Retinite por citomegalovírus em paciente HIV negativo: um relato de caso / Cytomegalovirus retinitis in HIV negative patient: a case report

Julia Teles Triglia Pinto, Gabrielle Menegucci, Erich Juergen Klein, Marina Leão Veloso Salles

Abstract


O Citomegalovírus (CMV) pertence à família do herpesviridae e estima-se que 50% a 80% dos adultos estejam infectados com o vírus. As infecções primárias em indivíduos imunocompetentes são geralmente assintomáticas ou semelhantes à síndrome dos mononucleosídeos. A retinite é a manifestação mais comum da doença por CMV em pacientes infectados pelo HIV. O diagnóstico da retinite é clínico, baseado nos sintomas e achados durante a fundoscopia. É uma retinite hemorrágica necrotizante típica com lesões brancas a amareladas com bordas granulares e extensas. A base do tratamento é o uso de inibidores da DNA polimerase viral potentes, como o Ganciclovir. O objetivo do presente estudo é descrever um caso raro de paciente com sorologia negativa para HIV que desenvolveu retinite por CMV.


Keywords


Retinite, Citomegalovírus, Citomegalovírus em Imunocompetente.

References


Anaizy N, PhD. Citomegalovírus in solid organ transplantation. Disponível em: http://ww6.thedrugmonitor.com/

Chawla HB, Ford MJ, Munro JF, Scorgie RE, Watson AR. Ocular involvement in a cytomegalovirus infection in a previously healty adult. Br Med J 1976; 2(6030): 281-2.

Coskuncan JM, Jabs DA, Dunn JP, Haller JA, Green WR, Vogelsang GB, et al. The eye in bone marrow transplantation.VI.Retinal complications. Arch Ophthalmol 1994; 112(3): 372-9.

Couto CFC, Rodrigues MV, Melo GEBA, Menezes GA, Leite JM. Citomegalovírus e Gestação: Um Antigo Problema sem Novas Soluções. Femina Jul. 2003 Nº. 06 Vol. 31; 509-516.

Egbert PR, Polland RB, Gallagher JG, Merigan TC. Cytomegalovirus retinitis in immussupressed hosts: ocular manifestations. Ann Intern Med 1980; 93: 664-70.

Friedberg DN. Cytomegalovirus Retinitis: Diagnosis and Status of Systemic Therapy. J. AIDS Hum Retrovirol. 1997;14;S1.

Gallant JE, Moore RD, Richman DD, et al. Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group. J Infect Dis 1992; 166:1223.

Gandhi MK, Khanna R. Human cytomegalovirus: clinical aspects, immune regulation, and emerging treatments. Lancet Infect Dis. 2004;4:725-38.

Goldberg DE, Smithen LM, Angelilli A, Freeman WR. HIV-associated retinopathy in the HAART era. Retina 2005; 25:633.

Gorensek MJ, Stewart RW, Keys TF, McHenry MC, Goormastic M. A Multivariate analysis of the risk of cytomegalovirus infection in heart transplant recipients. J Infect Dis 1988; 157: 515.

Hodge WG, Boivin JF, Shapiro SH, Shan KC, Dionne MA. Iatrogenic risk factors for cytomegalovirus retinitis. Can J Ophthalmol 2005; 40: 701-10.

Holland GN, Tufail A, Jordan MC. Cytomegalovirus diseases. In: Ocular Infection and Immunity, Pepose JS, Holland GN, Wilhelmus KR (Eds), CV Mosby, St. Louis 1996. p.1088.

Holland GN, Vaudaux JD, Jeng SM, et al. Characteristics of untreated AIDS-related cytomegalovirus retinitis. I. Findings before the era of highly active antiretroviral therapy (1988 to 1994). Am J Ophthalmol 2008; 145:5.

Hoover DR, Saah AJ, Bacellar H, et al. Clinical manifestations of AIDS in the era of pneumocystis prophylaxis. Multicenter AIDS Cohort Study. N Engl J Med 1993; 329:1922.

