染动物和人类。人类巨细胞病毒(HCMV)的初次感染后,病毒以潜伏形式持续存在。在生命过程中,病毒可重新激活,导致病毒再次排出或疾病发展。已确定CMV通过多种分子机制干扰宿主免疫控制,但最终,感染由宿主的免疫反应控制。因此,CMV疾病仅限于免疫功能低下或免疫未成熟的宿主。HCMV是先天性感染的主要原因,活产婴儿中的发病率为1-2.4%,其中10%可能出现严重的典型“巨细胞病毒包涵体病”。先天性CMV感染是儿童脑损伤和听力丧失的主要感染原因,也是移植受者和人类免疫缺陷病毒(HIV)感染患者的一个相关健康问题。在过去几年中,CMV检测取得了重大进展,但在免疫功能低下的患者中,CMV感染的诊断仍可能存在问题。应使用最敏感的分子扩增方法,如聚合酶链反应(PCR)。如何治疗感染的决定主要取决于宿主的免疫状态。在免疫功能正常的患者中,仅建议进行对症治疗,而在免疫功能低下的患者中,应使用抗病毒治疗和免疫治疗。最常用的抗病毒药物有:更昔洛韦、膦甲酸钠、西多福韦、缬更昔洛韦、伐昔洛韦。