obsolete Cytomegalovirus infectious disease

Cytomegalovirus (CMV) Infections: A Review of Signs and Symptoms

Cytomegalovirus (CMV) is a common virus that can cause a range of symptoms in people with weakened immune systems. While it's not typically considered an "obsolete" disease, its presentation has been well-documented in medical literature.

Common Symptoms in Healthy Individuals

• Mild flu-like symptoms [11]
• Fever
• Sore throat
• Fatigue
• Swollen glands

In some cases, CMV can cause more severe symptoms, such as:

• Mononucleosis or hepatitis (liver problems) [11]

Symptoms in People with Weakened Immune Systems

• Fever and fatigue [2]
• More severe flu-like symptoms
• Organ-specific involvement, such as:
  • Hepatomegaly (enlarged liver) [3]
  • Splenomegaly (enlarged spleen) [3]
  • Microcephaly (small head size) [3]
  • Jaundice and petechiae (rash-like symptoms) [3]

Congenital CMV Infection

• Infants may present with:
  • Intrauterine growth retardation
  • Neonatal jaundice
  • Purpura (bleeding under the skin)
  • Hepatosplenomegaly (enlarged liver and spleen) [8]
  • Microcephaly and brain damage [8]

Rare but Serious Complications

• Hemolytic anemia and thrombocytopenia (low red blood cell count and platelet count) [9]
• Neurological symptoms, such as:
  • Loss of bowel and bladder control
  • Flaccid paraplegia (paralysis of the lower limbs) [6]

Transmission and Reactivation

CMV is spread through body fluids, including blood, urine, saliva, breast milk, tears, semen, and vaginal secretions. The virus can remain dormant for long periods, only to reactivate when the immune system is compromised.

References:

[1] - CMV infection may cause hemolytic anemia and thrombocytopenia. A hematologist may be consulted in severe cases. Neurologist. CMV may cause neurological symptoms, such as loss of bowel and bladder control and flaccid paraplegia. [9]

[2] - CMV infections don't usually cause any symptoms in people with healthy immune systems. People with a weakened immune system often get a fever and can become more severely ill. [2]

[3] - Patients with generalized congenital CMV infection most commonly present with hepatomegaly, splenomegaly, microcephaly, jaundice, and petechiae. [3]

[6] - Clinical Features: Although most people with primary CMV infection are asymptomatic or have mild symptoms, some may experience a mononucleosis-like condition with prolonged fever and hepatitis. After initial infection with CMV, the virus establishes lifelong latency and may occasionally reactivate. Disease from reactivation of CMV infection rarely occurs unless the person's immune system is compromised. [13]

[8] - Most newborns with congenital CMV infection have no signs of illness at birth and remain well. However, they are at risk of hearing loss and developmental challenges in infancy and childhood. [15]

[9] - Most newborns with congenital CMV infection have no signs of illness at birth and remain well. However, they are at risk of hearing loss and developmental challenges in infancy and childhood. CMV infection can also cause serious illness in people with immune compromise. Here are ways to protect against the virus and what else parents need to know. [15]

[11] - Symptoms of CMV vary depending on whether the person who’s infected has a healthy or compromised immune system. Whether the infection is present at birth (congenital) or happens later. CMV symptoms with a healthy immune system. Most people who have a healthy immune system don’t get sick from CMV, but some may experience mild illness like: Fever. Sore throat. Fatigue. Swollen glands. Occasionally, CMV can cause mononucleosis or hepatitis (liver problems). [12]

[13] - Clinical Features. Although most people with primary CMV infection are asymptomatic or have mild symptoms, 3 17 some may experience a mononucleosis-like condition with prolonged fever and hepatitis. After initial infection with CMV, the virus establishes lifelong latency and may occasionally reactivate. Disease from reactivation of CMV infection rarely occurs unless the person's immune system is compromised. [13]

[14] - CMV disease: CMV infection with associated non-specific signs and symptoms and/or end-organ involvement. Pathophysiology. Once CMV is transmitted, and the primary infection clears, the virus remains dormant in myeloid cells. Vital replication and reactivation are contained primarily by cytotoxic T-cell immunity. However, when reactivation occurs, it can lead to serious complications. [14]

Based on the provided context, it appears that there are several diagnostic tests for Cytomegalovirus (CMV) infections that have been considered obsolete or less commonly used in recent years.

• Serology: While serology can be used to measure CMV IgG antibodies, it is not a reliable method for diagnosing primary infection, as it may indicate past exposure rather than active disease [14].
• Amplicor and antigenemia tests: These tests were effective in diagnosing CMV infection, monitoring response to therapy, and detecting viral shedding, but they have largely been replaced by more sensitive and specific methods such as quantitative nucleic acid testing (QNAT) and PCR [3].
• Histology and culture: While esophagogastroduodenoscopy or colonoscopy coupled with biopsies can be used to diagnose GI CMV disease, this approach is generally less commonly used due to its invasive nature and the availability of more sensitive diagnostic tests [9].

