CMV can establish long-lasting latent infections. Most infections are asymptomatic, but some are mononucleosis-like illnesses. [Cecil, p. 2131] Reactivation syndromes develop if T lymphocyte-mediated immunity is compromised. [Harrison ID, p. 808]
About 10% infants infected in utero will develop the most severe form of this disease. Neonatal CMV infection damages the central nervous system; survivors have mental retardation and chronic liver disease. CMV infection in adults may be unapparent or cause a mononucleosis-like disease. CMV is transmitted by intimate mucosal exposure, by blood transfusion, and by soiled diapers of infants. Immunocompromised patients may develop disseminated disease (pneumonitis, retinitis, enteritis, and hepatitis). [CCDM, p. 141] Leukopenia occurs in infected transplant patients. In the normal host, infrequent to rare complications include leukopenia, Bell's palsy, Guillain-Barre syndrome, interstitial pneumonia, colitis, and encephalitis. The "deadly triad" after transplantation are hepatitis, leukopenia, and pneumonitis. [ID, p. 1545]
Approximately 60% to 90% of adults have antibodies from a previous infection. [Merck Manual, p. 1416] Most cases involve sexually active young adults. Laboratory abnormalities in CMV mononucleosis include atypical lymphocytosis and transaminitis. Hemolytic anemia, thrombocytopenia, and granulocytopenia are rare complications. [Harrison ID, p. 809] Splenomegaly is not a common feature of CMV mononucleosis. Patients with CMV mononucleosis are older (median age 29 years), and they may have fever for 9-35 days (mean of 19 days). Severe hepatitis with jaundice is rare in CMV mononucleosis. Most patients have elevated liver function tests and atypical lymphocytes. Pharyngitis and lymphadenopathy are less common in CMV mononucleosis than in EBV mononucleosis. [ID, p. 1545] Conjunctivitis is associated with a mononucleosis-like syndrome. [Guerrant, p. 994]
CMV IN AIDS PATIENTS:
CMV can cause a progressive weakness and flaccid paralysis in AIDS patients. CMV retinitis in AIDS patients leads to blindness within 4-6 months. Another syndrome in AIDS patients is colitis with explosive watery diarrhea. [PPID, p. 1743] CMV causes GI tract ulceration in AIDS patients. Dysphagia is the main finding of esophagitis. Colitis usually presents with abdominal pain, diarrhea, and weight loss. [Cohen, p. 393, 966] CMV is a common cause of retinitis and ulcerations of the GI tract in AIDS patients. [Merck Manual, p. 1416] CMV, as an opportunistic infection, can cause pneumonia with dyspnea, dry cough, and infiltrates on chest x-ray. [Cohen, p. 966] CMV infections usually resolve when the CD4 count exceeds 100/mm3. [Cecil, p. 2133]
For updated text and symptoms of infectious diseases, see iddx.com.
Viral culture; PCR; Antigen detection; IgM antibodies; Paired sera; [Harrison, p. 696] In clinical practice, antigen studies have been largely replaced by PCR assays. [ABX Guide]