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What do you need to know about CMV? – Cytomegalovirus

Cytomegalovirus (CMV) is a widespread virus that causes an infectious disease. Here its symptoms, causes, treatment, and more.

This infection usually has a direct correlation with the salivary glands. It can go without symptoms (asymptomatic) on healthy people, but it can be life-threatening to people with a deficient immune system. It can also be passed down from mother to child, making it a congenital infection. Within this article, you will uncover explanations to some of the most common questions about this disease. There will be questions like the incubation period, how do you contract this disease and many more.

By reading this article, you will acquire fundamental insights about Cytomegalovirus, its symptoms, its complications, and many more. Therefore, please continue reading this article to get pearls on this specific topic by a doctor’s hand.

What is Cytomegalovirus (CMV)?

Cytomegalovirus is a virus that comes from the family Herpesviridae or the Herpes Virus. This group of viruses includes some like the Herpes Simplex Virus, responsible for the Human Herpes; the Varicella Zoster virus, responsible for chickenpox and the shingles, and the Epstein-Barr Virus, responsible for infectious mononucleosis.

The CMV DNA is the largest genome of the herpes viruses. Human cytomegalovirus grows only in human cells. CMV replication is an intricate process that happens within the human cells, like fibroblasts.

Before we dwell on this topic, there are some basic terms everybody should know. Cytomegalovirus has a range of possibilities of symptoms and terms that may become confusing. Therefore, there will be a brief explanation of each term.

  • Primary infection or Primary CMV: The new infection on seronegative patients, ergo, patients without CMV infection in the past. It may be asymptomatic or cause symptoms.
  • Recurrent Infection: It is used to describe the reinfection or the reactivation of CMV in patients who already had this infection in the past (seropositive patients), which often includes patients with a weak immune system (immunocompromised patients).
  • CMV infection: It refers to the presence of the CMV in body fluids such as blood, urine, or tissues like epithelial cells or endothelial cells.
  • CMV disease: It refers to the CMV infection with the association of non-specific signs and symptoms that suggest an underlying disease or organ involvement.

How do you contract cytomegalovirus, and how frequent is this disease?

CMV disease is one of the most frequent diseases in the world. According to studies, approximately 59% of the population older than six years has been exposed to CMV.

This virus infects about 60% to 70% of adults in developed countries and close to 100% in developing countries. In the United States, almost one in three children has CMV within their bodies by age 5. And over half of adults have CMV infection by age 40. One thing that happens with the CMV is that once it is in a person’s body, it stays there for the rest of their life. 

On the other hand, the transmission of CMV has many ways and forms. An infected person that carries the CMV may pass the virus through body fluids in the subsequent ways:

  • From personal contact with saliva or urine, especially for babies or young children.
  • Through sexual contact, vaginal fluids and semen may carry the CMV.
  • Breastfeeding nursing infants may imply a CMV transmission from the mother to the baby.
  • Through organ transplantation and blood transfusions. Many of the organ transplant recipients may become infected with CMV. This is why transplant patients should always be tested after the organ transplant.

If a woman acquires CMV disease while pregnant, the baby is at risk of having Congenital CMV infection, which is different from the perinatal CMV. On the congenital cytomegalovirus infection, the CMV passes through the placenta, causing a fetal infection. On the perinatal CMV, the baby acquires the CMV through breastfeeding from its mother.

What are the symptoms of cytomegalovirus?

On this question, we will talk about the symptoms of patients with a primary CMV infection.

The primary CMV infection usually has an asymptomatic or subclinical course. The most common presentation on these patients is CMV mononucleosis. Of course, these are patients with an intact immune system, which means they do not have HIV/AIDS, autoimmune diseases, or under treatment with steroids, among other situations that impair the immune system.

Patients with primary infection may suffer from mild flu-like symptoms. However, patients may also debut with the mononucleosis type, which includes the following symptoms:

  • Fatigue
  • Fever
  • Sore Throat (Pharyngitis)
  • Muscle Aches
  • Rash
  • Enlargement of the lymph nodes, especially around the neck (Swollen glands).
  • Splenomegaly or enlargement of the spleen.

The CMV mononucleosis’s signs and symptoms are very similar to those of the Epstein Barr Virus (EBV). However, it is more common to have pharyngitis and a more significant enlargement of the lymph nodes in the EBV mononucleosis. Both of these diseases cause as well an alteration of the lymphocytes in the blood, making them look atypical. Other studies may reveal alteration on the hepatic enzymes, which means these patients can also have liver swelling (hepatitis).