In contrast, more modern and widely used diagnostic tests for CMV infections include:

• Quantitative nucleic acid amplification testing (QNAT): This test is a rapid and sensitive method for diagnosing CMV infection and monitoring viral loads in transplant recipients [1].
• PCR: Real-time PCR is the most commonly used virological test for detecting CMV DNA, particularly in amniotic fluid/cord blood, which is diagnostic of fetal CMV infection [7].
• CMV PCR on amniotic fluid (AF): This test is considered the gold standard for diagnosing fetal CMV infection and is recommended by most guidelines [8].

Overall, while there are still some obsolete or less commonly used diagnostic tests for CMV infections, more modern and sensitive methods have largely replaced them in clinical practice.

Treatment Options for Obsolete Cytomegalovirus Infections

Cytomegalovirus (CMV) infections were once a significant concern, particularly in immunocompromised patients. While the disease is still present today, advances in antiviral therapy have made treatment more effective and accessible.

Traditional Antiviral Drugs

Historically, four antiviral drugs were used to prevent or treat CMV infections: ganciclovir, valganciclovir, foscarnet, and cidofovir. These medications were often used in combination with other treatments to manage the disease (3).

• Ganciclovir: An antiviral medication that was commonly used to treat CMV infections, particularly in immunocompromised patients.
• Valganciclovir: The oral prodrug of ganciclovir, which was often used as a first-line treatment for CMV infections (4).
• Foscarnet: An antiviral medication that was used to treat CMV infections, particularly in cases where ganciclovir-related toxicity was a concern (9).
• Cidofovir: An antiviral medication that was used to treat CMV infections, particularly in patients with compromised immune systems.

Newer Antiviral Agents

In recent years, newer antiviral agents have been developed to target CMV infections. These include:

• Letermovir: A novel antiviral drug that inhibits the CMV-terminase complex (7).
• Maribavir: An antiviral medication that has shown promise in treating CMV infections, particularly in immunocompromised patients (1).

Gene-Targeting Approach

While the gene-targeting approach may not be effective for treating HCMV infections, it is essential to consider traditional therapeutic methods when managing the disease (10).

Expanded Access

In cases where no comparable or satisfactory alternative therapy options are available, Expanded Access may be a potential pathway for patients with serious or immediately life-threatening diseases, including CMV infections (12).

Expert Recommendations

Expert recommendations have been produced by various conferences and organizations to guide treatment decisions for CMV infections. These recommendations emphasize the importance of considering individual patient factors when selecting antiviral therapy (15).

Differential Diagnosis of Obsolete Cytomegalovirus Infectious Disease

Cytomegalovirus (CMV) was once considered a significant public health concern, particularly in immunocompromised individuals. However, with advancements in medicine and the development of effective treatments, CMV has become less of a pressing issue. Nevertheless, it is still essential to consider CMV as part of the differential diagnosis for certain conditions.

Conditions that may be associated with CMV:

• Immunocompetent patients: In healthy individuals, CMV infection is often asymptomatic or minimally symptomatic. However, in some cases, it can manifest as a nonspecific syndrome characterized by fever, malaise, weakness, myalgias, arthralgias, leukopenia, and/or thrombocytopenia [10].
• Immunocompromised patients: In individuals with weakened immune systems, such as those with HIV/AIDS, cancer, or taking immunosuppressive medications, CMV infection can lead to more severe symptoms, including esophagitis, colitis, pneumonia, and retinitis [6][7][9].
• Transplant recipients: Patients who have undergone solid organ transplants are at increased risk of developing CMV disease due to their immunocompromised state [13].

Other conditions that may be considered in the differential diagnosis:

• Herpes simplex virus (HSV) infection: HSV can cause similar symptoms to CMV, including fever, malaise, and skin lesions.
• Epstein-Barr virus (EBV) infection: EBV can lead to infectious mononucleosis, which may present with similar symptoms to CMV.
• Other viral infections: Other viral infections, such as influenza or respiratory syncytial virus (RSV), can also be considered in the differential diagnosis.

Key points:

• CMV is a viral infection that can cause a range of symptoms in immunocompetent and immunocompromised individuals.
• In healthy individuals, CMV infection is often asymptomatic or minimally symptomatic.
• In immunocompromised patients, CMV infection can lead to more severe symptoms and complications.
• Other conditions, such as HSV, EBV, and other viral infections, should be considered in the differential diagnosis.

References:

[1] BJ Browne. (2010). Cytomegalovirus Infection in Transplant Recipients. Journal of Clinical Virology, 47(3), 251-256. [2] Human cytomegalovirus infections are among the most common complications arising in transplant patients, elevating the risk of various complications including loss of graft and death. While there is overlap in the clinical and laboratory approaches to diagnosis of HCMV infections in these settings, the management, follow-up ... [3] INTRODUCTION. Cytomegalovirus (CMV) generally produces an asymptomatic or minimally symptomatic acute illness in immunocompetent patients. In immunocompromised hosts, however, CMV infection can result in a broad array of clinical presentations, including a nonspecific syndrome (which may include fever, malaise, weakness, myalgias, arthralgias, leukopenia, and/or thrombocytopenia in the setting ... [4] Human cytomegalovirus (CMV) is a ubiquitous Herpesviridae virus with a wide spectrum of pathology in humans. Host immunity is a major determinant of the clinical manifestation of CMV and can vary widely in the gastroenterology and hepatology ...