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last
update October 2002
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| Cytomegalovirus
Infection: Retinal Photograph |
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Cytomegalovirus
(CMV) is a member of the herpesvirus family. Disseminated infection
usually presents as retinitis but may also manifest as colitis,
esophagitis, and polyradiculitis. Patients with retinitis complain
of nonspecific symptoms such as blurred vision and "floaters."
Diagnosis is made presumptively by ophthalmologic examination,
which shows perivascular exudates in the periphery of the retina
(early CMV retinitis) and perivascular exudates
and hemorrhage (advanced CMV retinitis). Treatment
consists of intravenous ganciclovir or valganciclovir followed
by oral ganciclovir for secondary prophylaxis. Intravitreal ganciclovir
implants have also been effective for initial management. Other
therapies for CMV infection include intravenous foscarnet and
cidofovir.
HIV-infected patients with a CD4 count less than 50 are at risk
for CMV infection. Although oral ganciclovir has been shown effective
for primary prophylaxis, its use has been limited by concerns
about toxicity (neutropenia) and cost. Regular screening ophthalmologic
examinations are recommended in those at risk for CMV infection.
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