Congenital CMV Symptoms

Most of the babies who are infected with the CMV may look healthy at birth. However, these babies may develop symptoms over time. It may take months or even years for these symptoms to develop in these babies. The most common symptom they suffer is hearing loss and a developmental delay. 

On the other hand, some babies have congenital CMV and are sick at birth. These babies tend to suffer from several brain, liver, spleen, lungs, and growing problems.

The following symptoms are the most common:

  • Premature birth.
  • Low birth weight
  • Jaundice or yellow skin and eyes
  • Purple skin splotches or a rash, or both.
  • Abnormally small head (Microencephaly)
  • Pneumonia
  • Seizures

What are the complications of cytomegalovirus infection?

Cytomegalovirus complications can be seen the most in an infected person with a deficient immune system—for example, people with HIV infection or AIDS.

It can also be possible to find them in people who are transplant recipients; these include patients with an organ, bone marrow, or stem cell transplant. 

These patients with a weak immune system may present a more severe type of Cytomegalovirus infection. It can affect several organs within their bodies, including the eyes, lungs, liver, brain, and esophagus.

The main complications of the CMV infection on these patients are the following:

  • Eye involvement, CMV retinitis: It is an inflammation of the retina (the inner layer of the eye), the CMV can even lead to blindness. The eye acquires the characteristic appearance of a “pizza pie” in the ophthalmic examination. It is the most common complication among patients who are HIV positive. 
  • Lungs involvement, CMV pneumonitis or CMV pneumonia
  • Esophagus involvement, CMV esophagitis
  • Liver involvement, CMV hepatitis can also lead to a fulminant liver failure
  • Transverse myelitis
  • Subacute encephalitis
  • Polyradiculopathy

On infants with congenital CMV, they may also experience several complications. These complications may take some time to appear nonetheless.

The complications these infants may suffer are the following:

  • Hearing Loss
  • Intellectual disability
  • Vision problems
  • Seizures
  • Lack of coordination
  • Weakness or problems using muscles

What are the risk factors for cytomegalovirus infection?

This is a worldwide spread infection; almost anyone can have it. People with a healthy immune system tend to go asymptomatic with this infection, making it very hard to identify. It usually shows up when doing the lab tests without people even knowing they have it. But if you really want to try to avoid this infection you should watch out for the following:

  • Blood Transfusions: Talk to your doctor about this procedure’s safety and if the blood you are receiving has been tested for CMV.
  • Children: CMV spreads very easily in places with lots of young children as they are the most likely carriers and spreaders of this disease. 
  • Sexual contact
  • Organ transplants
  • Medications like steroids that may weaken your immune system
  • Health conditions that may weaken the immune system

What is the incubation period for cytomegalovirus?

An incubation period is a time it takes for someone to manifest a disease after acquiring, in this case, the virus. The incubation period of the CMV tends to vary depending on the patient. However, several studies show that if there is any type of symptom, they will appear from one to eight weeks after the primary infection.

How can you prevent the Cytomegalovirus Infection?

The best way to prevent CMV seems very easy; all it takes is good personal hygiene. People tend to be very sloppy with daily life activities. Still, CMV is an easily transmitted disease, and one should always be aware that all of us are very likely to get it through time.

Among the precautions for daily life activities, we have the following:

  • Wash your hands: Washing hands very often will make a huge difference. Using soap from 15 to 20 seconds and constant water will get off everything. This is especially useful if you happen to be in direct contact with young children, diapers, saliva, or other oral secretions. Especially important as well if these kids are at centers like daycares. These sites are a potential nest for the CMV.
  • Please avoid contact with tears and saliva when you kiss a child: Giving attention and affection to your kids is essential. However, avoiding kissing them on the lips or when they are crying will help. Try kissing them on the forehead instead. This is very useful, especially for women who are pregnant.
  • Avoid sharing food or drinking out of the same glass as others: We do not know who can be a carrier of this disease, so avoid sharing glasses and kitchen utensils.
  • Be careful with disposable items: While dealing with disposable items like diapers, tissues, or napkins, be very careful if they have body fluids on them. After handling these items, wash your hands.
  • Clean toys and countertops.
  • Practice safe sex: as always, having protection while having sexual intercourse or a monogamous relationship will decrease the chances of contracting other people’s infections.

