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DR.MOHAMMED ARIF

ASSOCIATE PROFESSOR

CONSULTANT VIROLOGIST

HEAD OF THE VIROLOGY UNIT

Cytomegalovirus (CMV)

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Virology

Family: Herpesvirinae.

Subfamily: Betaherpesvirinae.

Enveloped, icosahedral particle, about 200nm. The viral genome is ds-DNA.

Replicate in the nucleus.

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EM of herpes virus .

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Disease associated with CMV

In immunocompetent host.

In immunocompromoized.

Congenital infection

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1- infection in immunocompetent hosts

CMV is an opportunistic virus that rarely causes diseases inhealthy people, particularly when infection occurs in childhood.

About 70-90% of adults have antibody to CMV.

In adolescence and early adult hood primary CMV infectionis usually asymptomatic, but may cause infectiousmononucleosis like syndrome.

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Infectious mononucleosis like syndrome

It is a disease of adolescent and young adults.

Symptoms include: fever, loss of appetite, malaise,

splenomegaly, impaired liver function,lymphocytosis with atypical lymphocytes, but

without characteristic pharyngitis andlymphadenopathy.

Patients are negative for heterophil antibody tosheep red blood cell (SRBC).

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Infectious mononucleosis like syndrome

Mild hepatitis and pneumonia may observed in patientswith primary CMV-infection and infectious mononucleosislike syndrome.

Duration; 2-4 weeks.

prognosis: recovery is usual.

Treatment: Infectious mononucleosis like syndrome is afairly mild illness, requires no antiviral drug treatment.

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Lab. diagnosis

By detection of Ig-M antibody to CMV.

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2- Infection in the immunocompromized hosts.

CMV causes severe diseases in the immunocompromizedsuch as transplant patients , patients with AIDS andpatients receiving chemotherapy or other

immunosuppressive therapy.

CMV causes disease in almost every organ of the body, e.g.,pneumonia, hepatitis, colitis, retinitis, and neuropathy.

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CMV and HIV-infection

Retinitis is the most common manifestation of CMV inpatients who are HIV-positive.

CMV-pneumonia in patients who are HIV-positive isuncommon.

Ulceration of GIT (esophagus and stomach) are associatedwith nausea, vomiting, dysphagia and abdominal pain.

Ulceration of the small intestine or colon may causeabdominal pain, diarrhea and gastrointestinal bleeding orperforation.

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Diagnosis of CMV infection

Antigenemia test, testing for CMV-antigen.

PCR, has been used to detect CMV-DNA in the blood andtissue samples.

Biopsy, for demonstration of intranuclear inclusion bodies

Chest x-ray for CMV-pneumonia.

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CMC-congenital infection.

The fetus is infected inside the uterus before ruptureof the fetal membrane.

The fetus is infected through the placenta. Most pregnant women are immune to CMV, due to

childhood exposure.

Most women who are infected during pregnancyhave no symptoms and very few have a diseaseresembling infectious mononucleosis.

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Congenital infection .

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Microcephaly .

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Congenital infection .

The most severe form of congenital CMV infection isreferred to as cytomegalic inclusion disease ( CID ) .

CID occurs when women acquire primary CMVinfection during pregnancy ( especially in the firsthalf of pregnancy ).

CID is characterized by hepatosplenomegaly ,

thrombocytopenia, hemolytic anemia, microcephaly,chorioretinitis, petechiae, deafness and mentalretardation.

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Congenital infection , Lab diagnosis .

By detection of CMV-DNA in urine , using PCR .