Related Terms AIDS, alizarin, antiviral, blessed thistle, blindness, CD4, CMV retinitis, dormant, floaters, fluorescein, fluorescein angiogram, HIV, herpes, immunocompromised, infection, intravitreal implant, latent, mono, mononucleosis, ophthalmoscope, ophthalmoscopy, photophobia, retina, viral infection, vitreo-retinal surgeon. Background Cytomegalovirus (CMV) is a common viral infection that is related to herpes. Like many other herpes viruses, CMV remains latent in healthy hosts, which means the virus remains dormant inside the individual. Cytomegalovirus retinitis is a type of retinitis that develops from viral infection of retina. However, if diseases, transplants or chemotherapy compromise the host’s immune system, the CMV may reactivate, causing the individual to become ill. Francis I Proctor Foundation, University of California, San Francisco, USA. CMV retinitis (inflammation of the retina) is a leading cause of blindness in patients with AIDS.
It is also increasingly common among organ transplant recipients, as the number of those procedures performed each year increases. Infectious causes should always be considered in all patients with uveitis. This was associated with headache and pain on ocular movements. The degree of vitreous inflammation in NHR-affected eyes depends in part upon the underlying level of immune suppression, with trace-to-mild inflammation typically occurring in severely immuno-compromised patients with acquired immune deficit syndrome (AIDS), and moderate-to-severe inflammation occurring more often in patients with limited or no immune deficits . The right eye showed a ciliary injection, cells and flare in the anterior chamber, and vitreous opacity. Mortality due to extraocular CMV disease is almost impossible to attribute without autopsy, and so is wrongly ascribed, usually to “advanced HIV infection” or tuberculosis. [Full Text].
2012 May 30. Natural Standard: The Authority on Integrative Medicine. It allows for better visualization of any peripheral retinal disease. Most patients, therefore, should have both a sensitive (FTA-ABS or MHA-TP) and titratable (RPR or VDRL) test for syphilis. . Active lesions show a hypoautofluorescent halo surrounding the edges of a hyperautofluorescent lesion. pneumonia—if CMV infects the lungs (rare in HIV-positive people).
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. In about 30% of cases, there is evidence of retina damage. Common symptoms include: floaters (seeing spots or spider webs), light flashes, blind spots, blurred vision, obstructed areas of vision, photophobia (abnormal sensitivity to light) and sudden decrease of vision. The condition usually requires the expertise of a vitreo-retinal surgeon. The incidence of sinusitis is greater in HIV seropositive individuals than in HIV-seronegative individuals.6 Although sinusitis can occur at any CD4 count, it increases in incidence and severity as CD4 counts decline. Diagnosis A vitreo-retinal surgeon should evaluate patients who experience CMV retinitis symptoms. Recently, the term ‘necrotizing herpetic retinopathies’ (NHR) has been proposed due to a variety of clinical manifestations of viral retinal infections that range in intensity from mild to progressive, depending on the patient’s immune status, as this term can convey the whole spectrum of ophthalmoscopic findings in viral retinitis [3,6].
During the procedure, the patient is given eye drops to dilate the pupils. Then the surgeon looks through the ophthalmoscope to see the retina. A fluorescein angiogram may be necessary to evaluate the circulatory system of the retina. 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.
First, the technique of indirect ophthalmoscopy is divided into small, well-described steps, accompanied by intensive practice with model eyes, and supported by four days of individual attention from trainers. If left untreated, CMV will almost always cause blindness. A vitreo-retinal surgeon usually treats the virus. Fluorescein angiography of the retinitis showed early hypofluorescence with late staining of retinal lesions and blood vessels. No treatment is also an option as the condition recovers spontaneously but treatment may speed the recovery and shorten the course of the disease. Similarly, we cannot conclude that this patient’s immuno-compromised status was caused by his PLE, or by his long term steroid use. Regarding the visual pathway, MR images have revealed changes after anterograde degeneration of optic radiations from lesions involving the lateral geniculate body (9).
Plausible explanations notably include regional variation in the length of survival of patients with low CD4 counts—short survival times reducing the period of risk for CMV—and different genetically determined host vulnerabilities to CMV . 2005 Sep. Ophthalmology. Avoid if pregnant or breastfeeding. Roche is targeting a small but lucrative market, and protecting its position through patent monopolies. Effects of blessed thistle (or chemicals in blessed thistle called lignans) against HIV are not clear. Human research of blessed thistle as a treatment for viral infections is lacking.