There are people with a weak immune system, and there are methods to protect them. Antiviral medications may benefit them, helping to prevent the disease. And for pregnant women, there are experimental CMV vaccines that can help avoid CMV infection in mothers and infants.

What types of disease does reactivation of latent cytomegalovirus cause?

To successfully reactivate the latent CMV infection, the body will have to go through a process in which its immune system becomes weak.

Several diseases will make this happen. For example, HIV infection will lower the count of lymphocytes. When the lymphocyte count goes down (AIDS), the CMV will take the chance and reproduce itself in larger quantities than before.

Among the diseases that can reactivate the CMV are the following:

  • Cancer: When cancer patients receive chemotherapy treatment, this treatment will likely attack healthy and cancerous cells as well. This will cause a drop in the immune system allowing the CMV to replicate itself. It also applies to certain types of cancer, like Leukemia. 
  • Organ Transplant: To successfully receive a new organ, the receiver’s immune system should be weakened. This will allow the body not to attack the new organ because the immune system identifies it as strange to the body.

How do physicians diagnose this infection?

This will depend if the patient is younger or older than 12 months old. For people older than 12 months old, the procedure is very simple. The physician will extract a blood sample and will perform a serologic test that is very sensible to the CMV antibody. The most common test for this is the ELISA. 

For people younger than 12 months old, the procedure is a bit different. These are beings whose immune system is not fully developed, and the maternal antibodies are on the bloodstream. Physicians search on these patients for the presence of congenital CMV. The standard laboratory test for congenital CMV is the Polymerase Chain Reaction or PCR.

Physicians will perform a PCR on saliva while taking a urine sample as well and testing it for confirmation. This is because the mother may pass the CMV through breast milk. This can cause a false positive on saliva, which is why a physician needs the urine sample to confirm. 

What happens if cytomegalovirus IgG is high?

It will depend. When having an isolated positive test for CMV IgG indicates that this person suffered a CMV infection at some time in their lives. Unfortunately, this test will not tell the exact time of infection.

On the other hand, the IgG high can help diagnose primary CMV infection compared to other IgG measurements over time. The physician will request paired samples for people who are suspicious of having this disease. These tests will have a space of one to three months apart between them. Suppose the first sample is negative for IgG, but the second is positive. In that case, the patient has clear evidence for recent primary infection. This process receives the name of seroconversion.

Moreover, if IgM is positive and IgG is very low, it is also possible to assume that we are in the situation of a primary infection.

What are the treatment options for CMV infections?

Treatment is not really necessary for healthy children and adults with a competent immune system. Healthy adults who develop CMV mononucleosis recover from it generally without specific medication.

For people who have a deficient immune system, the treatment will depend on the complications they have. The treatment will vary depending on the symptoms and the severity of the CMV infection.

The most common type of treatment for these people is antiviral medications. They will help to slow down the process of replication and reproduction of the virus. However, these medications will not eradicate the virus itself from the organism. Once the CMV infection takes place, the CMV will not leave the body of the patient. Nowadays, scientists are doing active research on new types of medications and developing a CMV vaccine to treat and prevent CMV infection. 

Do you have symptoms of this disease?

This tool is a Cytomegalovirus Symptoms Checker. It gathers the most important signs, symptoms, and risk factors for this infection. Therefore, the tool will tell anybody who uses the likelihood of their symptoms because of CMV infection. Using this tool is free and would only take a few minutes.

What do you think?

Written by Dr. Esteban Kosak

Doctor of Medicine - MD Recently Graduated from Medical School and inspired to aid the global population during this situation. I think that we shall no longer be waiting to see a doctor when we feel sick. Several times we feel disease searches in Google drive us to a rabbit hole and come out thinking that we may die of cancer or something very serious, given that symptoms may seem to fit a wide variety of illnesses. Since I recently graduated from medical school. I have all the medical information fresh in my mind. My thorough experience as an expert researcher allows me to very-well known the different diseases and conditions that affect human bodies. Empowered by the United Nations 17 Sustainable Development Goals (SGDs). I think that we all can provide a grain of sand to help humanity. That's why we created Symptoms.Care a place where you can come and screen your symptoms and find what different illnesses can be related to them. Armed with the right information you can instantly, discretely, secure and from the comfort of your home talk with a Doctor that can Evaluate your Symptoms and help you seek the right treatment.

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