Ganciclovir Treatment of Steroid-Associated Cytomegalovirus Disease in a Congenitally Infected Neonate

Vallejo, Jesús G.; Englund, Janet A.; Garcia‐Prats, Joseph A.; Demmler, G

doi:10.1097/00006454-199403000-00019

Cited by 29 publications

(17 citation statements)

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“…The first reports of the use of ganciclovir therapy for congenital CMV infection date to the late 1980s (75,206). In subsequent reports (16,60,76,117,124,175,185,186,220,272), ganciclovir has been shown to be generally safe and well tolerated when used in newborns and has appeared to be useful in the management of severe, focal end-organ disease (pneumonitis, hepatitis, etc.) in infants.…”

Section: Interventions Antiviral Drugsmentioning

confidence: 99%

Neuropathogenesis of Congenital Cytomegalovirus Infection: Disease Mechanisms and Prospects for Intervention

2009

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SUMMARY Congenital cytomegalovirus (CMV) infection is the leading infectious cause of mental retardation and hearing loss in the developed world. In recent years, there has been an improved understanding of the epidemiology, pathogenesis, and long-term disabilities associated with CMV infection. In this review, current concepts regarding the pathogenesis of neurological injury caused by CMV infections acquired by the developing fetus are summarized. The pathogenesis of CMV-induced disabilities is considered in the context of the epidemiology of CMV infection in pregnant women and newborn infants, and the clinical manifestations of brain injury are reviewed. The prospects for intervention, including antiviral therapies and vaccines, are summarized. Priorities for future research are suggested to improve the understanding of this common and disabling illness of infancy.

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Section: Interventions Antiviral Drugsmentioning

confidence: 99%

Neuropathogenesis of Congenital Cytomegalovirus Infection: Disease Mechanisms and Prospects for Intervention

2009

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“…We further identified 13 case reports, comprising 16 children in all [1,3,11,13,14,18,26,29,30,32,[34][35][36], three case series [19,28,33] together including 20 patients, and present data from two larger studies, comparing different treatment regimens.…”

Section: Resultsmentioning

confidence: 99%

“…Other sonographic findings in fetal cytomegalovirus infection of the brain include cystic leukomalacia, cerebellar vermis hypoplasia with large cisterna magna, intraventricular adhesions, and abnormal sulcation with or without hypoplastic corpus callosum [17]. There are no data on treatment of children without CNS manifestations, except for four patients who were treated for severe CMV pneumopathy [14,34,35]. However, 5% of asymptomatic congenitally infected children will present with SNHL, with a cumulative rate of 7.2% in the first 6 years of life [12].…”

Section: Discussionmentioning

confidence: 99%

“…Potential harms include hematological abnormalities, especially neutropenia, and catheter related problems, such as infection and catheter malfunction [15,19,22,35,37]. However, besides being a possible consequence of ganciclovir therapy, neutropenia and increased aminotransferase levels may be associated with active CMV infection, which causes neutrophil infection and liver involvement.…”

Section: Discussionmentioning

confidence: 99%

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Selecting neonates with congenital cytomegalovirus infection for ganciclovir therapy

et al. 2006

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All reported patients presented with central nervous system manifestation of CMV infection. Only the randomized controlled study showed a reduction of hearing deterioration in the treated group. Published predictors of hearing loss in congenitally CMV infected children allow identification of candidates that might benefit from treatment. Studies so far are promising but of insufficient number to make evidence based recommendations about indications for treatment of congenital CMV. As such, studies are very difficult to conduct and treatment of infants at high risk of hearing loss may appear justified. There is scientific data to help clinicians in selecting a subgroup of infants that is at higher risk of hearing deterioration and therefore might benefit the most from ganciclovir therapy.

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“…With the advent of ganciclovir, an effective antiviral drug for CMV, reports of therapy for congenital CMV infection began to be published in the late 1980s [76,77]. In numerous uncontrolled reports [78][79][80][81][82][83][84][85][86], ganciclovir has been shown to be generally safe and well-tolerated when used in newborns and has appeared to be useful in ameliorating the severity of focal, end-organ disease (for example, pneumonitis and hepatitis) in infants. Based on these reports, the use of ganciclovir is worth considering and in general is probably indicated in the short-term management of any infant with severe or symptomatic CMV disease, including symptomatic viremia, pneumonitis or refractory thrombocytopenia.…”

Section: Antiviral Therapy For Congenital and Perinatal CMV Infections mentioning

confidence: 99%

Overview of congenitally and perinatally acquired cytomegalovirus infections: recent advances in antiviral therapy

Schleiss

McVoy

2004

Expert Review of Anti-infective Therapy

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Congenital and perinatal infection with human cytomegalovirus (CMV) are commonly encountered in newborns. In recent years there has been increased awareness of the disabilities that result from congenital CMV infection, which in turn has prompted interest in examining the potential efficacy of antiviral agents to prevent or ameliorate neurodevelopmental injury. Currently, there are three licensed systemic antivirals for the treatment of CMV: ganciclovir (Cytovene, Roche] and its prodrug valganciclovir [Valcyte, Roche); foscarnet (Foscavir, AstraZeneca); and cidofovir (Vistide, Pharmacia). A CMV-specific immunoglobulin is also available. Experience with these agents in the setting of congenital and perinatal CMV infection is very limited, but there are encouraging data from a controlled clinical trial indicating that ganciclovir therapy may be of value in limiting one form of neurodevelopmental injury caused by congenital infection, that of sensorineural hearing loss. Licensed antivirals for the treatment of CMV all share the common mechanism of targeting the viral DNA polymerase, but novel therapies that employ alternative modes of action are in development. Ultimately, the problem of perinatal CMV infection may be best controlled by the development of CMV vaccines, which could be administered to young women of childbearing age to help control this important public health problem.

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Ganciclovir Treatment of Steroid-Associated Cytomegalovirus Disease in a Congenitally Infected Neonate

Cited by 29 publications

References 0 publications

Neuropathogenesis of Congenital Cytomegalovirus Infection: Disease Mechanisms and Prospects for Intervention

Neuropathogenesis of Congenital Cytomegalovirus Infection: Disease Mechanisms and Prospects for Intervention

Selecting neonates with congenital cytomegalovirus infection for ganciclovir therapy

Overview of congenitally and perinatally acquired cytomegalovirus infections: recent advances in antiviral therapy

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