先天性サイトメガロウイルス感染症 診療ガイドライン2023

出版社: 診断と治療社
発行日: 2023-10-16
分野: 臨床医学:内科  >  周産期(新生児)
ISBN: 9784787825506
電子書籍版: 2023-10-16 (電子版)
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先天性サイトメガロウイルス(cCMV)感染症に関するエビデンスに基づく「診療ガイドライン」と,専門家による「解説・エキスパートオピニオン」で構成.診療ガイドラインでは,胎児期からフォローアップまで包括した20のCQを,解説・エキスパートオピニオンでは,診断やフォローアップのほか2023年3月に世界初の適応拡大承認を受けた症候性cCMVへのバルガンシクロビル治療に関するQ&Aも掲載.cCMV感染症に関わるすべての医療従事者必携の書.

目次

  • Part I 診療ガイドライン
    ガイドライン作成方法・作成経過
    疾患トピックの基本的特徴
    診療アルゴリズム
    CQと推奨一覧

    クリニカルクエスチョンに対する推奨と解説
    重要臨床課題1:胎児期のリスク評価・診断された場合の対応
     CQ1―1 胎児期の垂直感染予防に啓発(情報提供)は有用か?
     CQ1―2 妊婦抗体スクリーニングは胎児の垂直感染リスク評価に有用か?
     CQ1―3 先天性感染を疑う胎児超音波検査所見は何か?
    重要臨床課題2:早期新生児期~出生後3週の時期における診断
     CQ2―1 症候性感染を疑う契機となる臨床所見は何か?
     CQ2―2 母体抗体検査でサイトメガロウイルス初感染が疑われる場合に,どのように対応するか?
     CQ2―3 妊娠中にどのような異常所見が認められたら,児の尿核酸検査が必要か?
     CQ2―4 先天性感染と診断した場合に,症候性かどうかを判断するための臨床検査は何か?
     CQ2―5 新生児聴覚スクリーニングでリファーであった場合の診断手順は?
     CQ2―6 出生後3週以降に保存検体等で診断するのは有用か?
    重要臨床課題3:治療
     CQ3―1 症候性先天性サイトメガロウイルス感染症にバルガンシクロビル内服は有効か?
     CQ3―2 バルガンシクロビル内服治療の対象となる症候は何か?
     CQ3―3 バルガンシクロビル内服治療の対象となる時期はいつか?
     CQ3―4 どのような症例にガンシクロビル静注が選択されるか?
     CQ3―5 バルガンシクロビル内服治療において,頻度の高い副作用は何か?
     CQ3―6 バルガンシクロビル内服治療において,治療効果の評価項目は何か?
     CQ3―7 バルガンシクロビル内服で治療効果が不十分な場合に抗ウイルス薬の変更は有用か?
    重要臨床課題4:フォローアップ
     CQ4―1 バルガンシクロビル内服治療例の長期フォローアップに必要な評価項目は何か?
     CQ4―2 耳鼻咽喉科的なフォローアップは有用か?
     CQ4―3 無症候性児の眼科的なフォローアップは有用か?
     CQ4―4 無症候性児の精神運動発達のフォローアップは有用か?
    資料:検索式

    Part II 解説・エキスパートオピニオン
    1.サイトメガロウイルス感染総論
    2.サイトメガロウイルス感染症の診断
     A.ウイルス学的診断
     B.先天性サイトメガロウイルス感染症におけるCMV量
     C.先天性サイトメガロウイルス感染症の頭部画像所見
    3.先天性サイトメガロウイルス感染症の治療
     A.治療総論
     B.治験の概要
     C.バルガンシクロビル治療の適正使用の手引き
       バルガンシクロビル治療に関するQ&A
    4.感染対策と生活指導
    5.発達フォローアップ
    6.耳鼻咽喉科診療の実際
    7.患者団体と患者家族支援

    資料:国立研究開発法人 日本医療研究開発機構(AMED)成育疾患克服等総合研究事業―BIRTHDAY
         サイトメガロウイルス,トキソプラズマ等の母子感染の予防と診療に関する研究班
         ホームページ掲載コンテンツ

