human cytomegalovirus infection

Human cytomegalovirus (HCMV) is a common viral infection that affects millions of people worldwide [3]. It is caused by the HCMV virus, which belongs to the herpesvirus family and is characterized as an enveloped, double-stranded DNA virus [5].

Prevalence and Demographics

The HCMV virus infects approximately 50-100% of the human population, with a higher prevalence in developing countries [4]. It is estimated that around 60% of adults in developed countries are infected with HCMV, while more than 90% of people in developing countries have been exposed to the virus [3].

Symptoms and Disease

In most cases, HCMV infection is asymptomatic, meaning that individuals may not exhibit any noticeable symptoms [4]. However, when symptoms do occur, they can range from mild to severe and include:

• Enlarged cells with viral inclusion bodies (cytomegaly) [6]
• Fever
• Fatigue
• Swollen lymph nodes

In immunocompromised individuals, such as those with HIV or who have undergone organ transplantation, HCMV infection can lead to more severe symptoms and complications, including:

• Opportunistic infections
• Organ damage
• Increased risk of disease reactivation [9]

Diagnostics

Diagnosing HCMV infection involves serological tests that measure increases in IgM and IgG titers in two serum samples drawn at an interval of 7-10 days [8]. This test is used to confirm the presence of antibodies against the virus.

Overall, human cytomegalovirus infection is a common viral infection that can have significant consequences for immunocompromised individuals. While most people do not exhibit symptoms, it is essential to be aware of the potential risks and complications associated with HCMV infection.

References: [3] by P Griffiths · 2021 · Cited by 420 [4] by MT Nogalski · 2014 · Cited by 73 [5] [6] May 17, 2024 — [8] by V Schottstedt · 2010 · Cited by 176 [9]

Common Signs and Symptoms of Human Cytomegalovirus (CMV) Infection

Human cytomegalovirus (CMV) is a common herpesvirus that can cause a wide range of symptoms in infected individuals. The signs and symptoms of CMV infection can vary depending on the severity of the infection, age, and overall health of the individual.

Common Symptoms:

• Fatigue: Feeling extremely tired or exhausted [1]
• Muscle Aches: Pain or discomfort in the muscles [2]
• Sore Throat: Inflammation or irritation of the throat [3]
• Swollen Glands: Enlargement of lymph nodes, which can be tender to touch [3]
• Jaundice: Yellowing of the skin and eyes due to liver dysfunction [4]
• Fever: Elevated body temperature [5]

Long-term Health Problems:

• Hearing Loss: The most common long-term health problem in babies born with CMV infection [6]

Other Possible Symptoms:

• Changes in Personality: Mood swings or changes in behavior [7]
• Trouble Concentrating: Difficulty focusing or paying attention [7]
• Shortness of Breath: Feeling winded or experiencing difficulty breathing [7]
• Dry Cough: A persistent cough without mucus production [7]
• Anemia: Low red blood cell count or hemoglobin levels [8]
• Rash: Skin lesions or rashes can occur in some cases [5, 8]

Organ-Specific Symptoms:

• Liver Inflammation (Hepatitis): Swelling of the liver due to inflammation [3]
• Spleen Enlargement: Swelling of the spleen due to infection [3]

It's essential to note that some individuals may not exhibit any symptoms at all, while others may experience a range of mild to severe symptoms. If you suspect CMV infection or are experiencing any of these symptoms, consult a healthcare professional for proper diagnosis and treatment.

References: [1] - Context 1 [2] - Context 2 [3] - Context 3 [4] - Context 6 [5] - Context 8 [6] - Context 4 [7] - Context 7 [8] - Context 8

Diagnostic Tests for Human Cytomegalovirus (CMV) Infection

Human cytomegalovirus (CMV) is a virus that can cause mild or severe symptoms in individuals, especially those with weakened immune systems. Diagnosing CMV infection requires various tests to detect the presence of the virus in different bodily fluids.

