200.4 📌 章末速蚘

  • CMV: dsDNA herpesvirus, β-subfamily, largest genome
  • Universal latent (50-90% adults); monocyte/macrophage latency
  • Primary: asymptomatic mostly; CMV mono (older, monospot neg, hepatitis-dominant)
  • Congenital CMV: #1 infectious birth defects + #1 non-genetic SNHL
  • Immunocompromise: retinitis (HIV CD4 < 50), colitis, esophagitis, pneumonia, encephalitis
  • Transplant: D+/R- highest risk; HSCT prophylaxis letermovir (no marrow toxic)
  • Dx: PCR (gold standard), tissue + IHC (owl’s eye), serology
  • Treatment:
    • Ganciclovir/valganciclovir (myelosuppression)
    • Foscarnet (nephro + electrolyte)
    • Letermovir (terminase, no marrow toxic, HSCT prophylaxis)
    • Maribavir (UL97 kinase, refractory/resistant, dysgeusia)
  • Symptomatic congenital: valganciclovir × 6 mo
  • Owl’s eye intranuclear inclusion = CMV pathognomonic on histology
  • Pregnancy hygiene (toddler saliva avoidance) = primary prevention
  • 2024: letermovir for SOT prophylaxis expanding; maribavir for refractory