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Cytomegalovirus Infection - Causes, Symptoms and Treatment

What is Cytomegalovirus Infection?

Also called generalized salivary gland disease and cytomegalic inclusion disease, cytomegalovirus (CMV) infection is caused by the cytomegalovirus, a deoxyribonucleic acid, ether-sensitive virus belonging to the herpes family. The disease occurs worldwide and is transmitted by human contact.

About four out of five people over age 35 have been infected with cytomegalovirus, usually during childhood or early adulthood. In most of these people, the disease is so mild that it's overlooked. CMV infection during pregnancy can be hazardous to the fetus, possibly leading to stillbirth, brain damage, and other birth defects or to severe neonatal illness.

What are the Causes of Cytomegalovirus Infection?

Cytomegalovirus has been found in the saliva, urine, semen, breast milk, stool, blood, and vaginal and cervical secretions of infected persons. The virus is usually transmitted by contact with these infected secretions, which harbor the virus for months or even years.

The virus may be transmitted by sexual contact and can travel across the placenta, causing a congenital infection. Immunosuppressed patients, especially those who have received transplanted organs, run a 90% chance of contracting cytomegalovirus infection. Recipients of blood transfusions from donors with positive cytomegalovirus antibodies are at some risk.

Signs and Symptoms of Cytomegalovirus Infection

Cytomegalovirus probably spreads through the body in lymphocytes or mononuclear cells to the lungs, liver, gastro-intestinal tract, eyes, and central nervous system, where it often produces inflammatory reactions. Most patients with cytomegalovirus infection have mild, nonspecific complaint, or none at all, even though antibody titers indicate infection. In these patients, the disease usually runs a self-limiting course.

Immunodelicient patients, such as those with acquired immunodeficiency syndrome (AIDS), and those receiving immunosuppressants may develop pneumonia or other secondary infections. AIDS patients may also develop disseminated CMV infection, which may cause chorioretinitis (resulting in blindness), colitis, or encephalitis.

Infected infants ages 3 to 6 months usually appear asymptomatic but may develop hepatic dysfunction, hepatosplenomegaly, spider angiomas, pneumonitis, and lymphadenopathy.

Congenital cytomegalovirus infection is seldom apparent at birth, although the infant's urine contains cytomegalovirus. About 1% of all newhorns have cytomegalovirus.

The virus can cause brain damage that may not show up for months after birth. Occasionally, it produces a rapidly fatal neonatal illness characterized by jaundice, petechial rash, hepatosplenomegaly, thrombocytopenia, hemolytic anemia, microcephaly, psychomotor retardation, mental deficiency, and hearing loss.

In some adults, cytomegalovirus may cause cytomegalovirus mononucleosis, with 3 weeks or more of irregular, high fever.

Other findings may include a normal or elevated white blood cell (WBC) count, lymphocytosis, and increased atypical lymphocytes.

Diagnosis for Cytomegalovirus Infection

Although virus isolation in urine is the most sensitive laboratory method, a diagnosis can also rest on virus isolation from saliva, throat, cervix, WBC (white blood cells), and biopsy specimens.

other laboratory tests support the diagnosis, including complement fixation studies, hemagglutination inhibition antibody tests and, for congenital infections, indirect immunofluorescent tests for cytomegalovirus immunogiobulin antibody.

Treatment for Cytomegalovirus Infection

Because cytomegalovirus infection is usually selflimiting, treatment aims to relieve symptoms and prevent complications. In the immunosuppressed patient, however, cytomegalovirus infection is treated with ganciclovir and foscarnet, combined with anti-cytomegalovirus immune globulin for pneumonitis and possible GI diseasc. A new oral agent, famciclovir, has a limited role.

Special Considerations and Prevention Tips for Cytomegalovirus Infection

Provide parents of children with sevcre congenital cytomegalovirus infection with counseling to help them cope with the possibility of brain damage or death.

Observe standard prccautions when handling body secretions.

Warn irnmunosuppressed patients and pregnant women to avoid exposure to conlirmed or suspected cytomegalovirus infection. Tell pregnant patients that maternal cytomegalovirus infection can cause serious fetal abnormalities.

Urge patients with this infection - especially young children-to wash their hands thoroughly to prevent spreading it.

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