CMV esophagitis: Difference between revisions
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==Management== | ==Management== | ||
**[[Ganciclovir]]: 5mg/kg/dose IV q12h | **[[Ganciclovir]]: 5mg/kg/dose IV q12h | ||
**[[Foscarnet]]: 60mg/kg/dose q8h or 90mg/kg/dose q12h | **[[Foscarnet]]: 60mg/kg/dose q8h or 90mg/kg/dose q12h | ||
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***May be used for induction therapy, in place of intravenous [[ganciclovir]], in patients who can tolerate and absorb oral medications | ***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 | **The recommended duration of therapy for CMV gastrointestinal disease in patients with AIDS is 3-6 weeks | ||
**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. | |||
**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== | ==Disposition== | ||
Revision as of 00:06, 26 February 2017
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
- Nausea
- 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
Evaluation
Management
- Ganciclovir: 5mg/kg/dose IV q12h
- Foscarnet: 60mg/kg/dose q8h or 90mg/kg/dose q12h
- Valganciclovir: 900mg 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
- 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)