CMV - immunocompromised host

Also known as: Cytomegalovirus - immunocompromised host

Definition

Cytomegalovirus (CMV) is a member of a group of herpes-type viruses that can cause disease in different parts of the body in people. This article discusses CMV in people with weakened immune systems.

Causes, incidence, and risk factors

Most humans are exposed to CMV in their lifetime, but typically only individuals with weakened immune systems become ill from CMV infection. Usually, CMV produces no symptoms. However, serious CMV infections can occur in people with weakened immune systems due to AIDS, organ transplants, bone marrow transplant, chemotherapy, or medicines that suppress the immune system.

A CMV infection may affect different parts of the body. Infections include:

• CMV esophagitis (infection of the esophagus)
• CMV gastroenteritis (infection of the stomach or intestines)
• CMV retinitis (infection of the eye)
• CMV pneumonia (infection of the lung)
• Mononucleosis-like illness

Once a person becomes infected, the virus remains alive, but usually dormant, within that person's body for life. Rarely does it cause recurrent disease, unless the person's immune system is suppressed due to medication or disease. Therefore, for most people, CMV infection is not a serious problem.

Primary CMV infection in pregnant women can cause harm to the developing fetus. See: Congenital cytomegalovirus

Symptoms

The symptoms of CMV infection are similar to those of mononucleosis. In fact, in a small percentage of people with mononucleosis, CMV is the cause. The symptoms of primary CMV infection are:

• Fatigue
• General discomfort, uneasiness, or ill feeling (malaise)
• Joint stiffness
• Loss of appetite
• Muscle aches or joint pain
• Night sweats
• Prolonged fever
• Sore throat
• Swelling of the lymph nodes
• Weakness
• Weight loss

In immunocompromised people, CMV can attack specific organs. The major symptoms of these organ-specific infections are:

Eye:

• Blindness
• Floaters in the eye
• Visual impairment

Lung:

• Pneumonia with impaired oxygen uptake (hypoxia)

Gastrointestinal:

• Diarrhea
• Swallowing difficulties or pain
• Ulcerations with bleeding

Brain:

• Coma
• Encephalitis with behavioral changes
• Seizures

Signs and tests

Blood and urine tests can detect and measure substances specific to CMV. A tissue biopsy is often required to be certain of the diagnosis (except in the eye or nervous system).

Treatment

Several antiviral medications are available to treat CMV. These medicines require close monitoring for side effects. Antiviral drugs can help stop the virus from copying itself within the body. However, the drugs do not eliminate the virus from the body.

Expectations (prognosis)

CMV infection in an immunocompromised person can be life threatening. The severity of the disease depends on the strength of the person's immune system. Research has shown that people who have had a bone marrow transplant have the highest mortality risk.

Any immunocompromised person, whether an HIV patient, organ transplant recipient, bone marrow transplant recipient, or other, should seek medical advice if any signs of infection occur.

Complications

• Blindness
• Kidney impairment (from medications used to treat the condition)
• Liver damage
• Low white blood cell count (from medications used to treat the condition)
• Meningitis
• Pneumonia

Calling your health care provider

Call your health care provider if you are immunosuppressed and you have symptoms of CMV infection.

Prevention

The following should be tested for CMV:

• Anyone who has symptoms of infectious mononucleosis, but has negative test results for mononucleosis and Epstein Barr virus
• Anyone who shows signs of hepatitis, but has negative test results for hepatitis A, hepatitis B, and hepatitis C

References

Drew WL. Cytomegalovirus. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 399.

See also:

• Disease

  Encephalitis

  Encephalitis is irritation and swelling (inflammation) of the brain, most often due to infections. See also:

• Special Topic

  Antibody

  

  An antibody is a protein produced by the body’s immune system when it detects harmful substances, called antigens. Examples of antigens include microorganisms (such as bacteria, fungi, parasites, and viruses) and chemicals. Antibodies are also produced when the immune system mistakenly ...

• Surgery

  Bone marrow transplant

  

  A bone marrow transplant delivers healthy bone marrow stem cells into the patient. It replaces bone marrow that is either not working properly or has been destroyed (ablated) by chemotherapy or radiation.

• Disease

  Viral gastroenteritis

  

  Viral gastroenteritis is inflammation of the stomach and intestines from a virus. The infection can lead to and vomiting. It is sometimes called the “stomach flu.”

• Test

  WBC count

  

  A WBC count is a blood test to measure the number of white blood cells (WBCs). White blood cells help fight infections. They are also called leukocytes. There are five major types of white blood cells: Basophils Lymphocytes (T cells and B cells) Monocytes Neutrophils See also:

• Special Topic

  Chemotherapy

  

  Chemotherapy is the use of drugs to kill bacteria, viruses, fungi, and cancer cells. Most commonly, the term is used to refer to cancer-killing drugs. This article focuses on cancer chemotherapy.

• Disease

  Cytomegalovirus retinitis

  

  Cytomegalovirus (CMV) retinitis is a viral inflammation of the retina of the eye.

• Disease

  Meningitis

  

  Meningitis is a bacterial infection of the membranes covering the brain and spinal cord (meninges). See also:

• Disease

  AIDS

  

  AIDS (acquired immune deficiency syndrome) is the final stage of , which causes severe damage to the immune system.

• Special Topic

  Immune response

  

  The immune response is how your body recognizes and defends itself against bacteria, viruses, and substances that appear foreign and harmful.

• Disease

  CMV - pneumonia

  

  Cytomegalovirus (CMV) pneumonia is an infection of the lungs that can occur in people who have a suppressed immune system. See also:

Review date:

December 1, 2009

Reviewed by:

David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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