The purpose of this paper was to present a case series of self-limiting, peripheral acute retinal necrosis and to demonstrate efficacy of treatment with valacyclovir in patients resistant to acyclovir. Cytomegalovirus retinitis is caused by the cytomegalovirus, a type of herpes virus. Like many other herpes viruses, CMV remains latent in healthy hosts, which means the virus remains dormant inside the individual. Even though the virus is present, no signs or symptoms of illness appear during this stage. However, if diseases, transplants or chemotherapy compromise the host’s immune system, the CMV may reactivate, causing the individual to become ill. HIV positive individuals are at the greatest risk for CMV, especially when their CD4 cell count decreases. Cataract: When you ignore retinitis pigmentosa for a long time, you might develop cataract.
It is also increasingly common among organ transplant recipients, as the number of those procedures performed each year increases. e. Clinically evident disease is found almost exclusively in individuals who are immunocompromised. Bibliography Hodge WG, Boivin JF, Shapiro SH, et al. Air travel, immigration, and globalization of business have overturned traditional pattern of geographic distribution of infectious diseases, and therefore one should work locally but think globally, though it is not possible always. There was no history of any other ocular or systemic problems. Immuno-suppressed patients are particularly at risk of developing necrotizing retinopathies typically associated with such states; for example, CMV retinitis and PORN.
The left fundus was uninvolved. In this article we provide preliminary data describing the problem and suggest possibilities for management of CMV retinitis in resource-poor settings. Am J Ophthalmol. Cytomegalovirus retinitis after the initiation of highly active antiretroviral therapy: a 2 year prospective study. . There is no need for any laboratory or eye tests. Treatment of uveitis is more challenging in patients with HIV disease than in immunocompetent patients.3 Every attempt should be made to encourage the use of HAART to promote immune reconstitution and to minimise the risk of HIV related complications.
Symptoms CMV retinitis may affect one eye at first, but usually progresses to both eyes, and symptoms worsen as the patient’s ability to fight off the infection decreases. The differential diagnosis includes other causes for posterior uveitis that course with multifocal or placoid choriorretinitis like Multifocal Choriorretinitis, APMPPE, Toxoplasmosis and Tuberculosis (TB). Symptoms of disseminated CMV can include unexpected tiredness, stiff joints, aching muscles, fever, swollen lymph nodes, sore throat and loss of appetite. The condition usually requires the expertise of a vitreo-retinal surgeon. Patients with CMV retinitis are at risk of retinal detachment, hemorrhages and inflammation of the retina, which can lead to permanent vision loss or blindness. Diagnosis A vitreo-retinal surgeon should evaluate patients who experience CMV retinitis symptoms. The surgeon will diagnose the patient after thoroughly examining the retina using an ophthalmoscope.
PCP often presents with gradually progressive dyspnea, fever, and cough. Then the surgeon looks through the ophthalmoscope to see the retina. There have also been very rare reports on ARN-like lesions associated with toxoplasmic retinitis [3,7–10]. During the procedure, a special dye called fluorescein is injected into the patient’s vein. In a few seconds, the dye travels to the blood vessels in the eye. A camera, which has special filters that highlight the dye, takes photographs of the blood vessels in the back of the eye. The pictures will show any swelling or abnormal blood vessels.
Treatment CMV retinitis can potentially cause serious eye damage, often including vision loss. If left untreated, CMV will almost always cause blindness. A vitreo-retinal surgeon usually treats the virus. Third, the workshop is based on active individual and group participation, and immediate immersion in clinical care. These drugs can be administered orally, intravenously, injected directly into the eye or through an intravitreal implant (small capsules of medications surgically inserted into the eye). Integrative therapies Unclear or conflicting scientific evidence: Alizarin: Limited available evidence suggests that alizarin may be useful for viral infections such as herpes. Vision remained the same or deteriorated in 87% of eyes.
These include encephalitis, myelitis, encephalomyelitis and paralysis of various cranial nerves. His immuno-suppressed status affected the degree of inflammation and made diagnosis difficult. From about 4 to 14 weeks after injury, the degenerated tracts appear as low-intensity signal changes on T2-weighted images, which suggests a transient increase in the lipid-protein ratio. The “gold standard” for diagnosis of CMV retinitis is examination of the retina through a dilated pupil by a skilled clinician using an indirect ophthalmoscope. Blessed thistle: Laboratory studies report no activity of blessed thistle against herpes viruses, influenza or poliovirus. [Medline]. Human research of blessed thistle as a treatment for viral infections is lacking.
Yet the shortage of ophthalmologists, (who tend to be in cities, far from where many of the most vulnerable patients are) means that diagnosis and treatment for CMV retinitis must be firmly placed within AIDS programs, and at the primary health care level, just like all other important opportunistic infections, to ensure early diagnosis. Allergic reactions to blessed thistle including rash may occur, as well as cross-sensitivity to mugwort and Echinacea. Cross-reactivity may also occur with bitter weed, blanket flower, Chrysanthemum, coltsfoot, daisy, dandelion, dwarf sunflower, goldenrod, marigold, prairie sage, ragweed or other plants in the Asteraceae/Compositae family. Avoid if pregnant or breastfeeding. Cranberry: Limited laboratory research has examined the antiviral activity of cranberry. There is currently a lack of reliable human studies in this area. Avoid if allergic to cranberries, blueberries or other plants of the Vaccinium species.