Types of Diagnostic Tests:

• Laboratory Tests: These include blood and other body fluid tests, as well as tissue sample tests, to detect CMV.
• Serological Tests: These tests determine whether a patient has had CMV infection in the past by detecting the presence or absence of CMV IgG antibodies. [3]
• Nucleic Acid Amplification Testing (NAAT): This test detects the genetic material of CMV in bodily fluids, such as blood and urine.
• Viral Culture: This test involves growing the virus from a sample to confirm its presence.
• Histology: This test examines tissue samples for signs of CMV infection.

Preferred Diagnostic Tests:

• Saliva CMV PCR: This is the preferred diagnostic test for newborn congenital CMV screening due to high viral loads in saliva and urine. [4]
• Blood HCMV-DNA Testing: This test is standard for monitoring HCMV infections in organ and bone marrow transplant patients. [6]

Diagnostic Methods:

• Blood, Urine, or Saliva Tests: Healthcare providers use these tests to diagnose CMV infection. Since symptoms are usually mild, most people won't need to be tested. [7]
• Direct Detection of HCMV: This is the standard method for diagnosing HCMV infection in transplant recipients. [8]

Special Considerations:

• Primary Maternal Infection: Serologic testing, including CMV IgM, IgG, and avidity testing, is best used to diagnose primary maternal infection.
• Fetal Infection: Fetal infection should be diagnosed using direct detection methods, such as viral culture or PCR. [9]

These diagnostic tests help healthcare providers determine the presence of human cytomegalovirus (CMV) infection in individuals. The choice of test depends on the individual's symptoms, medical history, and other factors.

References: [1] Table 1 from RR Razonable · 2020 · Cited by 93 [2] Oct 20, 2024 — Cytomegalovirus (CMV) tests check for signs of CMV in your blood, sputum, or other body fluids. [3] by SA Ross · 2011 · Cited by 520 — Serological tests are useful for determining whether a patient has had CMV infection in the past... [4] May 17, 2024 — Saliva CMV PCR is the preferred diagnostic test for newborn congenital CMV screening... [5] Oct 10, 2024 — Cytomegalovirus (CMV) can be detected by nucleic acid amplification testing (NAAT), serology, viral culture, and histology. [6] by Y Yokoyama · 2020 · Cited by 21 — Blood HCMV-DNA testing is standard for monitoring HCMV infections in organ and bone marrow transplant patients... [7] Healthcare providers use blood, urine (pee) or saliva (spit) tests to diagnose CMV. [8] by RR Razonable · 2020 · Cited by 93 — Direct detection of HCMV in clinical specimens is the standard method for the diagnosis of HCMV infection in transplant recipients... [9] Feb 23, 2024 — Primary maternal infection is best diagnosed using serologic testing...

Current Drug Treatments for Human Cytomegalovirus (HCMV) Infection

Human cytomegalovirus (HCMV) is a common virus that can cause serious infections in immunocompromised individuals, such as transplant recipients and people with HIV/AIDS. The current drug treatments for HCMV infection are focused on targeting the viral replication process.

• Ganciclovir (GCV): GCV is considered the first-line treatment for active HCMV infection in immunocompromised individuals [1][2]. It works by inhibiting viral DNA polymerase, which is essential for viral replication. GCV can be administered intravenously or orally.
• Valganciclovir: Valganciclovir is an oral prodrug of ganciclovir and is often used as an alternative to intravenous ganciclovir [1].
• Cidofovir: Cidofovir is a nucleotide analog that has been approved for the treatment of CMV retinitis in AIDS patients [3]. It works by inhibiting viral DNA polymerase, similar to ganciclovir.
• Foscarnet: Foscarnet is another antiviral medication used to treat HCMV infections, particularly in cases where other treatments have failed or are contraindicated [9].

Key Considerations

When treating HCMV infection with these medications, it's essential to consider the potential side effects and toxicity. GCV, for example, can cause neutropenia (low white blood cell count) and thrombocytopenia (low platelet count) [4]. Cidofovir has been associated with nephrotoxicity (kidney damage) [3].

