⚡It has the largest genome of any known human virus [230kb /200 genes]
⚡Most humans harbour latent CMV, infection MC aquired in childhood.
⚡Site of latency in humans- Not Known
In murine models - hepatic sinusoidal cells
D-/R+ > D+/R+ > D+/ R- > D- / R -
⚡The other risk factors are
1️⃣ T cell depletion
3️⃣ UCB SCT
4️⃣ GVHD requiring Rx
⚡ So why not give prophylaxis to these patients ??
⚡Lack of standardized reporting further compounds the problem.
⚡But >500copies/ml before D100 must trigger pre-emptive therapy.
UL97 ➡️➡️ Ganciclovir/Valgan resistance
UL54 ➡️➡️ Foscarnet & Cidofovir resistance
UL56 ➡️➡️ Letermovir resistance
⚡Risk fact for Resistant #CMV
1️⃣ Prolonged anti CMV rx
2️⃣ Inadequately dosed Rx
1️⃣ Reducing immunosuppression
2️⃣ Ganciclovir + Foscarnet combination
3️⃣ CMV specific T cell infusions
4️⃣ Maribavir / Brincidofovir / Letermovir
⚡Maribavir➡️UL97 protein kinase inhibitor. Blocks nuclear egress of viral capsids.