CMV Infection in Immunocompromised Host

CMV Infection in Immunocompromised Host

Article
Brain & Nerve
Eye & Vision
+5
Contributed byKrish Tangella MD, MBAAug 14, 2018

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

  • CMV Infection - Immunocompromised Host
  • CMV Infection - Immunosuppressed Patient
  • Cytomegalovirus - Immunocompromised Patient

What is CMV Infection in Immunocompromised Host? (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, but remains inactive in a healthy host. Such individuals, who carry the infection, but do not show any signs and symptoms of the disease, are called carriers of CMV virus
  • 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. Such an infection may affect the esophagus, stomach, intestines, lung, eye, etc.
  • This opportunistic infection mostly affects those, in whom the immunity system is compromised; like AIDS, HIV infected individuals, or those who have undergone an organ transplantation surgery, or those suffering from any prolonged illnesses. Hence, the condition is termed as CMV Infection in Immunocompromised Host
  • An early diagnosis of Cytomegalovirus Infection in an Immunocompromised Host and intervention with suitable medication (and nutritional supplementation) is necessary to prevent the occurrence of severe complications, which can adversely affect the prognosis

Who gets CMV Infection in Immunocompromised Host? (Age and Sex Distribution)

  • CMV Infection in Immunocompromised Host indicates that the cytomegalovirus affects those in whom the immune systems are weakened by immunodeficiency infections, other debilitating conditions, or those who had had recent organ transplants, etc.
  • There is no gender, race, or ethnic preference with this infection type. CMV Infection in Immunocompromised Host can affect individuals worldwide

What are the Risk Factors for CMV Infection in Immunocompromised Host? (Predisposing Factors)

All individuals, who are with weak immunity systems, organ or bone marrow transplant recipients - individuals, who are exposed to the virus that spreads through close physical contact, have the greatest risk of CMV infection.

The risk factors for CMV Infection in Immunocompromised Host include:

  • Patients, who have undergone any organ, or bone marrow transplantation (since they are on immuno-suppressant drugs)
  • Patients undergoing treatment for, or suffering from acute viral infections, such as HIV and AIDS; such individuals have reduced blood lymphocyte count (and decreased immunity)
  • Those undergoing blood transfusions, kidney dialysis, for prolonged periods
  • Those suffering from cancer, undergoing chemotherapy for cancer
  • Individuals on steroid therapy (either low or high dosage), for a variety of health issues

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones 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 CMV Infection in Immunocompromised Host? (Etiology)

  • The cytomegalovirus (CMV) occurs latently in most of the humans (60-80%), but remains inactive since, a healthy host immunity, is strong and resilient
  • The 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 while being treated with immunosuppressant drugs for any medical condition
  • In those who have a highly susceptible or immuno-compromised system, the virus is reactivated and can affect many body areas like, the large and small intestines (gastrointestinal tract) and other body parts. Thus, the infection is called CMV in Immunocompromised Host

What are the Signs and Symptoms of CMV Infection in Immunocompromised Host?

Most individuals are exposed to cytomegalovirus at an early phase of their life. Nevertheless, healthy children and adults, affected by the virus may hardly show any signs and symptoms of 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 immunities 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, sore throat
  • Enlarged lymph nodes (in the neck region)
  • Behavioral changes
  • Epileptic seizures
  • Shortness of breath, rapid heart beat
  • Diarrhea
  • Pneumonia
  • Certain specific organs may be affected, causing the following signs and symptoms:
    • Eye - leading to blindness, light sensitivity (CMV retinitis)
    • GI tract - causing bleeding ulcers, CMV esophagitis, CMV colitis, etc.
    • Liver - inflammation and hepatitis
    • Brain - leading to an inflammation, causing meningitis

How is CMV Infection in Immunocompromised Host Diagnosed?

The physician conducts a physical examination along with a study of the signs and symptoms. Since a diverse set of medical complications and diseases may be present, a differential diagnosis is considered. In an immune-compromised individual, a wide variety of diagnostic tests may be performed

Diagnostic tests that are performed for CMV Infection in Immunocompromised Host 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 tests, called comprehensive metabolic panel tests
  • Culture of stool samples
  • Test of body fluids, tissue biopsy to establish the presence of cytomegalovirus

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 CMV Infection in Immunocompromised Host?

Complications caused due to CMV Infection in Immunocompromised Host can be severe. The infection affects specific parts of the body and they include:

  • Infection of the nervous system, causing neurological problems, brain inflammation
  • Low blood count (WBC)
  • Lung infection, causing pneumonitis
  • Liver, kidney functional problems
  • Blood stools, diarrhea, severe abdominal pain, due to the virus affecting the intestines
  • CMV mononucleosis: A disease presenting signs and symptoms similar to infectious mononucleosis, which include fatigue, nausea, tonsillitis, sore throat
  • Eye problems, such as irritation, light-sensitivity, inflammation, and loss of vision

How is CMV Infection in Immunocompromised Host Treated?

Quick, early diagnosis and appropriate treatment is the key to preventing aggravation of the CMV Infection in Immunocompromised Host. Proper medications with nutritional supplementation are required to aid in recovery, for 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, which may require treatment
  • The immuno-compromised individuals have to be closely monitored for any CMV infection symptoms or complications

How can CMV Infection in Immunocompromised Host be Prevented?

The cytomegalovirus infection is an opportunistic infection. CMV infection can be prevented by averting immunodeficiency infections, providing suitable treatment and medical care after an organ transplant, 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, being careful, maintaining basic hygiene, and following simple practices (like regular hand washing), reduces the risk of CMV transmission through direct contact.

Some other precautionary steps to prevent CMV Infection in Immunocompromised Host include:

  • Washing hands at regular intervals
  • Avoiding the use of commonly shared items, such as for food and drink
  • Use of proper disposal techniques when handling tissues, contaminated items; washing of hands thoroughly after disposing them
  • Screening organ donors for the presence of CMV
  • Educate the immunocompromised patients and create an awareness of the possible infections/conditions that may affect them, in order that they are better prepared and seek timely medical treatment

Regular medical screening at periodic intervals with blood tests, scans and physical examinations are mandatory for those, who develop hepatitis-like symptoms or having infectious mononucleosis-like indications.

What is the Prognosis of CMV Infection in Immunocompromised Host? (Outcomes/Resolutions)

  • CMV Infection in Immunocompromised Host can be a serious complication to the already existing weakened state of the individual. The prognosis is adversely affected, if the health condition of the patient is not favorable, or if there are additional complications
  • Mortality in such immunocompromised individuals is caused due to complications, resulting from a damaged immune system. Those, who have undergone a recent bone marrow transplantation may be fatally infected
  • The cytomegalovirus infection can be effectively treated, if prompt medical attention is given. The prognosis depends upon the underlying medical conditions of the patient and response to treatment

Additional and Relevant Useful Information for CMV Infection in Immunocompromised Host:

The cytomegalovirus causes a host of other diseases in those who are rendered vulnerable, due to weak immune systems.

The following article link will help you understand acute cytomegalovirus infection:

http://www.dovemed.com/diseases-conditions/acute-cytomegalovirus-infection/

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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team

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