Disease: Cytomegalovirus (CMV) Infection

    Cytomegalovirus (CMV) infection facts

    • CMV is a common virus (herpes virus family) and can infect anyone.
    • CMV is spread by direct contact of body fluids such as saliva, blood, urine, semen, vaginal fluids, and breast milk.
    • Most healthy people do not experience any symptoms when infected with CMV. However, in those with a weakened immune system, CMV can cause serious disease (blindness, hepatitis, pneumonia, or encephalitis, for example).
    • As CMV spreads easily via any body fluid, breastfeeding, blood transfusions, organ transplants, and sexual contact are possible modes of transmission.
    • Infants born to mothers infected with CMV during pregnancy may develop congenital CMV infection.
    • Most healthy children and adults will recover from CMV infection without complications and do not require antiviral treatment.
    • Health-care professionals diagnose CMV infections by culturing the virus or detecting CMV DNA from the infected individual or detecting CMV antibodies.
    • Antiviral treatments may improve the prognosis in some patients.
    • There is no commercially available CMV vaccine; experimental vaccines are being studied.

    What is cytomegalovirus (CMV)?

    CMV, or cytomegalovirus (pronounced si-to-MEG-a-lo-vi-rus), is a virus that belongs to the herpesvirus family. Other members of the family include herpes simplex viruses (cause cold sores and genital herpes), varicella-zoster virus (causes chickenpox and shingles), and Epstein-Barr virus (causes infectious mononucleosis, also known as mono). This group of viruses remain dormant (not causing symptoms) in the body for life. Infection with CMV is very common and can cause fever, tiredness, and other symptoms. CMV infection occurs in people of all ages worldwide. Experts estimate that more than half of the adult population in the United States has been infected with CMV, and 80% of adults have had the infection by the time they are 40 years old. About one in 150 children is born with CMV infection.

    What causes cytomegalovirus infection?

    Direct contact with body fluids from an infected person exposes an individual to CMV. Most healthy children and adults do not experience any symptoms after infection with CMV. However, in people with a weakened immune system (such as those with HIV or AIDS), CMV may cause serious disease. CMV can cause retinitis (blurred vision and blindness), painful swallowing (dysphagia), diarrhea, and weakness or numbness in the legs.

    What are the risk factors for cytomegalovirus infection?

    People who work closely with young children, such as in child care, may be exposed to CMV and become infected. People at risk for complications from CMV infection include pregnant women and those with a weakened immune system, such as people infected with HIV, individuals who have undergone organ transplantation, cancer patients, or those who are taking medications that might suppress their immune system.

    How is cytomegalovirus transmitted?

    Infection with CMV is relatively common; CMV spreads easily through direct contact of body fluids (such as saliva [spit], urine, blood, semen, vaginal secretions, or breast milk) from an infected person. People become infected with CMV through sexual contact, breastfeeding, blood transfusions, injection drug use (sharing needles), or organ transplantation.

    CMV transmission can also occur during pregnancy and causes CMV infection in infants, called congenital CMV infection. Approximately 1%-4% of women who have never been infected with CMV will have their primary (first) infection during pregnancy. The virus can cross the placenta and infect the fetus' blood. Approximately one-third of women who become infected for the first time during pregnancy will pass the infection to the baby.

    What are cytomegalovirus symptoms and signs?

    Most people infected with CMV do not have any symptoms. Acute CMV infection may cause infectious mononucleosis-like (or mono-like) symptoms such as fever, enlarged lymph nodes, sore throat, muscle aches, loss of appetite, and fatigue.

    In people with a suppressed immune system, CMV infection can attack different organs of the body and may cause blurred vision and blindness (CMV retinitis), lung infection (pneumonia), diarrhea (colitis), inflammation of the liver (hepatitis), or inflammation of the brain (encephalitis), causing possible behavioral changes, seizures, or coma.

    Infants with CMV infection at birth (congenital CMV) can show signs and symptoms of yellow skin and eyes (jaundice), skin rash, low birth weight, pneumonia, big liver and spleen, and seizures.

