巨細(xì)胞病毒的指南

巨細(xì)胞病毒的指南第一頁，共十五頁，編輯于2023年，星期日WhyweshouldpayattentiontoCMV?Intheabsenceofpreventivemeasures,40%-100%ofallKTRsdevelopCMVinfectionandupto67%developCMVdisease.Themortalitycanbe90%withouteffectivetreatment.第二頁，共十五頁，編輯于2023年，星期日WhythemorbidityofCMVcanbesohigh?TheseroprevalenceofCMVinthegeneralpopulationrangesfrom30%-97%andincreaseswithage.Afterprimaryinfection,thevirusestablishesalifelonglatencywithinthehost.RiskforCMVaftertransplantationisstronglydependentondonor(D)andrecipient(R)serology,withpatientswhoareD+/R?,D+/R+orD?/R+atriskfordevelopingCMVinfectionanddisease,andD+/R?athighestriskforsevereCMVdisease.第三頁，共十五頁，編輯于2023年，星期日HowtheCMVtransmit?

CMVcanbetransmittedthroughsaliva,urine,sexualcontact,placentaltransfer,breastfeeding,bloodtransfusion,solid-organtransplantation,orhematopoieticstemcelltransplantation.第四頁，共十五頁，編輯于2023年，星期日HowdiagnosisCMVdisease?CytomegalovirusdiseaseisdefinedbythepresenceofclinicalsignsandsymptomsattributabletoCMVinfection,andthepresenceofCMVinplasmabyNATorpp65antigenemia.WhatistheclinicalsignsandsymptomsofCMVdisease?第五頁，共十五頁，編輯于2023年，星期日WhatistheclinicalsignsandsymptomsofCMVdisease?InKTRs,CMVdiseasecanmanifestasCMVsyndrome,characterizedbyfever,atypicallymphocytosis,neutropeniaorthrombocytopenia,andmalaise,orastissue-invasivedisease(pneumonia,gastrointestinaldisease,hepatitis,pancreatitis,encephalitis,chorioretinitis,myocarditis,nephritis,cystitis,ormucocutaneousdisease)第六頁，共十五頁，編輯于2023年，星期日Whatispp65?Theantigenemiaassayisarapidsemiquantitativeimmunofluorescentassaythatdetectsphosphoprotein65(pp65)producedinCMV-infectedpolymorphonuclearleukocytesinperipheralblood.第七頁，共十五頁，編輯于2023年，星期日WhichperiodoftimeCMVoccurmostoften?Infectionanddiseaseoccurmostofteninthefirst100daysaftertransplantation,atthetimeofthehighestimmunosuppressiveload.第八頁，共十五頁，編輯于2023年，星期日CMVprophylaxis:

WerecommendthatKTRs(exceptwhendonorandrecipientbothhavenegativeCMVserologies)receivechemoprophylaxisforCMVinfectionwithoralganciclovirorvalganciclovirforatleast3monthsaftertransplantation,(1B)andfor6weeksaftertreatmentwithaT-cell–depletingantibody.(1C)第九頁，共十五頁，編輯于2023年，星期日CMVprophylaxis:

InpatientswithCMVdisease,wesuggestweeklymonitoringofCMVbyNATorpp65antigenemia.(2D)第十頁，共十五頁，編輯于2023年，星期日CMVtreatment:

1.Werecommendthatallpatientswithserious(includingmostpatientswithtissueinvasive)CMVdiseasebetreatedwithintravenousganciclovir.(1D)2.WerecommendthatCMVdiseaseinadultKTRsthatisnotserious(e.g.episodesthatareassociatedwithmildclinicalsymptoms)betreatedwitheitherintravenousganciclovirororalvalganciclovir.(1D)第十一頁，共十五頁，編輯于2023年，星期日CMVtreatment:

3.WerecommendthatallCMVdiseaseinpediatricKTRsbetreatedwithintravenousganciclovir.(1D)4.WesuggestcontinuingtherapyuntilCMVisnolongerdetectablebyplasmaNATorpp65antigenemia.(2D)

第十二頁，共十五頁，編輯于2023年，星期日Wesuggestreducingimmunosuppressivemedicationinlife-threateningCMVdisease,andCMVdiseasethatpersistsinthefaceoftreatment,untilCMVdiseasehasresolved.(2D)WesuggestmonitoringgraftfunctioncloselyduringCMVdisease.(2D)

immunosuppressivemedication第十三頁，共十五頁，編輯于20