Congenital cytomegalovirus infection treated with idoxuridine

Treatment of congenital cytomegalovirus: where are we now?

Congenital cytomegalovirus (CMV) is the most common congenital infection in the USA, affecting approximately 1% of all live births. While the majority of infants will remain asymptomatic, approximately 10% will be symptomatic at birth and another 10-15% will go on to develop problems during the first 6 years of life. Congenital CMV is now the most common cause of nonhereditary sensorineural hearing loss in children. Accordingly, researchers and clinicians have long been interested in identifying strategies to prevent or treat symptomatic congenital CMV infection. This article reviews congenital CMV with a focus on treatment strategies.

Treatment of cytomegalovirus retinopathy with ganciclovir

Ganciclovir is an experimental antiviral drug with activity against human cytomegalovirus (CMV). Forty patients with acquired immune deficiency syndrome (AIDS) and CMV retinopathy were treated with ganciclovir on a compassionate protocol basis. Initial treatment doses ranged from 5.0 to 14.0 mg/kg/day for 9 to 26 days. Signs of drug response were a halt to enlargement of lesions, decreased opacification of retinal tissue, and resolution of hemorrhage and vasculitis. Complete response was seen in 88% of patients and incomplete response was seen in 9%. Vision improved or remained stable in 88% of patients. Initial treatment did not eradicate live virus from the eye. To prevent reactivation of disease, 26 patients received low-dose maintenance therapy ranging from 1.5 to 7.5 mg/kg/day, once or twice daily, 3 to 7 days per week. Reactivation of disease developed for unknown reasons in 50% of patients on continuous, uninterrupted maintenance therapy for longer than 3 weeks. Reversible neutropenia, requiring cessation of treatment, developed in 30% of patients on initial treatment and in 38% of patients on maintenance therapy. Rhegmatogenous retinal detachment was a late complication in seven patients. By reducing or delaying visual loss, ganciclovir appears to be useful in the management of CMV retinopathy in patients with AIDS.

Effects of acyclovir combined with other antiviral agents on human cytomegalovirus

At present, there is no effective therapy for human cytomegalovirus (CMV) infections. Although acyclovir inhibits in vitro clinical isolates of CMV, preliminary human trials suggest that acyclovir may not be successful as a single antiviral agent in treating CMV infections. The antiCMV activity of acyclovir in combination with human fibroblast interferon (IFN-beta), phosphonoformic acid (PFA), or trifluorothymidine (TFT) was therefore evaluated. When acyclovir (20 microM) was combined with IFN-beta (25 U/ml), additive antiviral effects were observed for the four clinical CMV isolates studied and the laboratory adapted strain, AD-169. The combination of acyclovir (20 microM) with PFA (25 microM) was synergistic for all four clinical isolates studied, but additive for the AD-169 strain. Similarly, the combination of acyclovir (20 microM) and TFT (0.17 microM) was synergistic for three of four clinical isolates, and additive for one clinical strain and the AD-169 virus. These findings suggest that acyclovir combined with other antiviral agents may be useful in the treatment of CMV disease.

Cytomegalovirus myocarditis

A male patient, aged 31 years, with a cytomegalovirus (CMV) myocarditis is described, who showed a high IgM antibody titer for cytomegalovirus infection of 1:1,024 and a rise of the titer for complement-fixing antibody from 1:< 16 to 1:256. CMV could be isolated from the urine. Investigations for other etiological factors were negative, and we assumed a connection between the cytomegalovirus infection and the myocardial involvement.

The management of ocular herpesvirus infections

The many treatment methods in current use for every known complaint only seem to aggravate the difficulty of treating ocular herpes simplex virus (HSV) infections, which are generally self-limited in the immunocompetent host. The cornea is already a somewhat immune-deficient tissue since its lack of blood vessels separates it partially from the host, and treatment with glucocorticoids, which are immunosuppressive, increases the risk of damaging complications such as scarring, prolonged morbidity, bacterial or fungal superinfection, and the occasional corenal perforation. Accepted methods of treatment of specific lesions, are discussed, as are some methods that are not yet accepted, but which seem promising. Herpes zoster may result in scarring and significant loss of vision even without the use of glucocorticoids, the disease often manifesting itself in the already compromised host. The major complication is postherpetic neuralgia. None of the available treatment methods has been fully satisfactory, and every effort should be made to prevent eye lesions in patients with early infection of the ophthalmic branch of the trigeminal nerve. Stimulation of cellular immunity by various means appears to offer some new promise for control of the disease. Management of varicella, cytomegalovirus, and infectious mononucleosis are also discussed.

[Mouse cytomegalovirus infection under cytosine arabinoside treatment]

The antiviral activity of cytosine arabinoside (ARA-C) against the mouse cytomegalovirus was investigated in animal experiments using various dosages. The substance did not exhibit any virostatic effect, but on the contrary fostered the viral infection. The virus concentration in the liver after administration of five dosages of 30 mg/kg of cytosine arabinoside was 35 times higher than that in untreated animals, and after five dosages of 45 mg/kg was 70 times higher. In addition the mortality rate for infected animals treated with cytosine arabinoside was significantly higher in relation to dosage. Cytosine arabinoside also acts as an immunosuppressor in humans. Adverse effects in cytomegalo-infection can therefore not be excluded. The use of cytosine arabinoside in therapy would thus appear to be highly questionable.

Cytomegalovirus infection in the north west of England. A report on a two-year study

The incidence and epidemiology of cytomegalovirus (CMV) in Manchester has been studied for two years. 36 cases of congenital infection were found. Over 90% of those detected in routine surveys or born without central nervous system disease have not shown any serious developmental defects following their virus infection and are progressing normally. Virus excretion was found in 3·2% of children admitted to hospital, but, except in cases with mental retardation (with or without symptoms of central nervous system disease) and with feeding problems, there was no definite relation between virus excretion and the clinical condition bringing them into hospital. Serological surveys of different groups in the population indicated that the majority of infections occurred in adolescence and early adulthood, that 40-45% of women of child-bearing age were not immune to CMV, and that 5% of blood donors were capable of transmitting infection to patients receiving blood transfusions. Virus was isolated from 5·2% of schoolchildren aged 5-6 years, from 0·4% of babies born in hospital, and from the cervix of 3-4% of women attending hospital clinics. In adults CMV infection was found to be associated sometimes with atypical glandular fever, hepatitis, and polyneuritis. Very close contact seems necessary for the spread of CMV.