What are the other Names for this Condition? (Also known as/Synonyms)

• Acute CMV Infection
• Disease due to Cytomegalovirus (CMV)
• HHV 5 Infection

What is Acute Cytomegalovirus Infection? (Definition/Background Information)

• The Cytomegalovirus (CMV) belongs to the herpes virus family and is commonly found in most humans. It can spread by a variety of  factors, such as:
  • Sexual contact
  • Through blood transfusions
  • Urine
  • Nose and mouth secretions
  • Occasionally, even breast milk
• The CMV stays in the body for life, after an initial infection. The virus occurs latently in most of the humans (about 60-80% of them), but remains inactive, since a healthy host immunity is strong and resilient. Such individuals, who carry the infection, but do not show any signs and symptoms of the disease, are called carriers of CMV virus
• Acute Cytomegalovirus Infection mostly affects those, in whom the immune system is compromised, such as:
  • AIDS, HIV infected individuals
  • Those, who have undergone an organ transplantation
  • And those suffering from any prolonged illnesses
• When a CMV carrier becomes immunocompromised for a variety of reasons, the CMV virus becomes active in the body, resulting in signs and symptoms of a CMV infection
• In such a scenario, the carrier does not get newly infected from a CMV-infected individual; rather, the virus already hibernating in the body, gets reactivated. Reactivation of cytomegalovirus occurs in those individuals:
  • With a highly susceptible immune system
  • Having an immunocompromised system
  • Being treated with immunosuppressant drugs for organ transplantation
  • Chemotherapy patients
  • Bone marrow transplantation recipients
  • Suffering from certain other medical conditions

Who gets Acute Cytomegalovirus Infection? (Age and Sex Distribution)

• All those who have been exposed to the virus during their lifetime, may get Acute Cytomegalovirus Infection. However, the virus affects only those in whom, the immune systems are weakened by:
  • Immunodeficiency infections
  • Other chronic, long-standing  debilitating conditions
  • Or those, who had had recent organ transplants
  • Treatment for cancer
  • Infected pregnant women can transmit the virus to their offspring
• The incidence of Acute CMV Infection is generally noted in the 10-35 year age group

What are the Risk Factors for Acute Cytomegalovirus Infection? (Predisposing Factors)

The risk factors of Acute Cytomegalovirus Infection include:

• All individuals with a weak immunity and exposed to CMV have the greatest risk. These include:
  • HIV infected and AIDS patients
  • Patients, who have undergone any organ or bone marrow transplantation (since they are on immuno-suppressant drugs)
  • Patients undergoing  immunosuppressive therapy for a variety of reasons, resulting in reduced blood lymphocyte count
  • Individuals with cancer or those undergoing chemotherapy for cancer
• Those undergoing  repeated blood transfusions for conditions, such as myelodysplastic syndrome, or chronic kidney failure requiring kidney dialysis for prolonged periods
• Individuals on chronic steroid therapy (either low or high dosage), for a diverse set of health issues
• Healthcare workers administering to such affected patients or newborn babies, are at a high risk; CMV spreads through close physical contact
• Chronic alcohol dependence
• Malnourishment, like protein deficiency or Kwashiorkor

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases one's chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Acute Cytomegalovirus Infection? (Etiology)

• Acute Cytomegalovirus Infection is a contagious disease spreading by physical contact, such as through:
  • Saliva
  • Nasal fluids
  • Vaginal fluids
  • Semen
  • Placenta
  • Blood
  • Organ transplantation
• It affects those who have weak immune systems, or those rendered vulnerable, being treated with immunosuppressant drugs for any medical condition
• The CMV viruses are also latently present in most humans (in about 60-80% of human population). However, the virus remains inactive, since healthy humans have a strong and robust immune system
• In those, who have a highly susceptible or compromised immune system, the cytomegalovirus gets reactivated and can affect many body areas, like the large and small intestines, gastrointestinal tract, etc.
• Acute Cytomegalovirus Infection is an indication of a frail immune system that is caused by other medical conditions. This infection imposes additional stress on the human body, resulting in barriers to recovery. This also results in  a worsening of the already feeble health condition
• Infants may be infected while in the womb or immediately after birth during breastfeeding, if the mother is infected

What are the Signs and Symptoms of Acute Cytomegalovirus Infection?

Most individuals are exposed to the virus, during an early phase of their life. Nevertheless, healthy children and adults affected by the virus may hardly show any signs and symptoms of Acute Cytomegalovirus Infection. When the body immune system becomes weakened, due to a variety of reasons, the CMV virus gets reactivated and affects the individual in varying degrees of severity.

Individuals with weak immunity may have:

• Signs and symptoms of another infection, called infectious mononucleosis (which is caused by another virus from the same family, called Epstein-Barr virus)
• Loss of appetite, weight loss, general malaise
• Muscular aches and fatigue, headaches
• Fever and sore throat
• Enlarged lymph nodes (in the neck region)
• Behavioral changes
• Epileptic seizures
• Shortness of breath, rapid heart beat
• Diarrhea
• Pneumonia
• Specific organs may be affected, causing signs and symptoms, affecting the:
  • Eye - leading to blindness, light sensitivity
  • GI tract - causing bleeding ulcers
  • Liver - inflammation and hepatitis
  • Brain - leading to an inflammation, causing meningitis

Pregnant women, who have signs of any infection, have to be evaluated for CMV. Babies may show indications of the disease, a few months or years after birth, even though they might appear healthy at birth. In such cases, the common signs include hearing and vision defects.

