EXPERIENCE WITH GANCICLOVIR IN THE TREATMENT OF THE GENERALIZED FORM OF CYTOMEGALOVIRUS INFECTION

Objective. To present the results of a follow-up of two ganciclovir-treated children with the clinically important forms of cytomegalovirus infection (CMVI). Material and methods. The data of a follow-up were analyzed in two children with 1.5- and 2-year histories of congenital clinically important CMVI. Both cases were found to have a clinical symptom complex of congenital infection at birth, the leading manifestation of which was hepatitis. Results. With the use of this drug, there was a gradual normalization of hematological parameters, which substantiates the viral etiology of these changes. No adverse reactions were found during the therapy. The data of polymerase chain reaction monitoring of a viral load in blood and urine suggested that the virus was better detectable in the latter. Nevertheless, blood DNA concentration better correlated with the clinical picture, which gives grounds to recommend urinalysis as a screening test while the blood viral load should be borne in mind on making a decision on the use and duration of therapy. There were clinical signs of encephalitis in no case; however, there were calcifications that might be due to congenital CMVI. A detailed neurological examination established that by the age of 1.5 and 2 years, the neuropsychic development of the children was consistent with their age. Altered hearing as birth unilateral bradyacusia was detected in one child. By the age of 1.5 years, these changes were retained without negative dynamics; hearing on the other side was preserved completely. The other child’s hearing was in the normal range. Ganciclovir treatment showed regression of pathological liver changes with a gradual, by the age of 1 year, complete functional recovery. Conclusion. The observations presented enable recommendations that ganciclovir should be used in the clinically important, generalized forms of CMVI including hepatitis, which have been substantiated by high CMV DNA levels in the blood and other media. A child’s stay in the health care facility that has high diagnostic and therapeutic capacities is a necessary condition. A decision must be made on the basis of the consultation of physicians, the opinions of a medical commission and an ethic council, and the parents’ informed consent.

cytomegalovirus infection, ganciclovir, neonatal infants