    How do physicians diagnose cytomegalovirus infection?

    Most CMV infections go undiagnosed because the virus causes little to no symptoms. When a person is infected with CMV, antibodies (proteins) to the virus called IgM and/or IgG anti-CMV antibodies develop and stay in the body for the rest of the person's life. A blood test to detect the antibodies will be positive if the person has had a CMV infection. If the antibody test is negative, the person is considered to be CMV negative.

    A diagnosis of an active CMV infection can be made if the virus is found in bodily fluids (such as blood, saliva, or urine) or body tissues by culturing (growing) the virus or detecting its DNA or specific protein called pp65 antigen by PCR tests. These tests are done if a person has a history of signs and symptoms consistent with an active CMV infection. The virus can become reactivated from its latent state (latent infection) when a person's immune system has weakened.

    A physician may diagnose a congenital CMV infection if he or she detects the virus in a newborn's urine, saliva, blood, or other body tissues within two to three weeks after birth.

    What is the treatment for cytomegalovirus infection?

    There is no cure for CMV, and treatment for CMV infection is not necessary in healthy children and adults. People with a weakened immune system who have symptoms of CMV infection are placed on antiviral medication. Up to 75% of transplant recipients develop CMV infection. Those who have a very high risk of developing severe CMV infection may be placed on antiviral medication to prevent CMV disease. This pretreatment is called prophylaxis. This method has helped reduce the number of CMV infections in these patients. The antiviral medications against CMV include the following:

    • Ganciclovir (Cytovene) is the first antiviral medication approved for the treatment of CMV infection. Ganciclovir, given intravenously, is the drug of choice for the treatment of CMV infection. Side effects include fever, rash, diarrhea, anemia, and low white blood cell and platelet counts.
    • Valganciclovir (Valcyte) is an oral medication that is activated to ganciclovir in the body and widely used to prevent CMV infection (prophylaxis). It is used in selected patients for the treatment of CMV infection and is as effective as intravenous ganciclovir in non-severe cases.
    • Foscarnet (Foscavir) is active against CMV by a different mechanism than ganciclovir and used to treat infections with CMV that are resistant to ganciclovir. It is a second-line therapy for patients who do not tolerate ganciclovir treatment. Foscarnet is toxic to the kidneys and can cause seizures due to an imbalance of minerals and electrolytes.
    • Cidofovir (Vistide) is an alternative therapy for patients who have failed ganciclovir and foscarnet treatment. Its use is limited due to toxicity to the kidneys. It is used mainly for the treatment of CMV infection of the eye (retinitis) in patients with acquired immune deficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV).
    • CMV immune globulin contains antibodies (proteins) that are specific to CMV. It is FDA-approved to prevent CMV infection in high-risk lung transplant patients when given in addition to ganciclovir. It is also used with ganciclovir to treat CMV pneumonia.

    No antiviral drug is FDA-approved for the treatment of congenital CMV infection. However, some infants who have infection involving the central nervous system (brain and spinal cord) may benefit from treatment. Some evidence shows that ganciclovir may prevent hearing loss and developmental problems in infants who have severe symptoms of congenital CMV infection. Because of the serious side effects of ganciclovir, a physician specialist should be consulted.

    There are no home remedies proven to be effective in treating CMV infection.

    What is cytomegalovirus (CMV)?

    CMV, or cytomegalovirus (pronounced si-to-MEG-a-lo-vi-rus), is a virus that belongs to the herpesvirus family. Other members of the family include herpes simplex viruses (cause cold sores and genital herpes), varicella-zoster virus (causes chickenpox and shingles), and Epstein-Barr virus (causes infectious mononucleosis, also known as mono). This group of viruses remain dormant (not causing symptoms) in the body for life. Infection with CMV is very common and can cause fever, tiredness, and other symptoms. CMV infection occurs in people of all ages worldwide. Experts estimate that more than half of the adult population in the United States has been infected with CMV, and 80% of adults have had the infection by the time they are 40 years old. About one in 150 children is born with CMV infection.