If the virus affects the child while in the womb, it is termed as congenital CMV infection. Such a child could show severe indications of the disease, upon birth. The signs and symptoms of congenital CMV infection may include:

• Skin rashes
• Enlarged spleen
• Low birth weight
• Jaundice (yellow eyes), liver function problems
• Pneumonia
• Seizures

However, those babies, who are born and appear healthy, may stay healthy.

How is Acute Cytomegalovirus Infection Diagnosed?

The physician conducts a physical examination along with a study of the signs and symptoms presented. Since, a diverse set of medical complications and diseases may be present, a differential diagnosis is considered. Diagnostic tests performed for Acute Cytomegalovirus Infection may include:

• CMV DNA serum PCR test (a special blood test)
• CMV antibody test, to understand how the body reacts to the CMV virus
• Liver function tests
• Mononucleosis spot test, to rule out infectious mononucleosis
• A group of chemical blood tests, called comprehensive metabolic panel tests
• Culture of stool samples
• Test of body fluids for CMV
• Tissue biopsy - the biopsy is examined under a microscope by the pathologist, to arrive at a definitive diagnosis
• Pregnant women can be screened for CMV infection, by performing an amniocentesis, if any fetal abnormalities are noted on ultrasound scans
• Tests are performed within the first 3-weeks of baby’s birth, if congenital CMV infection is suspected

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Acute Cytomegalovirus Infection?

Complications caused due to Acute CMV Infection are not frequent. The infection may affect specific parts of the body in those with poor immune systems and cause the following complications:

• Infection of the nervous system, leading to neurological problems, such as brain inflammation (meningitis and encephalitis)
• Lung infection, causing CMV pneumonia
• Liver functional problems, resulting in CMV hepatitis
• Blood in stools, diarrhea, severe abdominal pain, due to CMV affecting the intestines
• CMV mononucleosis - a disease presenting signs and symptoms similar to infectious mononucleosis, which include fatigue, nausea, tonsillitis, and sore throat

Complications due to congenital CMV infection in infants could include:

• Seizures
• Babies with small head
• Mental disorders, autism, ADHD
• Eye abnormalities, such as irritation, light-sensitivity, inflammation, and loss of vision
• Hearing loss

How is Acute Cytomegalovirus Infection Treated?

Quick, early diagnosis and appropriate treatment is the key to speedy recovery from severe cases of Acute Cytomegalovirus Infection. Immunocompromised individuals may have to be closely monitored for any CMV symptoms or complications.

A treatment of CMV Infection may include:

• Proper medications with nutritional supplementation are normally adequate to aid in recovery, for newborn babies and individuals with weak immune systems
• Intravenously or orally administered antiviral medications are effective in treating patients with weak immunity systems, caused by conditions other than HIV and AIDS
• Those affected by immunodeficiency viruses have shown improvement with antiretroviral therapy drugs that are normally prescribed for AIDS, HIV infections
• There may be secondary infections, such as pneumonia that may require treatment
• Healthy individuals, adults and children, do not require any treatment, if no symptoms are present
• If healthy individuals are mildly affected, then medical help should be sought and certain basic self-care steps to recovery followed - like, having plenty of fluids and rest

How can Acute Cytomegalovirus Infection be Prevented?

Acute Cytomegalovirus Infection is an opportunistic infection. CMV infection can be prevented by averting immunodeficiency infections, by providing suitable treatment and medical care after an organ transplant (especially lung or bone marrow), or when a body immunity system is weakened by other illnesses. Antiviral medications are effective against the CMV Infection in the immuno-compromised.

The virus affects a large percentage of the population and this makes it acutely pathologic. However, maintaining basic and careful hygiene and following simple practices (like regular hand washing), reduces the risk of CMV transmission through direct contact.

Some other precautionary steps to prevent Acute CMV Infection include:

• Practicing safe sex
• Washing hands at regular intervals, especially for individuals in the high-risk group
• Avoiding the use of commonly shared items, such as for preparation of food and drink
• Use of proper disposal techniques while handling tissues, diapers, other contaminated items; washing hands thoroughly, after disposing them
• Not performing actions, such as kissing, hugging, in a manner that puts you in direct contact with a child’s eyes, lips, and nose. Pregnant ladies have to be extremely careful in such situations
• Screening organ donors for the presence of CMV
• Educate the immunocompromised patients and create an awareness of possible conditions, to enable them be better prepared and seek timely medical treatment

What is the Prognosis of Acute Cytomegalovirus Infection? (Outcomes/Resolutions)

• A healthy immune system recovers faster, with little or no treatment, from Acute Cytomegalovirus Infection
• If the health condition of the patient is adversely affected, or if there are other complications, then the prognosis of Acute CMV Infection is guarded
• If proper and timely treatment is not administered, then in newborn infants, the Cytomegalovirus Infection can be fatal. Or, it may cause periodic complications, necessitating lifelong medical attention
• Mortality in such immunocompromised individuals is caused due to other complications, resulting from a damaged immune system
• Acute Cytomegalovirus Infection can be effectively treated, when other underlying medical conditions of the patients are favorable and responsive to treatment

Additional and Relevant Useful Information for Acute Cytomegalovirus Infection:

• The cytomegalovirus causes a host of other diseases in those who are rendered vulnerable, due to weak immune systems
• New drugs and vaccines against CMV are currently being developed, to decrease the chances of infection in developing babies in a pregnant women