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  • 1 Semmelweis Egyetem, Általános Orvostudományi Kar Transzplantációs és Sebészeti Klinika Budapest Baross u. 23. 1082
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A cytomegalovirus (CMV) az immunszupprimált szervtranszplantált betegek egyik veszélyes fertőzése. A transzplantáltak 80-90%-ánál a fertőzés inaktív; a tünetekkel járó CMV-betegség gyakorisága 30-40%-os. Gastrointestinalis CMV-betegség a szervátültetettek mintegy 10%-ában fordul elő, a kórkép a tápcsatorna bármelyik szakaszát érintheti. A CMV-betegség leggyakrabban a nyálkahártya károsodásával, fekélyekkel, eróziókkal, vérzésekkel jár, oka lehet a tápcsatorna motilitási zavarának, ritkábban gastrointestinalis gyulladásos teriméknek, perforációknak. A diagnosztika alapja az endoszkópos vizsgálat biopsziás mintavétellel. A biopsziás minta szövettani vizsgálatakor keresni kell a CMV-fertőzésre jellemző cytomegaliás sejteket intranukleáris („bagolyszem”) és intracitoplazmatikus zárványokkal. A vírus kimutatására számos mikrobiológiai, immunhisztokémiai és molekuláris biológiai módszer létezik. Igazolt kórkép esetén a kezelés kettős: az elváltozásoknak, tüneteknek megfelelő gasztroenterológiai kezelés mellett meg kell kezdeni az antivirális terápiát általában intravénás ganciclovirrel és/vagy orális valganciclovirrel. Lényeges a betegség kialakulásának megelőzése is: a magas rizikójú betegcsoportban általános profilaxis javasolt per os valganciclovirrel, speciális esetekben hiperimmunglobulinnal; közepes kockázat esetén a mikrobiológiai surveillance eredménye alapján preemptív kezelés kezdhető.

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