Blessed thistle is generally considered to be safe when taken by mouth in recommended doses for short periods of time, with few reported side effects such as birth defects, bleeding, breathing problems, bruising, cancer of the nose or throat, increased production of stomach acid, itching, kidney disease, liver toxicity, skin rash, stomach discomfort, stomach ulcers and vomiting. Multiple relapses of human cytomegalovirus retinitis during HAART in an AIDS patient with reconstitution of CD4+ T cell count in the absence of HCMV-specific CD4+ T cell response. 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. Diagnosis is by computed tomography or magnetic resonance imaging and biopsy, since malignant cells are found in the cerebrospinal fluid in only 15% to 25% of patients.
Sweetened cranberry juice may affect blood sugar levels. Intravitreal foscarnet or ganciclovir (Vitrasert) are also sometimes used in patients with very severe ARN [2,7]. Avoid more than the amount usually found in foods if pregnant or breastfeeding. Sorrel: There is currently a lack of well-conducted published studies that demonstrate antiviral or antibacterial activity of sorrel. In an in vitro study, sorrel did not demonstrate activity against herpes simplex virus-1, herpes simplex virus-2, HIV, B. subtilis, E. coli, Proteus morganii, Pseudomonas aeruginosa, P.
vulgaris, Serratia marcescens, or Staphylococcus aureus. Avoid with a known allergy to sorrel. One year after the workshop most of the trainees were providing systematic eye examination for early diagnosis of CMV retinitis as standard care for at-risk patients. 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. To summarize, the individuals, with anterior uveitis with pigmented keratic precipitates or confluent posterior pole retinochoroiditis or optic neuritis or neuroretinitis and a history of fever with arthralgia who live in or come from endemic area for chikungunya virus, may have this entity included in the differential diagnosis. Avoid if pregnant or breastfeeding.
Turmeric: Early evidence suggests that turmeric may help treat viral infections. However, there is not enough human study in this area. In our recent work in Myanmar, 13/42 (31%) patients diagnosed with CMV retinitis had no symptoms; an MSF study in Cambodia that used a questionnaire specifically designed to elicit symptoms of CMV retinitis found that almost half of the patients with CMV retinitis (17/39, 44%) had no symptoms at the time the disease was detected by screening examination . Avoid if allergic or hypersensitive to turmeric, curcumin, yellow food colorings, or plants belonging to the Zingiberaceae (ginger) family. 124(1):61-70. Use cautiously with blood-thinners, such as warfarin (like Coumadin®), and blood sugar-altering medications. Avoid in medicinal amounts if pregnant or breastfeeding.
Turmeric should be stopped prior to scheduled surgery. 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. Diagnostic tests revealed evidence of meningitis, and single demyelinating lesions were also found on brain MRI. 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. Use cautiously if taking blood thinners (anticoagulants), blood sugar medication, or drugs that are broken down by the liver (like amiodarone, phenobarbital, valproic acid).
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.
Euro Surveill. 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. The stark reality is that conditions favorable to the development of CMV retinitis—patients with low CD4 counts in the absence of HAART—are most common in impoverished rural areas where profound blindness will have a devastating impact on the entire family, and often a fatal outcome for the patient. Use cautiously with phenylketonuria (a genetic disorder of a liver enzyme that disrupts normal body functions), autoimmune diseases, bleeding disorders, diabetes, and osteoporosis. 129(1):9-15.
Avoid in children and if pregnant or breastfeeding. Prevention To prevent CMV infection in pregnancy, wash hands with soap and water before meals and especially after changing diapers. If mononucleosis-like symptoms, such as fatigue, fever, headache, sore throat, chills or muscle aches, appear during pregnancy, consult a qualified healthcare provider. 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. Among 10 patients who were followed up at our study center, 1 required chronic corticosteroid use because of SLE and 1 due to the kidney transplantation surgery performed 6 years ago, 1 had generalized zoster with diffuse skin involvement, and 1 received interferon and ribavirin combination therapy for chronic hepatitis C 1 year ago. 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. Information is based on review of scientific research data, historical practice patterns, and clinical experience. 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.