CMV esophagitis: Difference between revisions
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*The incidence of CMV gastrointestinal disease has decreased substantially since antiretroviral therapy (ART) became available | *The incidence of CMV gastrointestinal disease has decreased substantially since antiretroviral therapy (ART) became available | ||
==Clinical | ==Clinical Features== | ||
*[[Odynophagia]] | *[[Odynophagia]] | ||
*[[Dysphagia]] | *[[Dysphagia]] | ||
Revision as of 07:36, 12 July 2016
Background
- Cytomegalovirus (CMV) gastrointestinal disease is an uncommon but serious complication of AIDS.
- The diagnosis of CMV gastrointestinal disease should be suspected in patients with CD4 cell counts <50 cells/microL who present with symptoms of esophagitis, gastritis, enteritis, or colitis.
- The incidence of CMV gastrointestinal disease has decreased substantially since antiretroviral therapy (ART) became available
Clinical Features
- Odynophagia
- Dysphagia
- Fever
- Naseau
- Substernal burning pain
Differential Diagnosis
Esophagitis Types
- Inflammatory
- GERD
- Allergic (eosinophilic)
- Infectious Mainly seen in patients w/ immunosuppression (HIV/AIDS, cancer, steroids)
- Esophageal candidiasis: often an AIDS defining lesion
- HSV
- CMV esophagitis
- aphthous ulceration
- Medication-induced (i.e. "pill") esophagitis, common culprits:
- Doxycycline
- Tetracycline
- Clindamycin
- NSAIDs
- ASA
- Bisphosphonates
- Ferrous sulfate
- Potassium chloride
- Ascorbic acid
CMV Diseases
Diagnosis
Management
- Template:Induction therapy:
- Ganciclovir: 5 mg/kg/dose IV q12h
- foscarnet: 60 mg/kg/dose q8h or 90 mg/kg/dose q12h
- Valganciclovir: 900 mg PO twice daily
- May be used for induction therapy, in place of intravenous ganciclovir, in patients who can tolerate and absorb oral medications
- The recommended duration of therapy for CMV gastrointestinal disease in patients with AIDS is 3-6 weeks
- Template:Management Therapy:
- Chronic maintenance therapy is not recommended for CMV gastrointestinal disease unless there is concurrent retinitis or recurrent gastrointestinal disease after induction therapy has been discontinued.
Disposition
Antivirals
- Ganciclovir 5mg/kg IV q12hrs daily x 21 days (or until symptom resolution)
- Foscarnet 90mg/kg IV q12 hrs daily x 21 days (or until symptom resolution)