ENLmedical.com: Conditions And Concerns: Medical Encyclopedia: CMV in immunocompromised host

CMV in immunocompromised host

Causes and Risks:
Infection with CMV is very common. Eighty percent of adults have antibodies (an indication of previous infection) to it in their blood. Usually CMV produces no symptoms. However, serious CMV infections can occur in people with impaired immunity (immunocompromised host), such as those with AIDS , organ transplant and bone marrow transplant recipients, and people receiving chemotherapy or other immunosuppressive treatments. Infections can include CMV pneumonia , CMV gastroenteritis , CMV retinitis , and CMV encephalitis and a mononucleosis-like illness. The incidence is 1 in 10,000 people.

Prevention:
Cytomegalovirus hyperimmune globulin may be helpful for seronegative renal transplant or bone marrow transplant recipients (patients who do not have antibodies in their blood indicating a previous infection).

Symptoms:

prolonged fever
general discomfort, uneasiness, or ill feeling ( malaise )
loss of appetite
fatigue
night sweats
muscle aches or joint pain
joint stiffness
weakness
weight loss
symptoms specific to the infected organ
- eye--major symptoms are:
  - visual impairment
  - blindness
- lungs--major symptoms are:
  - pneumonia with impaired oxygen uptake ( hypoxia )
- gastrointestinal--major symptoms are:
  - diarrhea
  - ulcerations with bleeding
- brain--major symptoms are:
  - encephalitis with behavioral changes
  - seizures
  - coma

Signs and Tests:

urine culture (clean catch) may demonstrate virus in the urine
blood culture
CMV serology by IFA
tissue biopsy for culture

Treatment:
The objective of treatment is to stop the replication of the virus within the body through the use of the antiviral agents cytovene or foscarnet. Prolonged treatment may be required.

Prognosis:
Fatal infections are associated with persistent viral infection in the blood and multiple organ system involvement. Antiviral medications stop the replication of the virus but do not destroy it. CMV is, in itself, immunosuppressive and may worsen the manifestations of other causes of immunosuppression .

Complications:

low white blood cell count with use of cytovene
kidney impairment with use of foscarnet
pneumonia
meningitis
blindness

Call Your Healthcare Provider:
Call your health care provider if symptoms of CMV infections occur and you are an immunosuppressed person.