    What causes cytomegalovirus infection?

    Direct contact with body fluids from an infected person exposes an individual to CMV. Most healthy children and adults do not experience any symptoms after infection with CMV. However, in people with a weakened immune system (such as those with HIV or AIDS), CMV may cause serious disease. CMV can cause retinitis (blurred vision and blindness), painful swallowing (dysphagia), diarrhea, and weakness or numbness in the legs.

    What are the risk factors for cytomegalovirus infection?

    People who work closely with young children, such as in child care, may be exposed to CMV and become infected. People at risk for complications from CMV infection include pregnant women and those with a weakened immune system, such as people infected with HIV, individuals who have undergone organ transplantation, cancer patients, or those who are taking medications that might suppress their immune system.

    How is cytomegalovirus transmitted?

    Infection with CMV is relatively common; CMV spreads easily through direct contact of body fluids (such as saliva [spit], urine, blood, semen, vaginal secretions, or breast milk) from an infected person. People become infected with CMV through sexual contact, breastfeeding, blood transfusions, injection drug use (sharing needles), or organ transplantation.

    CMV transmission can also occur during pregnancy and causes CMV infection in infants, called congenital CMV infection. Approximately 1%-4% of women who have never been infected with CMV will have their primary (first) infection during pregnancy. The virus can cross the placenta and infect the fetus' blood. Approximately one-third of women who become infected for the first time during pregnancy will pass the infection to the baby.

    What are cytomegalovirus symptoms and signs?

    Most people infected with CMV do not have any symptoms. Acute CMV infection may cause infectious mononucleosis-like (or mono-like) symptoms such as fever, enlarged lymph nodes, sore throat, muscle aches, loss of appetite, and fatigue.

    In people with a suppressed immune system, CMV infection can attack different organs of the body and may cause blurred vision and blindness (CMV retinitis), lung infection (pneumonia), diarrhea (colitis), inflammation of the liver (hepatitis), or inflammation of the brain (encephalitis), causing possible behavioral changes, seizures, or coma.

    Infants with CMV infection at birth (congenital CMV) can show signs and symptoms of yellow skin and eyes (jaundice), skin rash, low birth weight, pneumonia, big liver and spleen, and seizures.

    How do physicians diagnose cytomegalovirus infection?

    Most CMV infections go undiagnosed because the virus causes little to no symptoms. When a person is infected with CMV, antibodies (proteins) to the virus called IgM and/or IgG anti-CMV antibodies develop and stay in the body for the rest of the person's life. A blood test to detect the antibodies will be positive if the person has had a CMV infection. If the antibody test is negative, the person is considered to be CMV negative.

    A diagnosis of an active CMV infection can be made if the virus is found in bodily fluids (such as blood, saliva, or urine) or body tissues by culturing (growing) the virus or detecting its DNA or specific protein called pp65 antigen by PCR tests. These tests are done if a person has a history of signs and symptoms consistent with an active CMV infection. The virus can become reactivated from its latent state (latent infection) when a person's immune system has weakened.

    A physician may diagnose a congenital CMV infection if he or she detects the virus in a newborn's urine, saliva, blood, or other body tissues within two to three weeks after birth.

    What is the treatment for cytomegalovirus infection?

    There is no cure for CMV, and treatment for CMV infection is not necessary in healthy children and adults. People with a weakened immune system who have symptoms of CMV infection are placed on antiviral medication. Up to 75% of transplant recipients develop CMV infection. Those who have a very high risk of developing severe CMV infection may be placed on antiviral medication to prevent CMV disease. This pretreatment is called prophylaxis. This method has helped reduce the number of CMV infections in these patients. The antiviral medications against CMV include the following:

