Xiao Wang is a 28-year-old male, who is in his youth. He is in the financial industry and looks handsome. He is a handsome guy who can attract a lot of girls’ attention when walking on the street. He has a successful career and he always feels watching things after working overtime recently. Blurred, there were floating objects or flashes in front of him, and he did not care that overtime caused myopia to increase, but after a month he became more and more fatigued, and his right eye was blurred, leaving only a little light. Xiao Wang was anxious and immediately went to the hospital ophthalmology department for an examination and found that the retina of the right eye was yellowish white, and the retinal blood vessels were ruptured and bleeding. Why is there such a serious situation? Xiao Wang was hospitalized immediately and the doctor in bed told him a heavy tone one day: Your HIV preliminary screening test is uncertain. Currently considering “AIDS combined with giant cell retinitis”, the prognosis is poor. Xiao Wang almost fainted at that time. past.
Time went back 4 years ago. At that time, Xiao Wang was a college student. At one time, after meeting with many social celebrities, he couldn’t resist the temptation to experience the same-sex passion, but after that Xiao Wang never happened again. Things have been said, Xiao Wang’s heart is basically clear about the origin of the infection. After treatment, Xiao Wang’s left eye vision has been preserved, but his right eye is almost blind. Xiao Wang regrets it.
So why is giant cell infection so severe? What lessons should be learned?
Human cytomegalovirus belongs to the herpesvirus family and is one of the most common pathogens causing human viral diseases. Humans are the only host for human CMV infection. Most CMV infections are asymptomatic and are latent. The latent parts are mainly in the salivary glands, breast milk, kidneys, white blood cells or other glands, and can excrete viruses from saliva, breast milk, urine, semen, cervix and vagina secretions for a long time or intermittently. Viruses can be spread vertically and horizontally. The study found that patients with HIV and CMV infection accounted for only 19.59% of patients with CMV-related clinical manifestations, most of whom were latently infected. The onset of CMV infection can involve multiple organs, common gastroenteritis, pneumonia, retinitis, can also cause encephalitis, hepatitis, pancreatitis or adrenal necrosis.
Previous studies have shown that CMV retinitis is a late complication of AIDS patients, and most of them occur in patients with CD4T lymphocytes <50 cells/ul. Therefore, CMV retinitis is often referred to as a landmark disease of AIDS. In addition, many studies at home and abroad have confirmed that hormone therapy is ineffective and refractory ulcerative colitis is closely related to CMV infection. Serological testing Whole blood CMV NDA quantitative testing and pp65 antigen testing are three common clinical laboratory testing methods for diagnosing CMV infection. They are used to detect patients with CMV carrying cells <50μ) or fail to receive HAART. The fourth preferred drug, such as amikacin or streptomycin. Generally, antiviral therapy should be started two weeks after MAC treatment to reduce the drug burden of patients with drug interactions and the incidence of immune reconstitution inflammatory syndrome. If the patient has already received antiviral therapy, antiviral therapy should be continued, and anti-MAC therapy should be given. Attention should be paid to adjusting and optimizing antiviral therapy to reduce the mutual treatment between drugs. The patient’s clinical performance has not improved after 4-8 weeks 2. The patient has persistent bacteremia, which can be considered a treatment failure.
Causes and characteristics of giant cell retinitis
The characteristic changes of CMV retinitis can be seen on fundus examination: yellow-white, villi or granules can be seen on the retina
Lesions, lesions often close to the blood vessels of the retina and cause bleeding. Vitreous inflammation was milder among those who did not fight HIV. Untargeted
Treatment, CMV retinitis will progress, usually within 10-21 days of symptomatic disease progression. According to the degree of retinal opacity and whitening, retinal hemorrhage, and the shape and location of the lesion, the lesions were divided into “outbreak edema type” and “rest granule type”. Not all patients with CMV viremia develop CMV end-organ disease, and not all patients with CMV retinitis have CMV viremia. A positive CMV antibody is not helpful in the diagnosis of CMV retinitis, while a negative CMV IgG usually indicates that retinitis is probably not caused by CMV.
Key points:
- CMV retinitis is a late-stage complication of AIDS patients, and it mostly occurs in patients with CD4T lymphocytes <50 cells/ul;
- The prognosis of CMV retinitis is poor, and it is often easy to cause blindness;
- Patients with CD4T lymphocyte counts less than 200cells/ul are prone to opportunistic infections, review on time, and avoid the incentives for opportunistic infections.