Sweetened cranberry juice may affect blood sugar levels. Use cautiously with a history of kidney stones. HIV-infected individuals have a 60-fold greater risk of developing non-Hodgkin’s lymphoma than the general population. Sorrel: There is currently a lack of well-conducted published studies that demonstrate antiviral or antibacterial activity of sorrel. For 9 subjects, the follow-up period was 2–11 years (mean follow-up duration of 4.2±2.8) (). subtilis, E. coli, Proteus morganii, Pseudomonas aeruginosa, P.
vulgaris, Serratia marcescens, or Staphylococcus aureus. Avoid with a known allergy to sorrel. Avoid large doses of sorrel because there have been reports of toxicity and death. This may be because of the oxalate found in sorrel. Be aware that many tinctures contain high levels of alcohol and should be avoided when driving or operating heavy machinery. 2. Avoid if pregnant or breastfeeding.
Turmeric: Early evidence suggests that turmeric may help treat viral infections. In the ideal laboratory condition, the average incubation period for dengue ranges from 8 to 14 days, while for chikungunya it is 2 to 5 days. Well-designed trials are needed to make a conclusion. Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. Use cautiously with a history of bleeding disorders, immune system deficiencies, liver disease, diabetes, hypoglycemia, or gallstones. Once there is some restitution of immune function and the CD4 count is increased to above 100 cells/μl (and commonly after at least three months), reactivation of CMV retinitis is unlikely [29,30]. Avoid in medicinal amounts if pregnant or breastfeeding.
Risk of immune recovery uveitis in patients with AIDS and cytomegalovirus retinitis. Traditional or theoretical uses lacking sufficient evidence: Astragalus: Astragalus is frequently found in herbal combinations used to treat viral infections. Antiviral effects have been demonstrated in early study, however human evidence is currently lacking. Additional research is needed in this area. Avoid if allergic to astragalus, peas, or any related plants or with a history of Quillaja bark-induced asthma. Avoid with aspirin or aspirin products or herbs or supplements with similar effects. Avoid with inflammation (swelling) or fever, stroke, transplant or autoimmune diseases (like HIV/AIDS).
Stop use two weeks before surgery/dental/diagnostic procedures with a risk of bleeding and avoid use immediately after these procedures. Use cautiously with bleeding disorders, diabetes, high blood pressure, lipid disorders or kidney disorders. Use cautiously with blood-thinners, blood sugar drugs, or diuretics or herbs and supplements with similar effects. Avoid if pregnant or breastfeeding. Chaparral: Chaparral has been shown to have antiviral activity in early research, however human studies are currently lacking. Avoid if allergic to chaparral or any of its components, including nordihydroguaiaretic acid. Intravenous acyclovir was introduced in compliance with Uveitis Study Group guidelines, followed by valacyclovir at a dose of 1.0 g t.i.d.
Stop use two weeks before surgery/dental/diagnostic procedures with bleeding risk, and do not use immediately after these procedures. Use cautiously if driving or operating heavy machinery. Avoid if pregnant or breastfeeding. Garlic: Preliminary studies have demonstrated effects of garlic against several viruses, including influenza B virus, herpes simplex virus type 1, herpes simplex virus type 2, parainfluenza virus type 3, vaccinia virus, vesicular stomatitis virus, human rhinovirus type 2, and cytomegalovirus. Human research is needed to confirm the antiviral effects of garlic. Avoid if allergic or hypersensitive to garlic or other members of the Lilaceae(lily) family (like hyacinth, tulip, onion, leek, chive). Avoid with a history of bleeding problems, asthma, diabetes, low blood pressure, or thyroid disorders.
Stop using supplemental garlic two weeks before dental/surgical/diagnostic procedures and avoid using immediately after such procedures to avoid bleeding problems. Avoid in supplemental doses if pregnant or breastfeeding. Spirulina: Polysaccharides found in Arthrospiria platensis (formerly known as Spirulina platensis) have been shown to inhibit viruses in animal study. Human research is needed to confirm the antiviral effects of spirulina. Avoid if allergic or hypersensitive to spirulina or blue-green algae. Use cautiously with phenylketonuria (a genetic disorder of a liver enzyme that disrupts normal body functions), autoimmune diseases, bleeding disorders, diabetes, and osteoporosis. Use cautiously with products containing the blue-green algae species Anabaena spp., Aphanizomenon spp., and Microcystis spp.; in underweight patients or in those taking antiobesity agents or appetite suppressants; and if consuming a high-protein diet.
In the West, in the pre-HAART era, CMV infection was found at autopsy in over half of patients with AIDS [43,44,45], and CMV disease of the central nervous system (CNS) was found in about 10% of autopsy patients [46,47,48]. Prevention To prevent CMV infection in pregnancy, wash hands with soap and water before meals and especially after changing diapers. Foscarnet-Ganciclovir Cytomegalovirus Retinitis Trial: 5. Treating underlying disorders may help prevent the development of retinitis. Pregnancy A pregnant mother with CMV can potentially pass the virus to her fetus, which increases the risk of birth defects. CMV is the most common congenital infection. The majority of babies who are infected with the virus before birth are asymptomatic (experience no symptoms) at birth.
However, up to 15% will develop neurological abnormalities like deafness, blindness or mental retardation, according to the Centers for Disease Control and Prevention (CDC). Pregnant women undergo a blood test to determine whether or not they have CMV. If the pregnant woman tests positive, the physician may test the fetus for infection with amniocentesis. If the fetus shows signs of infection, an ultrasound can be used to detect any abnormalities in the fetus. Treatment may include an antiviral medication. However, antiviral drugs have not been proven to be safe during pregnancy. Also, there is no scientific evidence that antiviral drugs can protect the fetus from CMV.
The information in this monograph is intended for informational purposes only, and is meant to help users better understand health concerns. This low incidence of viral retinitis is surprising in large populations of patients. This information should not be interpreted as specific medical advice. Users should consult with a qualified healthcare provider for specific questions regarding therapies, diagnosis and/or health conditions, prior to making therapeutic decisions.