Thursday, June 23, 2011

Cytomegalovirus infection in children - Treatment

Treatment of choice is etilogic.Of antiviral chemotherapy proved the following three active CMV: ganciclovir (CYMEVAN), foscarnet (FOSCAVIR) and cidofovir.
Ganciclovir is administered orally or iv infusion of 30'-60 slow '. Im or sc injections are contraindicated because trains necrosis.Loading dose is 5 mg/12h x 1/zi and maintenance dose of 5 mg / kg / day. Duration of therapy is 14-21 days for treatment of stroke; indefinite maintenance therapy.
Adjuvant treatment (symptomatic) consists of:
- Physiotherapy and medical gymnastics for neuromotor retardation;- Speech-therapist (speech) for speech difficulties in children with varying degrees of mental retardation;- Psychiatric care (occupational therapy) for patients and caregivers simultaneously;- Auditory Prosthesis;- Correction neurosurgical (microcephaly / craniosynostosis);- Anticonvulsant therapy;- Assistance eye.
Evolution and prognosis:
In evoultie, cytomegalovirus infection so many complications and sequelae.
Sensorineural deafness is the most important disabilities caused by CMV. This is the first cause of deafness in childhood.Asimptomaticii symptomatic and affects 50% of cases showing high amplitude bilateral deafness: 50-100 dB. In 50% of cases develop or worsen over the first years of life (even 8-14 years).
Impaired vision is to varying degrees, to blindness. A 22% of asymptomatic presents severe impairment. Some children may be the nature of cortical blindness, strabismus 29%, optic atrophy and retinal scarring.
Neuro-psychiatric disorders and neuro-motor impairment include verbal and written communication (Dyslexia, Dysgraphia).Psychomotor retardation may be sick in 41% of cases (IQ <70%), neurological dysfunction (tetraparesis, displegie, seizures), disorders and attention disorders in community and school integration.
Disorders of growth and development is manifested by disorders related to food and malnutrition with consequences.

The prognosis is unfavorable in the short term in case of: Ig M titer increased in cord blood, maternal infection with newborn primary symptomatic, severe generalized disease, prematurity and blood transfusions or derivatives.
Long-term prognosis for symptomatic infection is generally unfavorable, 92% of infants surviving one or more of moderate to severe disabilities. Detection of CMV DNA in CSF is significantly associated with mental retardation, intracranial calcifications, mental retardation moderate to severe microcephaly (neurological complications, psychomotor retardation, neurological problems at 1 year of age), eye damage and bilateral deafness.In asymptomatic infection the prognosis is generally good, 5% of newborns become disabling and have complications. Environment with low socioeconomic level is an unfavorable factor. A good prognosis is noted in asymptomatic infection with Lack of vision, hearing and neurological.

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