What is Cytomegalovirus Infection?
Cytomegalovirus infection, caused by the virus of the same name that is a genus of Herpes viruses known as human herpesvirus 5 (HHV-5). CMV especially attacks salivary glands. For most healthy individuals who acquire CMV after birth there are few symptoms. In more severe cases, persons experience a syndrome similar to infectious mononucleosis, with prolonged fever, a mild hepatitis and a very sore throat. CMV infection can also be life threatening for patients who are immunocompromised (e.g. patients with HIV, organ transplant recipients, or neonates).
How does it occur?
In humans, CMV is found throughout all geographic locations and socioeconomic groups, and infects between 50% and 80% of adults in the United States as indicated by the presence of antibodies in much of the general population. CMV is also the virus most frequently transmitted to a developing child before birth.
Transmission of CMV occurs from person to person. 58.9% of individuals aged 6 and over are infected with CMV; this number rises to 90.8% of individuals aged 80 and over.
Infection requires close, intimate contact with a person excreting the virus in their saliva, urine, or other bodily fluids. CMV can be sexually transmitted and can also be transmitted via breast milk, transplanted organs, and rarely from blood transfusions.
Although the virus is not highly contagious, it has been shown to spread in households and among young children in day care centers. Transmission of the virus 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. Therefore, care should be taken when handling children and items like diapers. Simple hand washing with soap and water is effective in removing the virus from the hands.
What are the symptoms?
For most healthy individuals there are few symptoms. In more severe cases, a syndrome similar to infectious mononucleosis occurs with prolonged fever, a mild hepatitis and sore throat.
Once a person becomes infected, the virus latently persists in the body for the person's life and can exhaust the immune system at old age, increasing risk of mortality from other diseases. Recurrent disease rarely occurs unless the person's immune system is suppressed due to therapeutic drugs or disease. Initial CMV infection, which may have few symptoms, is always followed by a prolonged, unapparent infection during which the virus resides in cells without causing detectable damage or clinical illness. Severe impairment of the body's immune system by medication or disease (see below) may reactivate the virus from the latent or dormant state.
CMV infection is important to certain high-risk groups. Major areas of risk of infection include pre-natal or post-partum infants and immunocompromised individuals, such as organ transplant recipients, persons with leukemia, or those infected with human immunodeficiency virus (HIV). CMV is considered an AIDS-defining infection, indicating that the T-cell count has dropped to low levels.
How is it diagnosed?
Most infections with CMV are not diagnosed because the virus usually produces few, if any, symptoms and tends to reactivate intermittently without symptoms. However, persons who have been infected with CMV develop antibodies to the virus, and these antibodies persist in the body for the lifetime of that individual. A number of laboratory tests that detect these antibodies to CMV have been developed to determine if infection has occurred and are widely available from commercial laboratories. Both qualitative and quantitative polymerase chain reaction (PCR) testing for CMV are available as well, allowing physicians to monitor the viral load of CMV-infected patients.
CMV should be suspected if a patient has symptoms of infectious mononucleosis but has negative test results for mononucleosis and Epstein-Barr virus, or if they show signs of hepatitis, but has negative test results for hepatitis A, B, and C.
For best diagnostic results, laboratory tests for CMV antibody should be performed by using paired serum samples. One blood sample should be taken upon suspicion of CMV, and another one taken within 2 weeks. Laboratory testing for antibody to CMV can be performed to determine if a woman has already had CMV infection.
How is it treated?
No treatment is generally necessary for CMV infection in the healthy individual since the majority of infections resolve on their own. Antiviral drug therapy is now being evaluated in infants.
Ganciclovir treatment is used for patients with depressed immunity who have either sight-related or life-threatening illnesses. Valganciclovir (marketed as Valcyte) is an antiviral drug that is also effective and is given orally. Foscarnet or cidofovir can be given in patients with CMV resistant to ganciclovir, though foscarnet is not as well tolerated as ganciclovir.
Vaccines are still in the research and development stage.