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Cytomegalovirus-Beta herpes virus group

  • Virus replicates in epithelial cells in salivary glands, kidneys and respiratory epithelium
  • Virus may be present in milk, saliva, faeces and urine
a. Transmission :
  1. Infection is transmitted by close contact between individuals
  2. Blood transfusion
  3. Vertical transmission (prenatal, perinatal & postnatal)          
  4. Once infected, an individual probably carries the virus for life
  5. The infection usually remains latent
  6. CMV reactivation syndromes develop frequently when T-lymphocyte mediated immunity is compromised
Pathology : Cytomegalic cells in vivo, " Owl's Eye " appearance
b. Clinical manifestations :
  1. Prenatal CMV infection :
  2. Most common agent responsible for intrauterine infection
  3. Primary maternal infection or reactivation during pregnancy
  4. M/C presenting features- Growth retardation, hepatosplenomegaly, jaundice, thrombocytopenia, microcephaly, encephalitis, chorioretinitis, deafness, mental retardation
  5. Lab abnormalities in decreasing order of frequency
    1. Serum IgM level > 20mg / dl
    2. Atypical lymphocytosis, thrombocytopenia
    3. Elevated liver aminotransferases, Hyperbilirubinemia
    4. CSF protein level > 20 mg / dl
ii. Perinatal CMV infection:
  • Acquired either from infected maternal genital secretions or from breast milk
iii. Postnatal infection:
  • Acquired by kissing, sexual intercourse, blood transfusion or organ transplantation
  • Generally subclinical    
iv. CMV Mononucleosis:
  • Most often involves sexually active young adults
  • I.P.   20 - 60days, Illness lasts for 2 - 6 weeks
  • Characteristic laboratory abnormality - Relative lymphocytosis in peripheral blood with > 10% atypical lymphocytes
v. CMV infection in Immunocompromised host
  • MC & important viral pathogen complicating organ transplantation- Period of    maximum risk b/w 1 and 4 months after transplantation
  • Patients with CD4 + T cell count below 100 / μl are highly susceptible to CMV
  • Disseminated infection leading to interstitial pneumonia, retinitis, hepatitis, arthritis, encephalitis, GBS, transverse myelitis
c. Laboratory diagnosis
  1. Direct detection: inclusion bodies, viral antigen (immunofluorescence), virus (electron microscopy)
  2. Culture: virus grows slowly taking 1-2 weeks for appearance of cytologic changes (multinucleate giant cells with perinuclear cytoplasmic and intranuclear inclusions)
  3. Nucleic acid detection: DNA probe, PCR for CMV DNA
  4. Serology: Nt, CF, IFA, RIA
d. Treatment: Drug of choice ganciclovir

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