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

• CMV Lymphadenopathy
• Enlarged Lymph Nodes due to Cytomegalovirus
• Human Herpes Virus 5 Infection Lymphadenitis

What is Cytomegalovirus Lymphadenopathy? (Definition/Background Information)

• Cytomegalovirus Lymphadenopathy is the inflammation and enlargement of lymph nodes due to underlying Cytomegalovirus Infection, which is caused by cytomegalovirus (or CMV) belonging to the herpes virus family
• The virus is commonly found in most humans; and it can spread through sexual contact, through blood transfusions, urine, nose and mouth secretions, and occasionally, even by breast milk
• The acute Cytomegalovirus Infection mostly occurs in those with compromised immune system including AIDS, HIV-infected individuals, those who have undergone an organ transplantation, and individuals with prolonged illnesses
• In immunocompromised individuals, the CMV virus becomes active in the body resulting in signs and symptoms of a CMV Infection, which are non-specific and organ-specific. The signs and symptoms of Cytomegalovirus Lymphadenopathy include enlarged lymph nodes that are painless.
• The treatment of Cytomegalovirus Lymphadenopathy due to CMV Infection in immune compromised individuals includes intravenously or orally administered antiviral medications, nutritional supplementation, and symptomatic management of the condition. Normally healthy individuals may not require any treatment
• The prognosis of Cytomegalovirus Lymphadenopathy generally depends upon the severity of the underlying signs and symptoms due to the viral infection. Although, it is also dependent upon the health status of an individual

Who gets Cytomegalovirus Lymphadenopathy? (Age and Sex Distribution)

• Cytomegalovirus Lymphadenopathy occurs due to underlying Cytomegalovirus Infection, which can affect individuals of all age group, both genders, and racial or ethnic profile
• However, the signs and symptoms of this viral infection is observed only in individuals, whose immune systems are weakened by the following conditions:
  • Immunodeficiency infections
  • Any chronic, long-standing and debilitating condition
  • Recent organ transplants
  • Treatment for cancer
  • Infected pregnant women can transmit the virus to their offspring

Note: The incidence of acute CMV Infection is generally noted in the 10-35 year age group.

What are the Risk Factors for Cytomegalovirus Lymphadenopathy? (Predisposing Factors)

The main risk factor for Cytomegalovirus Lymphadenopathy is the underlying CMV Infection. The risk factors for the infection include:

• Individuals with weak immunity exposed to CMV have the greatest risk. These include:
  • Those who have undergone any organ or bone marrow transplantations (and are on immunosuppressant drugs)
  • Those undergoing immunosuppressive therapy for a variety of reasons, resulting in reduced blood lymphocyte count
  • Individuals with cancer or undergoing chemotherapy for cancer
• Individuals who undergo 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 such as due to 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 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 Cytomegalovirus Lymphadenopathy? (Etiology)

• Cytomegalovirus Lymphadenopathy is caused by cytomegalovirus. The Cytomegalovirus Infection is a contagious disease that spreads through physical contact such as through:
• Cytomegalovirus Lymphadenopathy is caused by cytomegalovirus. The Cytomegalovirus Infection is a contagious disease that spreads through 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
• CMV viruses are also latently present in most humans (in about 60-80% of them). 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 virus gets reactivated and can affect many body areas, such as the large and small intestines, gastrointestinal tract, or other body systems
• 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 Cytomegalovirus Lymphadenopathy?

The signs and symptoms of Cytomegalovirus Lymphadenopathy may include:

• Lymphadenopathy or enlarged lymph nodes that may involve lymph nodes all over the body
• Commonly, the lymph nodes of the head and neck region are involved
• The swollen lymph nodes are generally painless

The associated signs and symptoms of underlying Cytomegalovirus Infection depend upon the health condition of the individual affected and the severity of the infection. Individuals with weak immunities may have:

• Signs and symptoms of another infection, called infectious mononucleosis (that is caused by the Epstein-Barr virus)
• Loss of appetite, weight loss, and 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 that include:

• Blindness, light sensitivity
• Bleeding ulcers, when the GI tract is affected
• Liver inflammation or hepatitis
• Inflammation of the brain causing meningitis

Note:

Pregnant women, who have signs of infection, should 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 may show severe indications of the disease upon birth.

How is Cytomegalovirus Lymphadenopathy Diagnosed?