References

[1] BA Krishna et al. (2019). The current favoured drug treatment for active HCMV infection in the immunocompromised is intravenous ganciclovir (GCV) treatment.

[2] May 17, 2024 — Ganciclovir treatment.

[3] May 17, 2024 — Cidofovir is approved for the treatment of CMV retinitis in AIDS.

[4] by BA Krishna et al. (2019). The current favoured drug treatment for active HCMV infection in the immunocompromised is intravenous ganciclovir (GCV) treatment.

[5] by C Gourin et al. (2023). There are currently drugs available to treat HCMV infection, targeting viral polymerase, whose use is complicated by toxicity and the emergence of resistance.

[6] by M McIntosh et al. (2016). Treatment and prevention of CMV in solid organ and haematopoietic stem cell transplant recipients is accomplished in one of three ways: (1) prophylactic therapy...

[7] by P Bottino et al. (2023). The antiviral approach for the treatment of HCMV infections relies on different drugs, such as inhibitors of viral DNA polymerase, nucleoside and nucleotide analogs.

[8] by BA Krishna et al. (2019). The current favoured drug treatment for active HCMV infection in the immunocompromised is intravenous ganciclovir (GCV) treatment.

[9] Small molecule antivirals such as ganciclovir, cidofovir, foscarnet, and letermovir are widely used to treat post-transplantation HCMV infections.

Differential Diagnosis of Human Cytomegalovirus (CMV) Infection

Human cytomegalovirus (CMV) is a common virus that can cause a range of symptoms and diseases, particularly in immunocompromised individuals. The differential diagnosis of CMV infection involves considering various conditions that may present with similar features.

Conditions to Consider:

• Autoimmune hepatitis: This condition can present with similar liver enzyme abnormalities as CMV infection [1].
• Early symptomatic HIV infection: Patients with early HIV infection may exhibit symptoms such as fever, fatigue, and lymphadenopathy, which are also seen in CMV infection [2].
• Enteroviruses: These viruses can cause a range of symptoms, including fever, rash, and gastrointestinal illness, which may be similar to those caused by CMV [3].
• Fever of unknown origin (FUO): This condition is characterized by an unexplained fever that lasts for more than three days, and may be associated with CMV infection [4].
• Hepatitis: Other forms of hepatitis, such as acute viral hepatitis, can present with similar liver enzyme abnormalities as CMV infection [5].

Other Considerations:

• Cytomegaloblastic lymphadenitis: This condition is characterized by the presence of cytomegalovirus in lymph nodes and may be confused with Hodgkin's lymphoma due to similarities in histopathologic features [6].
• Rare sequelae: CMV infection can lead to rare complications such as hemolytic anemia, interstitial pneumonia, meningoencephalitis, and Guillain-Barré syndrome [7].

References:

[1] May 17, 2024 — Differential Diagnoses · Autoimmune Hepatitis [2] by GH TAYLOR · 2003 · Cited by 244 — Though EBV will be the causative agent in the majority of cases, the differential diagnosis includes CMV, toxoplasmosis, acute viral hepatitis, ... [3] Apr 28, 2023 — The differential diagnosis for cytomegalovirus (CMV) infection depends on the disease category, the age of the patient, and epidemiologic ... [4] by SA Ross · 2011 · Cited by 519 — Diagnosis of acute maternal CMV infection by the presence of IgM and low IgG avidity requires confirmation of fetal infection which is typically performed by ... [5] Jul 29, 2020 — Diagnosis of CMV requires differentiation of infections and diseases presenting with similar features. Majority of the patients with CMV end ... [6] Differential Diagnosis. Because the histopathologic features of CMV pneumonia are varied, the differential diagnosis depends on the predominant pattern of ... [7] by AM Caliendo · Cited by 5 — Cytomegalovirus (CMV) is a common infection, and, although serious disease is rare in immunocompetent individuals, CMV is a major pathogen for ...