Cytomegalovirus Infection

Causes

Cytomegalovirus is a member of the herpesvirus family. Other members of the herpesvirus family cause chickenpox, infectious mononucleosis, fever blisters, and genital herpes. These viruses all share the ability to remain alive, but dormant, in the body for life.

A first infection with CMV usually causes no symptoms. The virus continues to live in the body silently without causing obvious damage or illness. It rarely becomes active for the first time or reactivates unless the immune system weakens and is no longer able to hold the virus in check.

Symptoms and Signs

A healthy person who is infected may feel ill and have a fever. CMV infection in adolescents and young adults can produce an illness with symptoms of fever and fatigue that resembles infectious mononucleosis. If a person receives a transfusion of blood containing CMV, fever and sometimes liver inflammation may develop 2 to 4 weeks later.

A person with a weakened immune system who becomes infected with CMV is particularly likely to develop a severe infection; serious illness and death may result. In people with AIDS, CMV infection is the most common viral complication. The virus tends to infect the retina of the eye (CMV retinitis), which can cause blindness. Infection of the brain (encephalitis) or ulcers of the intestine or esophagus may also develop.

In a pregnant woman, CMV infection can cause miscarriage, stillbirth, or death of the newborn.

Death is caused by

• Bleeding
• Anemia or extensive damage to the liver or brain.
• Hearing loss
• Mental retardation.

Diagnostic tests

Isolating the virus or demonstrating increasing serologic titers allows diagnosis of CMV. Complement fixation studies, hemagglutination inhibition antibody tests and, in congenital infections, indirect immunofluorescent tests for CMV immunoglobulin M antibody may be performed. Chest X-ray typically shows bilateral, diffuse, white infiltrates.

Treatment

Although antiviral therapy for herpesviruses has had encouraging results, CMV is more difficult to prevent and treat than other herpesviruses. Ganciclovir and, less frequently, high-dose acyclovir prove helpful for certain patients, although relapse may occur. Immunoglobulin specific to CMV has been helpful in transplant recipients. The second line of therapy is foscarnet.

Prevention

Transmission of Cytomegalovirus is often preventable because it is most often transmitted through infected bodily fluids that come in contact with hands and then are absorbed through the nose or mouth of a susceptible person. People who interact with children should use safe hygiene practices including good hand washing and wearing gloves when changing diapers. Hand washing with soap and water is effective in preventing the spread of CMV.

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