Florica Stăniceanu *, Sabina Zurac **, Adrian Streinu-Cercel ***
Conf. dr. Florica Stăniceanu, UMF “Carol Davila”, șef Laboratornl de Anatomie Patologică, Spitalul Clinic Colentina, București
** Dr. Sabina Zurac, Laboratorul de Anatomie Patologică, Spitalul Clinic Colentina, București
*** Dr. Adrian Streinu-Cercel, șef lucrări UMF “Carol Davila”, medic primar șef secție Institutul de Boli lnfecțioase “Prof. dr. Matei Balș”, București
Abstract
Cytomegalovirus (CMV) is a DNA virus producing asymptomatic disease in immunocompetent acute infected persons. The virus remains in tissues after the ,,cure” of the acute infectious episode; in HIV infected patients the coexistence of a CMV infection (most often due to the reactivation of a latent infection, rarely due to a CMV superinfection) is expressed by the appearance of the cytomegaly as a disease, the main risk factor being the level of the CD4+ T cells less than 50 cell/mm3.l(n immunocompetent CMV inected persons the immune response can be both humoral and cellular with high levels of CD4+ T cells helper and memory type (the latter developed against a limited number of CMV epitopes) and insignificant levels of CD8+ cytotoxic lymphocytes.In HIV infected persons the cellular response implies an elevation of the CD8+ cytotoxic lymphocytes anti pp65 phosphoprotein and a dimishing of CD4+ T helper response.Most frequent, the CMV infection in HIV infected patients determines cytomegalic retinitis and digestive disease, but also lung disease (interstitial pneumonia), encephalitis or peripheral neuropathy.The positive diagnosis in cytomegalic retinitis is performed based on the positive seric markers of active inflammation and the specific ophthalmologic appearance; the histopathologic diagnosis, even the most specific ones, is not recommended due to the higher risk of an irreversible damage of the retina.The cytomegalic gastrointestinal disease may be lethal; digestive hemorrhages, perforations and diarrhea. The histopathologic examination identifies specific nuclear inclusions (,.owl eye” type), most often in the endothelial cells and, only in severe cases of infection, in the. macrophages or cryptic epithelial cells.