Related Subjects:
|Herpes Varicella-Zoster (Shingles) Infection
|Chickenpox Varicella Infection
|Varicella Cerebral Vasculopathy
|Herpes Viruses
|Herpes Zoster Ophthalmicus (HZO) Shingles
|MonkeyPox
|Mumps
|Measles
|Rubella (German Measles)
|Epstein-Barr Virus infection
|Cytomegalovirus (CMV) infections
|CMV retinitis infections
|Toxoplasmosis
Cytomegalovirus shares a similar clinical picture with EBV and toxoplasmosis. In most cases asymptomatic.
About
- Common virus and over 50% of adults have evidence of infection
- It is important in the immunocompromised and the pregnant
- Infection peaks around the age of 30
Aetiology
- Herpesviridae and so is a double-stranded DNA virus
- CMV found in - saliva, urine, semen, genital secretions
Clinical
- Most often asymptomatic. Some get an Infectious Mononucleosis like illness
- Malaise, Headache, Pharyngitis, Cervical lymphadenopathy
- Guillain-Barré syndrome, Meningoencephalitis
- Pericarditis and myocarditis
- Thrombocytopenia and autoimmune haemolytic anaemia
- Maculopapular rash, Ampicillin induced rash
- Hepatomegaly, Jaundice and mild hepatitis
- CMV in the Immunocompromised (CD4 < 50 cells/mm3)
- Pneumonitis, Hepatitis, Encephalitis, Radiculitis
- Pancreatitis and Diabetes, Adrenalitis
- Oesophagitis, Colitis - bloody diarrhoea and abdominal pain
- Monitor response with CMV DNA with polymerase chain reaction (PCR)
- Pregnancy
- 1 in 800 develops complications
- Jaundice, Hepatosplenomegaly, Thrombocytopenia
- Intrauterine growth retardation
- Microcephaly, and chorioretinitis
- Cerebral calcification, Deafness
Investigations
- Atypical lymphocytosis may be seen
- Monospot/Paul Bunnell negative (positive with EBV)
- Tissues show enlarged cells with inclusions with an "owl's eye" appearance.
- CMV IgM antibodies may be found as early as 1-2 months
- CMV DNA can be detected with polymerase chain reaction (PCR)
- Autoimmune Haemolytic anaemia
- ↑Cortisol with adrenalitis
- ↑Glucose - Diabetes
- ↑Amylase with pancreatitis
- ↑ AST/ALT and ↑ ALP with usually a mild hepatitis
Management
- Treatment of severe CMV infection is with IV Ganciclovir or Foscarnet for those with resistance
- Ganciclovir 5 mg/kg iv 12 hourly . Similar to Aciclovir and effective against HSV and VZV. Phosphorylation by CMV kinase makes it active against CMV
- Like Aciclovir a prodrug Valganciclovir 900 mg bd for 14 days is available orally
- Side effects are neutropenia, thrombocytopenia and male infertility
- Used for life-threatening or sight-threatening CMV infections