Cytomegalovirus
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Contents |
Etiology
- Risk factors for infection:
- AIDS (especially in association with Pneumocystis carinii)
- organ transplantation
- lymphoreticular malignancy
- cardiopulmonary bypass
- multiple blood transfusions
Epidemiology
- most common congenital infection [5]
- 2nd most common infection in patients with AIDS
- most common infectious complication of organ transplantation
- can be transmitted by blood transfusions:
- CMV is transmitted by granulocytes
- may be introduced by transplantation of CMV- infected organ
- disease may occur as reactivation of latent CMV infection
Pathology
- retinitis (20-30% of patients with advanced AIDS)
- pneumonia
- gastrointestinal ulcerations
- encephalitis
- adrenalitis
- infectious mononucleosis-like syndrome
- putative receptor is beta-2 microglobulin/ MHC [3]
- cytomegalovirus glycoprotein UL16 binds to & causes sequestration of MICB in the endoplasmic reticulum
- endothelial cells infected with CMV secrete renin, angiotensin-2 & pro- inflammatory cytokines & develop intimal hyperplasia & atherosclerosis (mouse model) [4]
- hearing loss in early childhood with congenital infection [5]
Clinical-manifestations
- generally asymptomatic
- mononucleosis-like syndrome
- fever
- adenopathy
- fatigue
- symptomatic CMV in organ transplant patients
- fever, malaise, anorexia, epigastric distress
- dry cough with progressive dyspnea in 1/3
- diarrhea & GI bleeding may occur
- retinitis is uncommon in transplant patients
- encephalitis, fever, dementia, brainstem manifestations & myelitis with CNS disease
- CMV neuropathy
- polyradiculopathy
Laboratory
- serology for cytomegalovirus
- inclusion bodies
- culture:
- isolation from respiratory tract does not always establish infection
- up to 4 weeks for diagnosis
- useful for CMV viral load
- CSF viral load correlates with CNS disease
- not widely available (available at UCLA)
- direct antigen staining techiniques for CMV
- elevated liver function tests ( LFTs)
- HIV testing
- CD4 count < 50/ uL with ecephalitis [2]
- brain biopsy if encephalitis & diagnosis in question
Radiology
-
- diffuse small nodular or hazy infiltrates (15%)
- interstitial pneumonia in 50% of bone marrow transplants
Differential-diagnosis
Management
- ganciclovir ( IV)
- add IV immune globulin for CMV pneumonia after bone marrow transplantation
- foscarnet ( IV)
- infusion of T-lymphocyte clones with cytolytic activity against CMV- infected cells into bone marrow recipients
- CMV hyperimmune globulin within 1st 4 months of liver or renal may be of benefit
- reduction in immunosuppression (transplant patients)
- interferon-alpha plus hyperimmune globulin
More General Terms
Additional Terms
- cytomegalovirus (CMV) pneumonitis
- cytomegalovirus (CMV) retinitis
- indications for CMV seronegative blood products
- PCR/southern blot/in-situ hybridization for cytomegalovirus (CMV)
References
- Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 515-16, 794
- Medical Knowledge Self Assessment Program (MKSAP) 11, 14, American College of Physicians, Philadelphia 1998, 2006
- Harrison's Principles of Internal Medicine, 13th ed. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1994, pg 769
- Cheng J et al Cytomegalovirus infection causes an increase of arterial blood pressure. PLoS Pathog 2009 May; 5:e1000427. PMID: [1]
- Boppana SB et al. Saliva polymerase-chain-reaction assay for cytomegalovirus screening in newborns. N Engl J Med 2011 Jun 2; 364:2111 PMID: [2]
- NINDS Cytomegalic Inclusion Body Disease (CIBD) Information [3]
