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Gastroenterologie
a hepatologie

Gastroenterology and Hepatology

Gastroent Hepatol 2017; 71(6): 517–523. doi:10.14735/amgh2017517.

Cytomegalovirová infekce a játra

Klára Chmelová, Soňa Fraňková, Jan Šperl

Souhrn

Cytomegalovirus (CMV) je DNA virus patřící do čeledi Herpesviridae a podčeledi Betaherpesviridae. Stejně jako další herpesviry má po primoinfekci schopnost v organizmu perzistovat v latentní formě. Séroprevalence CMV u dospělých se celosvětově významně liší, negativně koreluje se socioekonomickým stavem a pohybuje se od 40 % v zemích západní Evropy až po více než 90 % v rozvojových zemích. Séroprevalence se zvyšuje s věkem. CMV se přenáší tělesnými tekutinami, pohlavním stykem nebo transplantovaným orgánem. CMV je schopen replikace v řadě buněk vč. hepatocytů, v myeloidních buňkách kostní dřeně se pak udržuje latentní infekce schopná reaktivace při imunosupresi. CMV primoinfekce u imunokompetentních osob má většinou asymptomatický průběh, ale u imunokompromitovaných jedinců může primoinfekce i reaktivace probíhat jako život ohrožující CMV nemoc. Klinická manifestace CMV infekce kolísá od asymptomatické viremie (CMV infekce v užším slova smyslu) přes CMV nemoc typu nespecifického virového syndromu až po CMV nemoc s orgánovým postižením, kterým může být CMV hepatitida, kolitida, pneumonie apod. CMV infekce, resp. nemoc představuje závažnou a život ohrožující komplikaci zejména u pacientů po orgánových transplantacích a u pacientů s HIV infekcí. Incidence CMV hepatitidy v 1. roce po transplantaci jater dosahuje až 20 %. Profylaxe i protivirová léčba CMV infekce jsou vysoce důležitým bodem v péči o imunosuprimované pacienty. Naopak u imunokompetentních pacientů představuje CMV hepatitida jen asi 1 % příčin zvýšení jaterních enzymů. Roční incidence CMV hepatitidy je odhadována na 4 případy na 100 000 obyvatel, postihuje osoby středního věku a má obvykle mírný průběh a nevyžaduje protivirovou léčbu, fulminantní průběh je raritní. CMV infekce nepatří mezi příčiny chronických hepatitid. Vyšetření protilátek proti CMV či CMV DNA nepatří do 1. linie diferenciální diagnostiky zvýšení jaterních enzymů. Na CMV hepatitidu je nutno pomýšlet při neobjasněném zvýšení jaterních enzymů provázeném virovým syndromem zejména u osob středního věku.

Klíčová slova

cytomegalovirus, hepatitida, imunosuprese, incidence, léčba, riziko, séroprevalence

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