Cytomegalovirus infection

Posted by e-Medical PPT Saturday, October 20, 2012
It is the most common congenital infection in USA.
It is a leading cause of hearing loss,mental retardation, and cerebral palsy.
It is an opportunistic pathogen in Immunocompromised.
It is a double stranded DNA virus.
It is the largest member of herpesviridae family..
Exit the cells by pinocytosis.
Restriction endonuclease.

Epidemiology
The prevalence of CMV infection and the age at first infection vary according to living conditions,child rearing practices, and sexual behavior.
Virus is present in saliva,tears,semen,urine,cervical secretions, and blood for months to years after initial infection  as well as the  milk of seropositive mothers.
It is transmitted  via direct contact with body fluids, intimate contact, care of young children, blood transfusion, and organ transplant.
Congenital CMV infection occurs in approximately 0.5% to 1.5% of births. It is well known that CMV can be transmitted to the fetus even when maternal infection occurred long before conception.
It occurs in immune mothers due to reactivation of latent virus during pregnancy ,chronic infection, or reinfection with a new strain.
When primary infection occurs during pregnancy the risk of transmission to the fetus is 35%. It occurs either by sexual contacts or contact with young children regardless of the gestational age.
Intrapartum transmission or transmission by human milk occur more commonly than congenital infection.
Infants who acquire the virus shed it in saliva and urine for years.

Clinical manifestations
Mostly asymptomatic.
CMV accounts for 50% of cases of  heterophile-negative mononucleosis.
Differ from EBV?
Fever and malaise often persist for more than 2 weeks.
The expected outcome is complete recovery.
Rare complications: peripheral  neuropathy, hemolytic anemia, thrombocytopenia, pneumonia, retinitis, gastrointestinal ulceration and encephalitis.

Congenital CMV infection
More than 90% of children have no clinical evidence of disease as newborns.
Lab abnormalities reflect involvement of hepatobiliary , hematopoeitic and CNS.
Newborns with symptomatic infection have wide range of severity.
Mortality is 10-15%
Among symptomatic survivors, neonatal clinical abnormalities can be expected to resolve within weeks except for those involving CNS and hearing.

Congenital CMV infection
Factors associated with increased risk of CNS sequel:
Primary maternal infection during pregnancy.
Abnormal neurologic examination findings.
Microcephaly.
Brain C.T.scan abnormalities.
Increased CSF protein.
Chorioretinitis.
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