Cytomegalovirus Infections

Introduction

-CMV is a double-stranded DNA herpes virus 

-It is present in urine, saliva, semen, and cervical secretions.

-It’s transmission occurs through person-to-person,mother-to-fetus/infant, sexual contact, breastfeeding, blood products, transplantation routes 

-CMV is the most common viral pathogen complicating organ transplantation

Symptoms & Signs 

-Most CMV infections are asymptomatic

-Acute acquired CMV infection is similar to infectious mononucleosis, though exudative pharyngitis or cervical lymphadenopathies are uncommon

-There are three recognizable clinical syndromes: 

(1) Perinatal disease: Congenital infection is a leading cause of deafness; It is characterized by microcephaly, periventricular CNS calcifications, mental retardation, motor disability, thrombocytopenia, hepatitis. 

(2) diseases in immunocompetent persons : CMV causes mononucleosis-like syndrome with negative heterophile antibodies; It is characterized by fever, malaise, arthralgias, myalgias, splenomegaly; Cutaneous rashes (including the typical maculopapular rash after exposure to ampicillin) 

(3) diseases in immunocompromised persons: CMV causes serious illnesses such as CMV retinitis, esophagitis, pneumonitis, encephalitis, transverse myelitis 

Diagnosis 

Prenatal diagnosis: Amniotic fluid PCR

Postnatal diagnosis: 

Serologic testing by PCR 

Tissue biopsy: Cytomegalovirus-infected cells showing “owl’s eye” appearance of intranuclear inclusions and intracytoplasmic inclusions 

Treatment 

Immunocompetent: supportive treatment; no antivirals necessary 

Immunosuppressed: Ganciclovir, Valganciclovir,Foscarnet,Cidofovir 

HIV patients: CMV is a common cause of serious opportunistic diseases in HIV patients; ART is indicated Prevention: strict personal hygiene