    • Ganciclovir (Cytovene) is the first antiviral medication approved for the treatment of CMV infection. Ganciclovir, given intravenously, is the drug of choice for the treatment of CMV infection. Side effects include fever, rash, diarrhea, anemia, and low white blood cell and platelet counts.
    • Valganciclovir (Valcyte) is an oral medication that is activated to ganciclovir in the body and widely used to prevent CMV infection (prophylaxis). It is used in selected patients for the treatment of CMV infection and is as effective as intravenous ganciclovir in non-severe cases.
    • Foscarnet (Foscavir) is active against CMV by a different mechanism than ganciclovir and used to treat infections with CMV that are resistant to ganciclovir. It is a second-line therapy for patients who do not tolerate ganciclovir treatment. Foscarnet is toxic to the kidneys and can cause seizures due to an imbalance of minerals and electrolytes.
    • Cidofovir (Vistide) is an alternative therapy for patients who have failed ganciclovir and foscarnet treatment. Its use is limited due to toxicity to the kidneys. It is used mainly for the treatment of CMV infection of the eye (retinitis) in patients with acquired immune deficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV).
    • CMV immune globulin contains antibodies (proteins) that are specific to CMV. It is FDA-approved to prevent CMV infection in high-risk lung transplant patients when given in addition to ganciclovir. It is also used with ganciclovir to treat CMV pneumonia.

    No antiviral drug is FDA-approved for the treatment of congenital CMV infection. However, some infants who have infection involving the central nervous system (brain and spinal cord) may benefit from treatment. Some evidence shows that ganciclovir may prevent hearing loss and developmental problems in infants who have severe symptoms of congenital CMV infection. Because of the serious side effects of ganciclovir, a physician specialist should be consulted.

    There are no home remedies proven to be effective in treating CMV infection.

    Source: http://www.rxlist.com

    There is no cure for CMV, and treatment for CMV infection is not necessary in healthy children and adults. People with a weakened immune system who have symptoms of CMV infection are placed on antiviral medication. Up to 75% of transplant recipients develop CMV infection. Those who have a very high risk of developing severe CMV infection may be placed on antiviral medication to prevent CMV disease. This pretreatment is called prophylaxis. This method has helped reduce the number of CMV infections in these patients. The antiviral medications against CMV include the following:

    • Ganciclovir (Cytovene) is the first antiviral medication approved for the treatment of CMV infection. Ganciclovir, given intravenously, is the drug of choice for the treatment of CMV infection. Side effects include fever, rash, diarrhea, anemia, and low white blood cell and platelet counts.
    • Valganciclovir (Valcyte) is an oral medication that is activated to ganciclovir in the body and widely used to prevent CMV infection (prophylaxis). It is used in selected patients for the treatment of CMV infection and is as effective as intravenous ganciclovir in non-severe cases.
    • Foscarnet (Foscavir) is active against CMV by a different mechanism than ganciclovir and used to treat infections with CMV that are resistant to ganciclovir. It is a second-line therapy for patients who do not tolerate ganciclovir treatment. Foscarnet is toxic to the kidneys and can cause seizures due to an imbalance of minerals and electrolytes.
    • Cidofovir (Vistide) is an alternative therapy for patients who have failed ganciclovir and foscarnet treatment. Its use is limited due to toxicity to the kidneys. It is used mainly for the treatment of CMV infection of the eye (retinitis) in patients with acquired immune deficiency syndrome (AIDS) caused by the human immunodeficiency virus (HIV).
    • CMV immune globulin contains antibodies (proteins) that are specific to CMV. It is FDA-approved to prevent CMV infection in high-risk lung transplant patients when given in addition to ganciclovir. It is also used with ganciclovir to treat CMV pneumonia.

    No antiviral drug is FDA-approved for the treatment of congenital CMV infection. However, some infants who have infection involving the central nervous system (brain and spinal cord) may benefit from treatment. Some evidence shows that ganciclovir may prevent hearing loss and developmental problems in infants who have severe symptoms of congenital CMV infection. Because of the serious side effects of ganciclovir, a physician specialist should be consulted.

    There are no home remedies proven to be effective in treating CMV infection.

    Source: http://www.rxlist.com

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