Jabs DA, Wingard JR, de Bustros S, de Miranda P, Saral R, Santos GW. BW B759U for cytomegalovirus retinitis: intraocular drug penetration. Arch Ophthalmol 1986; 104(10): 1436-7.

Jabs DA. Ocular manifestations of HIV infection. Trans Am Ophthalmol Soc 1995; 93: 623-83.

Jacobson MA, Maecker HT, Orr PL, et al. Results of a cytomegalovirus (CMV)-specific CD8+/interferon- gamma+ cytokine flow cytometry assay correlate with clinical evidence of protective immunity in patients with AIDS with CMV retinitis. J Infect Dis 2004; 189:1362.

Kempen JH, Jabs DA, Dunn JP, West SK, Tonascia JA. Retinal detachment risk in cytomegalovirus retinitis related to the acquired immunodeficiency syndrome. Arch Ophthalmol 2003; 119(2): 33-40.

Kuo IC, Kempen JH, Dunn JP, Vogelsang G, Jabs DA. Clinical Characterisric and outcomes of cytomegalovirus in persons without human immunodeficiency virus infection. Am J Ophthalmol 2004; 138: 341-6.

Maquire AM, Nichols CW, Crooks GW. Visual loss in cytomegalovirus retinitis caused by cistoid macular edema in patients without the acquired immune deficiency syndrome. Ophthalmol 1996; 103: 601-5.

Murray HW, Knox DL, Green WR, Susel RM. Cytomegalovirus in adults. Am J Med 1977; 43: 574-84.

Northfield JW, Harcourt G, Lucas M, Klenerman P. Immunology of viral co-infections with HIV. Arch Immunol Ther Exp (Warsz). 2005; 53(1): 3-12. Review

Pires, V.A.M.; Pereira, S. V. Retinite a Citomegalovírus em doente com SIDA – Caso Clínico e Revisão de Literatura. Lisboa, Abril 2016.

Rodrigues, C. E. M.; Gadelha, C. S.; Nobre, C. A.; Calado, M.R.; Vieira, R. M. R. A.; Vieira, W.P. Retinite por citomegalovirus (CMV) após terapia imunossupressora para vasculite leucocitoclástica Cytomegalovirus (CMV) retinitis after immunossupressive therapy for leukocytoclastic vasculitis. Rev Bras Reumatol, 2009;49(1):64-9.

Rook AH, Manischewitz JF, Frederick WR, et al. Deficient, HLA-restricted, cytomegalovirus-specific cytotoxic T cells and natural killer cells in patients with the acquired immunodeficiency syndrome. J Infect Dis 1985; 152:627.

Stewart MW. Optimal management of cytomegalovirus retinitis in patients with AIDS. Clinical Ophthalmology (Auckland, NZ). 2010;4:285-299.

Studies of Ocular Complications of AIDS Research Group, AIDS Clinical Trials Group. Mortality in patients with the acquired immunodeficiency syndrome treated with either foscarnet or ganciclovir for cytomegalovirus retinitis. N Engl J Med 1992; 326:213.

Sugar EA, Jabs DA, Ahuja A, Thorne JE, Danis RP, Meinert CL. Studies of the Ocular Complications of AIDS Research Group. Incidence of cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2012;153:1016-24.e5. 3.

Tan BH. Cytomegalovirus Treatment. Current Treatment Options in Infectious Diseases. 2014;6:256-270.

Tufail A, Holland GN. Cytomegalovirus retinitis: are intraocular devices the answer? Br J Ophthalmol 1995;79(12):1066-7.

Walter EA, Greenberg PD, Gilbert MJ, et al. Reconstitution of cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by transfer of T-cell clones from the donor. N Engl J Med 1995; 333:1038.




DOI: https://doi.org/10.34119/bjhrv4n2-091

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