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Cytomegalovirus Infection

Also called generalized salivary gland disease and cytomegalic inclusion disease, cytomegalovirus (CMV) infection is caused by the cytomegalovirus, which is a deoxyribonucleic acid, ether-sensitive virus belonging to the herpes family. The disease occurs worldwide and is transmitted by human contact.

About four out of five persons over age 35 have been infected with CMV, usually during childhood or early adulthood. In most of these people, the disease is so mild that it's overlooked.

CMV spreads very easily. Infected people may shed the virus in their urine or saliva for months. The virus is also excreted in cervical mucus, semen, stool, and breast milk. Thus, both sexual and nonsexual transmission of the virus takes place. CMV infection may develop in people who receive infected blood.

Causes

CMV has been found in the saliva, urine, semen, breast milk, stool, blood, and vaginal and cervical secretions of infected persons. Transmission usually happens through contact with these infected secretions, which harbor the virus for months or even years.

The virus may be transmitted by sexual contact and can travel across the placenta of a pregnant woman, causing a congenital infection. Immunosuppressed patients, especially those who have received transplanted organs, run a 90% chance of contracting CMV infection. Recipients of blood transfusions from donors with positive CMV antibodies are at some risk.

Signs and symptoms

Most children and adults who are infected with CMV do not develop symptoms whereas others may experience the following symptoms three to twelve weeks after exposure:

• Fever
• Swollen glands
• Exhausted or run down

Diagnosis

Although virus isolation in urine is the most sensitive laboratory method, a diagnosis can also rest on virus isolation from saliva, throat, cervix, WBC, and biopsy specimens.

Other laboratory tests support the diagnosis, including complement fixation studies, hemagglutination inhibition antibody tests and, for congenital infections, indirect immunofluorescent tests for CMV immunoglobulin M antibody.

Treatment

Because CMV infection is usually self­limiting, treatment aims to relieve symptoms and prevent complications. In the immunosuppressed patient, however, CMV is treated with acyclovir, ganciclovir, and foscarnet, combined with anti-CMV immune globulin for pneumonitis and possible GI disease.

Is cytomegalovirus an emerging infectious disease?

Yes. Increasing numbers of persons are at risk for CMV infection. Expanding use of child-care centers is increasing the risk to children and staff. Also, the number of people with weakened immune systems is growing because of increases in HIV infection, organ transplantation, and cancer chemotherapy.

Prevention of Cytomegalovirus Infection

To help prevent CMV infection, follow these guidelines:

1. Warn immunodeficient patients and pregnant women to avoid any individuals with confirmed or suspected CMV infection. Maternal CMV infection can cause fetal abnormalities.
2. Urge patients with CMV infection to wash their hands thoroughly to prevent spreading it. It is especially important to stress this with young children, who are usually unconcerned about personal hygiene.
3. Be careful when handling urine and saliva or articles contaminated with these or other body secretions. Dispose of such articles properly. Mark contaminated linens for special handling.
4. Because of the risks of CMV during pregnancy, pregnant women should be counseled about the risks and the need to practice good hygiene.