Background Systemic symptoms without any organ involvement may be observed in HIV pos patients (pts) with positive CMV blood culture Objective To describe the clinical picture and course of symptomatic CMV viremia (SCV) in HIV pos pts Design: All the pts fulfilling the following criteria have been included: -fever (> 38°C) lasting more than 14 days, with negative cultures and normal chest X -ray; -no signs and symptoms of specific organ involvement; -presence of unexplained weight loss, and/or hypotension and/or asthenia; -positive culture for CMV from blood polymorphonudear cells (PMN), with positive shell vials test Results From Ian 1990 to Dec 1994 we diagnosed 752 cases with AIDS. 11 pts (1.5%) fulfilled the criteria of SCV. 9 were severely immonodepressed (CD4+ counts <20/uL). Symptoms included: fever (11/11), asthenia (11/11), unexplained weight loss (> 4 kg/1 month-mo.) (4/11), hypotension (3/11). All the pts were given an acute course of anti-CMV drugs: ganciclovir (10 mg/kg/day for 21 days) in 9, foscamet (180 mg/kg/day for 21 days) in 2 pts. In all the pts a complete resolution of symptoms was observed at the end of acute therapy, with negativization of both CMV culture and shell vials test. All were given maintenance therapy (with the same drugs at half doses, every 6/7 days). One pt was lost to follow-up. 2 pts survived for 12 mo.s without any CMV end-organ disease. 4 pts suffered from the same initial symptoms, with positive CMV culture after 6 mo.s (1-15 mo.․), 4 pts suffered from with positive CMV culture after 6 mo.s (1-15 mo.․), 4 pts suffered from CMV retinitis after 6 mo.s (4-8 mos). Autopsy was performed in 4 cases, died after 11 mo.s (3-13 mo.s): CMV adrenalitis was diagnosed in 3 cases (1 pneumonia too); in one multi-organ involvement CMV Conclusions We suggest to take into account this clinical condition, probably due to CMV disease of adrenal organs. Specific therapies seem to be effective on the resolution of symptoms and negativization of CMV culture; their efficacy on the prevention of CMV end-organ disease is to be assessed.

SYSTEMIC CMV DISEASE WITHOUT DOCUMENTED ORGAN INVOLVEMENT IN SEVERELY IMMONODEPRESSED PATIENTS / L. Testa, A. d'Arminio Monforte, L. Balotta, M. Mena, L. Vago, T. Bini, M. Barbi, S. Binda, M. Moroni. ((Intervento presentato al 5°. convegno European conference on clinical aspects and treatment of HIV infection tenutosi a Copenhagen nel 1995.

SYSTEMIC CMV DISEASE WITHOUT DOCUMENTED ORGAN INVOLVEMENT IN SEVERELY IMMONODEPRESSED PATIENTS

A. d'Arminio Monforte;L. Vago;M. Barbi;S. Binda;
1995

Abstract

Background Systemic symptoms without any organ involvement may be observed in HIV pos patients (pts) with positive CMV blood culture Objective To describe the clinical picture and course of symptomatic CMV viremia (SCV) in HIV pos pts Design: All the pts fulfilling the following criteria have been included: -fever (> 38°C) lasting more than 14 days, with negative cultures and normal chest X -ray; -no signs and symptoms of specific organ involvement; -presence of unexplained weight loss, and/or hypotension and/or asthenia; -positive culture for CMV from blood polymorphonudear cells (PMN), with positive shell vials test Results From Ian 1990 to Dec 1994 we diagnosed 752 cases with AIDS. 11 pts (1.5%) fulfilled the criteria of SCV. 9 were severely immonodepressed (CD4+ counts <20/uL). Symptoms included: fever (11/11), asthenia (11/11), unexplained weight loss (> 4 kg/1 month-mo.) (4/11), hypotension (3/11). All the pts were given an acute course of anti-CMV drugs: ganciclovir (10 mg/kg/day for 21 days) in 9, foscamet (180 mg/kg/day for 21 days) in 2 pts. In all the pts a complete resolution of symptoms was observed at the end of acute therapy, with negativization of both CMV culture and shell vials test. All were given maintenance therapy (with the same drugs at half doses, every 6/7 days). One pt was lost to follow-up. 2 pts survived for 12 mo.s without any CMV end-organ disease. 4 pts suffered from the same initial symptoms, with positive CMV culture after 6 mo.s (1-15 mo.․), 4 pts suffered from with positive CMV culture after 6 mo.s (1-15 mo.․), 4 pts suffered from CMV retinitis after 6 mo.s (4-8 mos). Autopsy was performed in 4 cases, died after 11 mo.s (3-13 mo.s): CMV adrenalitis was diagnosed in 3 cases (1 pneumonia too); in one multi-organ involvement CMV Conclusions We suggest to take into account this clinical condition, probably due to CMV disease of adrenal organs. Specific therapies seem to be effective on the resolution of symptoms and negativization of CMV culture; their efficacy on the prevention of CMV end-organ disease is to be assessed.
set-1995
Settore MED/42 - Igiene Generale e Applicata
SYSTEMIC CMV DISEASE WITHOUT DOCUMENTED ORGAN INVOLVEMENT IN SEVERELY IMMONODEPRESSED PATIENTS / L. Testa, A. d'Arminio Monforte, L. Balotta, M. Mena, L. Vago, T. Bini, M. Barbi, S. Binda, M. Moroni. ((Intervento presentato al 5°. convegno European conference on clinical aspects and treatment of HIV infection tenutosi a Copenhagen nel 1995.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2434/195872
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