Diagnostic tests performed for Cytomegalovirus Lymphadenopathy may include:

• Complete physical examination and evaluation of medical history
• 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
• Comprehensive metabolic panel tests
• Culture of stool samples
• Test of body fluids for the presence of CMV
• Tissue biopsy of the affected region
• 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

In majority of the cases, a lymph node biopsy is not performed for Cytomegalovirus Lymphadenopathy. However, if the signs and symptoms persist despite suitable treatment, then a biopsy may be undertaken to rule-out other causes of swollen glands (such as a lymphoma).

In case of a lymph node biopsy, the following information may be noted:

• Lymph node biopsy: A lymph node biopsy is performed and sent to a laboratory for a pathological examination. The pathologist examines the biopsy under a microscope. After putting together clinical findings, special studies on tissues (if needed) and with microscope findings, the pathologist arrives at a definitive diagnosis. The pathologist may use special techniques, such as immunohistochemistry stains, to help reveal the presence of the pathogen
• The lymph node biopsy may be performed through any of the following procedures:
  • Fine needle aspiration biopsy (FNAB): A device called a cannula is used to extract tissue or fluid from the lymph nodes
  • Lymph node core biopsy of the enlarged lymph node
  • Lymph node open biopsy of the enlarged lymph node

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 Cytomegalovirus Lymphadenopathy?

Complications of acute Cytomegalovirus Infection (causing Lymphadenopathy) 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 abnormalities including brain inflammation (meningitis and encephalitis)
• Lung infection causing CMV pneumonia
• Liver dysfunction resulting in CMV hepatitis
• Blood in stools, diarrhea, and severe abdominal pain due to CMV affecting the intestines
• CMV mononucleosis: It is a disease that presents signs and symptoms similar to infectious mononucleosis and includes fatigue, nausea, tonsillitis, and sore throat

How is Cytomegalovirus Lymphadenopathy Treated?

The management of Cytomegalovirus Lymphadenopathy may include undertaking treatment of the underlying Cytomegalovirus Infection. This involves the following measures:

• Suitable 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, which may require treatment

Healthy individuals (adults and children) generally 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, such as having plenty of fluids and rest.

How can Cytomegalovirus Lymphadenopathy be Prevented?

The prevention of Cytomegalovirus Infection can reduce the risk for Cytomegalovirus Lymphadenopathy, which may be achieved through the following measures

• Practicing safe sex
• Washing hands at regular intervals
• Avoiding the use of commonly shared items with those who are infected
• Use of proper disposal techniques while handling tissues, diapers, and 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 very careful to avoid infection
• 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 Prognosis of Cytomegalovirus Lymphadenopathy? (Outcomes/Resolutions)

The prognosis of Cytomegalovirus Lymphadenopathy is based on the severity of the underlying Cytomegalovirus Infection.

• A healthy immune system recovers faster with or without symptomatic treatment
• If the health condition 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 CMV Infection can be fatal; or it may cause periodic complications, necessitating lifelong medical attention
• Mortality in immunocompromised individuals occurs due to the development of complications resulting from a poor 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 Cytomegalovirus Lymphadenopathy:

General information on lymph nodes:

The lymph nodes are part of one’s immune system. The lymph nodes are present throughout the body, usually in groups. In normal healthy adults, one cannot feel (see or touch) the lymph nodes readily. However, if they are enlarged, they can be felt either by the individual himself/herself or by the healthcare provider.

Enlarged lymph nodes can occur in both benign and malignant conditions. Hence, the cause of enlarged lymph nodes should be evaluated. If no obvious cause for enlargement of lymph nodes is found, then the possibility of a lymph node malignancy should be ruled out.

In a majority of individuals, a lymph node swelling is caused by a benign process such as an inflammation or infection. In many cases, swollen lymph nodes are part of other signs and symptoms. This can help a healthcare provider arrive at a list of follow-up tests and ensure an accurate diagnosis. Superficial enlarged lymph nodes can be felt by the healthcare provider through palpation. Enlarged lymph nodes deep in the body are often detected by radiological studies such as X-rays, ultrasound scan, CT and MRI scans.

Some enlarged lymph nodes can be painful, while others may be painless. Depending upon the underlying cause, enlarged lymph nodes can be localized to a particular area of the body, or they can be generalized, meaning that they are present throughout the body.