この書籍の参考文献

参考文献のリンクは、リンク先の都合等により正しく表示されない場合がありますので、あらかじめご了承下さい。

本参考文献は電子書籍掲載内容を元にしております。

Part I 診療ガイドライン

P.9 掲載の参考文献
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P.18 掲載の参考文献
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P.20 掲載の参考文献
1) Soper DE : Congenital cytomegalovirus infection : an obstetrician's point of view. Clin Infect Dis 2013 ; 57 (Suppl 4) : S171-S173
2) Torii Y, et al. : Serological screening of immunoglobulin M and immunoglobulin G during pregnancy for predicting congenital cytomegalovirus infection. BMC Pregnancy Childbirth 2019 ; 19 : 205
3) Tanimura K, et al. : Prediction of Congenital Cytomegalovirus Infection in High-Risk Pregnant Women. Clin Infect Dis 2017 ; 64 : 159-165
4) Toriyabe K, et al. : Anti-cytomegalovirus immunoglobulin M titer for congenital infection in first-trimester pregnancy with primary infection : a multicenter prospective cohort study. J Perinatol 2017 ; 37 : 1272-1277
5) Sert Y, et al. : Antenatal Cytomegalovirus Infection Screening Results of 32,188 Patients in a Tertiary Referral Center : A Retrospective Cohort Study. Fetal Pediatr Pathol 2019 ; 38 : 112-120
6) Leruez-Vill M, et al. : Cytomegalovirus infection during pregnancy : state of the science. Am J Obstet Gynecol 2020 ; 223 : 330-349
7) Kouri V, et al. : Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns : 2007-2008. Pediatr Infect Dis J 2010 ; 29 : 1105-1110
8) Delforge ML, et al. : Presence of Cytomegalovirus in urine and blood of pregnant women with primary infection might be associated with fetal infection. J Clin Virol 2017 ; 90 : 14-17
9) Puhakka L, et al. : Primary versus non-primary maternal cytomegalovirus infection as a cause of symptomatic congenital infection-register-based study from Finland. Infect Dis (Lond) 2017 ; 49 : 445-453
10) Tanimura K, et al. : Universal screening with use of immunoglobulin G avidity for congenital cytomegalovirus infection. Clin Infect Dis 2017 ; 65 : 1652-1658
11) Maltezou PG, et al. : Maternal type of CMV infection and sequelae in infants with congenital CMV : Systematic review and meta-analysis. J Clin Virol 2020 ; 129 : 104518
12) Vauloup-Fellous C, et al. : Does hygiene counseling have an impact on the rate of CMV primary infection during pregnancy? Results of a 3-year prospective study in a French hospital. J Clin Virol 2009 ; 46 (Suppl 4) : S49-S53
13) Shahar-Nissan K, et al. : Valaciclovir to prevent vertical transmission of cytomegalovirus after maternal primary infection during pregnancy : a randomised, double-blind, placebo-controlled trial. Lancet 2020 ; 396 : 779-785
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P.22 掲載の参考文献
1) Hughes BL, et al. : Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol 2016 ; 214 : B5-B11
2) Leruez-Ville M, et al. : Cytomegalovirus infection during pregnancy : state of the science. Am J Obstet Gynecol 2020 ; 223 : 330-349
3) Imafuku H, et al. : Clinical and ultrasound features associated with congenital cytomegalovirus infection as potential predictors for targeted newborn screening in high-risk pregnancies. Sci Rep 2020 ; 10 : 19706
4) Buca D, et al. : Outcome of fetuses with congenital cytomegalovirus infection and normal ultrasound at diagnosis : systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021 ; 57 : 551-559
5) Faure-Bardon V, et al. : Refining the prognosis of fetuses infected with Cytomegalovirus in the first trimester of pregnancy by serial prenatal assessment : a single-centre retrospective study. BJOG 2020 ; 127 : 355-362
P.24 掲載の参考文献
1) Rawlinson WD, et al. : Congenital cytomegalovirus infection in pregnancy and the neonate : consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis 2017 ; 17 : e177-e188
2) Luck SE, et al. : Congenital Cytomegalovirus : A European Expert Consensus Statement on Diagnosis and Management. Pediatr Infect Dis J 2017 ; 36 : 1205-1213
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P.26 掲載の参考文献
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5) Maltezou PG, et al. : Maternal type of CMV infection and sequelae in infants with congenital CMV : Systematic review and meta-analysis. J Clin Virol 2020 ; 129 : 104518
6) Chiopris G, et al. : Congenital cytomegalovirus infection : update on diagnosis and treatment. Microorganisms 2020 ; 8 : 1516
7) Rawlinson WD, et al. : Congenital cytomegalovirus infection in pregnancy and the neonate : consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis 2017 ; 17 : e177-e188
8) Buca D, et al. : Outcome of fetuses with congenital cytomegalovirus infection and normal ultrasound at diagnosis : systematic review and meta-analysis. Ultrasound Obstet Gynecol 2021 ; 57 : 551-559
9) Hughes BL, et al. : A Trial of Hyperimmune Globulin to Prevent Congenital Cytomegalovirus Infection. N Engl J Med 2021 ; 385 : 436-444
10) Shahar-Nissan K, et al. : Valaciclovir to prevent vertical transmission of cytomegalovirus after maternal primary infection during pregnancy : a randomised, double-blind, placebo-controlled trial. Lancet 2020 ; 396 : 779-785
P.27 掲載の参考文献
1) Pereira L, et al. : Intrauterine growth restriction caused by underlying congenital cytomegalovirus infection. J Infect Dis 2014 ; 209 : 1573-1584
2) Ito Y, et al. : Risk factors for poor outcome in congenital cytomegalovirus infection and neonatal herpes on the basis of a nationwide survey in Japan. Pediatr Int 2013 ; 55 : 566-571
3) Denef M, et al. : First-line noninvasive management of cytomegalovirus primary infection in pregnancy. J Perinat Med 2021 ; 50 : 270-276
4) Imafuku H, et al. : Clinical and ultrasound features associated with congenital cytomegalovirus infection as potential predictors for targeted newborn screening in high-risk pregnancies. Sci Rep 2020 ; 10 : 19706
5) Messinger CJ, et al. : Association Between Congenital Cytomegalovirus and the Prevalence at Birth of Microcephaly in the United States. JAMA Pediatr 2020 ; 174 : 1159-1167
6) Minsart AF, et al. : Prenatal findings, neonatal symptoms and neurodevelopmental outcome of congenital cytomegalovirus infection in a university hospital in Montreal, Quebec. J Perinat Med 2020 ; 48 : 234-241
7) Tanimura K, et al. : Prediction of Congenital Cytomegalovirus Infection in High-Risk Pregnant Women. Clin Infect Dis 2017 ; 64 : 159-165
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11) Hadar E, et al. : Antenatal risk factors for symptomatic congenital CMV disease following primary maternal CMV infection. J Perinat Med 2016 ; 44 : 339-344
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P.30 掲載の参考文献
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P.32 掲載の参考文献
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P.35 掲載の参考文献
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3) Tagawa M, et al. : Retrospective diagnosis of congenital cytomegalovirus infection at a school for the deaf by using preserved dried umbilical cord. J Pediatr 2009 ; 155 : 749-751
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18) Corazzi V, et al. : Vestibular and postural impairment in congenital cytomegalovirus infection. Int J Pediatr Otorhinolaryngol 2022 ; 152 : 111005

