Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2
➤ Gửi thông báo lỗi ⚠️ Báo cáo tài liệu vi phạmNội dung chi tiết: Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2
Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2
CHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•E Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2Epidemiology•Transmission of CMV•Pathogenesis•Immune Response to Infection•Pathogenesis of Congenital Infection•Pathology•Clinical Manifestations•Laboratory Diagnosis•Diagnosis During Pregnancy•Treatment•Prognosis•PreventionThe VirusCMV (human herpesvirus 5) is the largest and most complex member of Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2 the family of herpesviruses. The virion consists of three regions: the capsid containing the double-stranded DNA viral genome, the tegument, and theEbook Hematology, immunology and infectious disease expert consult (second edition): Part 2
envelope. The viral genome consists of more than 235 kilobase pairs, which contain more than 252 open reading frames.1 The complexity of the genetic mCHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•E Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2 has demonstrated that no two clinical isolates are alike? The viral tegument contains viral proteins that function to maintain the structural integrity of the virion, are important for assembly of an infectious particle, and are involved in regulator)' activities in the replicative cycle of the vir Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2us. The viral envelope contains eight glycoproteins that have been described, as well as an unknown number of additional proteins. The most abundant eEbook Hematology, immunology and infectious disease expert consult (second edition): Part 2
nvelope glycoproteins arc the gM/gN, gB. and gH/gưgO complexes, all of which are important lor virus infectivity. In addition, gB. gH. and gM/gN have CHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•E Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 24EpidemiologyCytomegalovirus infections have been recognized in all human populations. CMV is acquired early in life in most populations, with the exception of people in the economically well developed countries of northern Europe and North America.171172 CMV: Diagnosis, Treatment, and Consideration Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2s on Vaccine-Mediated PreventionPatterns of CMV acquisition vary greatly on the basis of geographic and socioeconomic backgrounds, and seroprevalenceEbook Hematology, immunology and infectious disease expert consult (second edition): Part 2
generally increases with age. Studies have shown that most preschool children (>90%) in South America, Sub-Saharan Africa, East Asia, and India are CMCHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•E Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2imilar age are seropositive.5 A recent study of CMV seroprevalence that utilized samples from the National Health and Examination Survey (NHANES) 1988-2004 showed that overall age-adjusted CMV seroprevalence in the United States was 50.4%? That study also showed that CMV seroprevalence was higher am Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2ong non-Hispamc black children and Mexican-American children compared with non-Hispanic while children?Transmission of CMVAlthough the exact mode of CEbook Hematology, immunology and infectious disease expert consult (second edition): Part 2
MV acquisition is unknown, it is assumed to be acquired through direct contact with body fluids from an infected person. Breastfeeding, group care of CHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•E Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2aryngeal secretions, urine, cervical and vaginal secretions, semen, breast milk, blood products, and allografts (Table 11-1). Presumably, exposure to saliva and other body fluids containing infectious virus Is a primary mode of spread because infected infants typically excrete significant amounts of Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2 CMV for months to years following infection. Even older children and adults shed virus for prolonged periods (>6 months) following primary CMV infectEbook Hematology, immunology and infectious disease expert consult (second edition): Part 2
ion. In addition, a significant proportion of seropositive individuals continue to shed virus intermittently An important determinant of the frequencyCHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•E Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2own that the seropositivity rates in young women range from less than 50% to 85%.'" In contrast, most women of child-bearing age in less developed regions arc CMV antibody positive.71*Vertical TransmissionCMV can be transmitted from mother to child transplacentally, during birth, and in the postpart Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2um period via breast milk. Congenital CMV infection rates are directly related to maternal seroprevalence rates (Table 11-2). Rates of congenital CMVEbook Hematology, immunology and infectious disease expert consult (second edition): Part 2
infection are higher in developing countries and among low-income groups in developedTable 11-1 SOURCES AND ROUTES OF TRANSMISSION OF CMV INFECTIONModCHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•E Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2uired; mother-to-infani transmissionInfancy and childhoodExposure to saliva and other body fluids; child-to-child transmissionAdolescence and adulthoodExposure to young children; sexual transmission; possible occupational exposuresHospital AcquiredSource Blood productsBlood products from seropositiv Ebook Hematology, immunology and infectious disease expert consult (second edition): Part 2e donors; multiple transfusions; white blood cell containing blood productsAllograft recipientsAllograft from seropositive donorsReproduced with permiEbook Hematology, immunology and infectious disease expert consult (second edition): Part 2
ssion from In: Arvin A. Campadclli-Fiume G. 2007.Boppana SB. Fowler KB. Persistence in the population: Epidemiology and transmission. Mocarski E. cl aCHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•ECHAPTER 11CMV: Diagnosis, Treatment, and Considerations on Vaccine-Mediated PreventionShannon A. Ross, MD, MSPH, and Suresh B. Boppana, MD•The Virus•EGọi ngay
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