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Cytomegalovirus

Cytomegalovirus infection as with other herpes viruses is life-long. After primary infection it replicates at low levels throughout life. Only when immunity is suppressed, does the rate of replication increase and reactivation occurs. Infection is transmitted by blood transfusion, from the mother to the fetus or by infected organs transplanted from seropositive donors. It occurs in over 90% of AIDS patients.

Symptoms

In healthy individuals infection is usually asymptomatic but in some cases it may cause an illness similar to infectious mononucleosis with glandular fever (fever and lymph gland enlargement) & atypical lymphocytes in the blood picture.

In immunocompromised patients, it produces widespread visceral involvement with fever, interstitial pneumonitis (diagnosed by transbronchial biopsy), hepatitis, hemorrhage, gastroenteritis, choroidoretinitis (inflammation of the eye).

Intraunterine infection results in microcephaly (small head), motor disorders (e.g paralysis), jaundice, hepatosplenomegaly (enlargement of the liver and spleen), thrombocytopenia (low platelet counts) and hemolytic anemia (anemia as a result of breaking down of red blood cells).

Diagnosis

Serological diagnosis: IgM antibodies denote current infection while IgG antibodies denote past infections. The virus can be identified in tissues by the presence of the characteristic intranuclear (owl's eye) inclusions and by direct immunofluorescence. It can also be cultured in the human embryo fibroblasts with immunofluorescent detection of antigens in the culture.

Treatment

In immunocompetent individuals, no specific therapy is indicated and infection is self limited.

Gancyclovir is the treatment of choice in immunocompromised individuals. 

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