Cytomegalovirus (CMV) Infection
Original Editors - Students from Bellarmine University's Pathophysiology of Complex Patient Problems project.
Top Contributors - Elizabeth Levay, WikiSysop, Kim Jackson, Lucinda hampton, 127.0.0.1, Elaine Lonnemann and Nupur Smit Shah
Description[edit | edit source]
Cytomegalovirus (CMV) Infection, also known as herpesvirus type 5, is a common virus belonging to the herpes family that affects a variety of individuals across the lifespan[1]. It is currently the leading cause of congenital infections in the world, and can cause long term consequences such as hearing loss, visual deficits, and cognitive delays[2][3]. It is frequently acquired in late childhood or early adulthood, and is rarely symptomatic, except in the immunocompromised.
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Prevalence[edit | edit source]
Reported incidence of CMV varies. Recent evidence suggests that one percent of newborns have the virus, as well as eighty percent of people over 35 years of age[1]. Other studies report that 50-80% of people are infected with the virus, and up to 90% or more in developing countries[2]. After infection, the virus may remain latent within monocytes, frequently causing it to be difficult to detect[4]. Therefore, true prevalence may be different than numbers reported.
Characteristics/Clinical Presentation[edit | edit source]
Cytomegalovirus rarely presents with symptoms and may be be left undetected. Like other viruses in the herpes family, CMV resides dormant in the body[5]. After dormancy, it can be reactivated by some trigger, which commonly includes immunosuppression, stress, and medication use[4]. When active, individuals with CMV may show signs of lower extremity weakness which can later result in flaccid paralysis due to nerve root damage[1]. Cytomegalovirus can also present with a variety of other symptoms such as:[5][6]
- Cough
- Fatigue
- Fever
- Malaise
- Loss of appetite
- Joint pain
- Shortness of breath
- Dyspnea
- Night sweats
- Rash
- Upper Respiratory Infection
Associated Co-morbidities[edit | edit source]
Cytomegalovirus is often associated with systemic diseases during times of immunosuppression manifesting as:[4]
- Hepatitis
- Retinitis
- Colitis
- Pneumonitis
- Esophagitis
- Bone marrow suppression
Medications[edit | edit source]
The most common treatment for CMV includes antiviral use, such as Ganciclovir (intravenous) and Valganciclovir (oral). Less common medications include Foscarnet and Cidofovir[1]. Ganciclovir works by inhibiting the replication of viral DNA by ganciclovir-5’-triphosphate, which involves inhibition of the viral DNA polymerase. The use of two vaccines is currently being investigated in phase II and phase III clinical trials in healthy, postpartum females and transplant recipients (9). More research must be completed in this area to determine if CMV vaccinations are effective. Individuals who have the disease but are asymptomatic are not typically treated.
Diagnostic Tests/Lab Tests/Lab Values[edit | edit source]
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Etiology/Causes[edit | edit source]
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Systemic Involvement[edit | edit source]
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Medical Management (current best evidence)[edit | edit source]
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Physical Therapy Management (current best evidence)[edit | edit source]
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Differential Diagnosis[edit | edit source]
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Case Reports/ Case Studies[edit | edit source]
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Resources
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Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 Goodman C, Snyder T. Differential Diagnosis for Physical Therapists: Screening for Referral. 5th ed. St. Louis, MO: Elsevier; 2013: 336-337.
- ↑ 2.0 2.1 Cytomegalovirus (CMV). https://pedclerk.bsd.uchicago.edu/page/cytomegalovirus-cmv (accessed 04 March 2016).
- ↑ Dollard S, Grosse S, Ross D. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Reviews In Medical Virology [serial on the Internet]. (2007, Sep), [cited April 4, 2016]; 17(5): 355-363. Available from: MEDLINE.
- ↑ 4.0 4.1 4.2 Guo R, Gebreab F, Tang E, Piao Z, Lee S, Perez M. Cutaneous Ulcer as Leading Symptom of Systemic Cytomegalovirus Infection. Case Reports In Infectious Diseases [serial on the Internet]. (2015, Feb 16), [cited April 4, 2016]; 20151-4. Available from: Academic Search Complete.
- ↑ 5.0 5.1 Ohlin M, Söderberg-Nauclér C. Human antibody technology and the development of antibodies against cytomegalovirus. Molecular Immunology [serial on the Internet]. (2015, Oct), [cited April 4, 2016]; 67(2 Pt A): 153-170. Available from: MEDLINE.
- ↑ Scripps. CMV - pneumonia. https://www.scripps.org/articles/3053-cmv-pneumonia (accessed 04 March 2016).
