Cytomegalovirus Inclusion Disease
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Cytomegalovirus (CMV) is a ubiquitous virus that commonly infects people across all ages, ethnic and socioeconomic groups, and geographic areas.
- Although most CMV infections are asymptomatic or cause mild disease, the virus can cause serious disease in neonates and immunocompromised people.
- Because of its ubiquity, it is often difficult to define the role of CMV in a disease process.
- CMV is a DNA virus in the Herpesvirus family. It is a member of the β-herpesvirus subfamily, which also includes HHV-6 and -7.
- Primary infection: Often asymptomatic; may remain latent throughout a person’s life if not immunocompromised
- Severe disease can result from primary infection of the fetus and newborn or reactivation in setting of immunocompromise or organ transplantation.
- Name derives from the infected cells, which are large and contain intranuclear inclusions, described as “owl’s eye” inclusions
- Not highly contagious:
- Spread via close contact with persons shedding virus from saliva, urine, blood, breast milk, or semen
- Also acquired via infected transplant organs
- Any organ can be affected.
- Categories of CMV infections:
- Acute infection in a normal host
- Latent infection
- Infection in bone marrow and solid organ transplant patients:
- Heart, lung, bone marrow, liver, and kidney transplants
- Infection in patients with AIDS
- Infections in other immunocompromised patients
- System(s) affected: Ophthalmic; Pulmonary; GI; Neurologic; Renal; Skin/Exocrine
- Synonym(s): Giant cell inclusion disease; CID CMV
- CMV infection in pregnancy may cause illness in the newborn ranging from asymptomatic infection to severe disease or even death.
- Infection may occur in utero, intrapartum, or postnatally.
- Pre-existing maternal CMV seropositivity substantially decreases, but does not completely eliminate fetal infection.
Breastfeeding can transmit virus to high-risk preterm infants. However, there is low risk of symptomatic disease and no evidence of long-term sequelae from transmission from breastfeeding. Currently, there are no recommendations for avoidance or treated breast milk (1).
- Common, but frequently asymptomatic
- <2–3 cases of end-organ disease per 100 person-years in HIV patients
- CMV infection is even more prevalent in populations at higher risk for HIV infection (IV drug users, 75%; homosexual males, 90%).
- Predominant age: All ages, peaks at <3 months, 16–40 years, and 40–75 years
- Predominant sex: Male > Female
- HIV infection with specific risks, including:
- Organ transplantation
- Blood transfusion
- Living in closed population
- Corticosteroid therapy
- Daycare environment, infant, or geriatric
- For congenital infection, maternal infection during pregnancy
- Low socioeconomic status (1)[C]
- Critically ill immunocompetent adults in ICU settings (up to 1/3 develop CMV, primarily between days 4 and 12 after admission) (4)[A]
- Inflammatory bowel disease (5)[A]
- Hand washing/basic hygiene
- Avoid immunosuppression.
- Highly active antiretroviral therapy (HAART) is the best method for high-risk HIV patients (2)[A].
- Chronic maintenance therapy for life in HIV patients with CMV end-organ disease unless successfully treated with ART (6)[A]
- Options include:
- CMV antibody+, HIV+ children who are severely immunosuppressed require PO ganciclovir 30 mg/kg t.i.d.
- Antiviral suppression of CMV reactivation in CMV+ transplant recipients or recipients of CMV+ organs:
- CMV immunoglobulins decrease rate of severe disease after liver transplant (8)[A] and decrease incidence of disease after renal transplant.
- Primary infection
- Reinfection with different CMV strains
- Reactivation of latent virus in patients who are immunosuppressed
Commonly Associated Conditions
AIDS, corticosteroid therapy, transplantation, or immunosuppression