Part II 解説・エキスパートオピニオン

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P.79 掲載の参考文献
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6) 日本医療研究開発機構 成育疾患克服等総合研究事業-BIRTHDAY サイトメガロウイルス, トキソプラズマ等の母子感染の予防と診療に関する研究班. http://cmvtoxo.umin.jp/
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3) Kimberlin DW, et al. : Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system : a randomized, controlled trial. J Pediatr 2003 ; 143 : 16-25
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P.90 掲載の参考文献
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3) Morioka I, et al. : Efficacy and safety of valganciclovir in patients with symptomatic congenital cytomegalovirus disease : Study Protocol Clinical Trial (SPIRIT Compliant). Medicine (Baltimore) 2020 ; 99 : e19765
4) Rawlinson WD, et al. : Congenital cytomegalovirus infection in pregnancy and the neonate : consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis 2017 ; 17 : e177-188
5) Luck SE, et al. : Congenital cytomegalovirus-a European expert consensus statement on diagnosis and management. Pediatr Infect Dis J 2017 ; 36 : 1205-1213
6) Morioka I, et al. : Oral valganciclovir therapy in infants aged <- 2 months with congenital cytomegalovirus disease : a multicenter, single-arm, open-label clinical trial in Japan. J Clin Med 2022 ; 11 : 3582
7) Kimberlin DW, et al. : Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system : a randomized, controlled trial. J Pediatr 2003 ; 143 : 16-25
8) Oliver SE, et al. : Neurodevelopmental outcomes following ganciclovir therapy in symptomatic congenital cytomegalovirus infections involving the central nervous system. J Clin Virol 2009 ; 46 (Suppl 4) : S22-S26
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