8.5.09 wilson cmv in immunocompetent host

7/23/2019 8.5.09 Wilson CMV in Immunocompetent Host

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CMV in Immunocompetent Hosts

Internal Medicine

Morning Report August 2009Lindsay A. Wilson



A Herpes Virus:

A double-stranded linear DNA virus with 162 hexagonalprotein capsomeres surrounded by a lipid membrane. CV has the largest genome o! the herpes viruses" ranging

!rom 2#$%2&$ 'ilobase pairs. ost closely related to HHV%6and (.



CV ononucleosis:

) ost common presentation o! symptomatic CV in!ection inimmunocompetent adults.

) *ystemic symptoms and !ever predominate and signs o!enlarged cervical nodes" tonsillitis" and splenomegaly arenot as commonly seen as they are in +,V.

) -atients with CV mononucleosis may be older and have a

longer duration of fever .

) !ten see mild transaminitis" which can aid in diagnosis.



-revalance o! CV /orldwide%%*eroprevalence

rates ranging between 40 to 100 percent o! the adultpopulation. *tudies suggest that certain groups 0iedeveloping countries have a higher prevalence.



ransmission

) Via body fluids: CV has been cultured !rom multiplesites" including urine" blood" throat" cervix" semen" stool"tears" and breast mil'.

ypical owl3s eye inclusion seen on H+ stain.



Other Presentations:

Disease localized to a single organ hasbeen described in immunocompetenthosts. Of course, this is much lesscommon.



45:

C55*:) Diarrhea, fever, and abdominal pain are the common

presenting symptoms.) Can be bloody diarrhea 0about hal! o! the time and mimic

ischemic colitis.

Can also have CV hepatitis" gastroduodenititis" gastric

ulcers" cholangitis" pancreatitis.



CV:

-ericarditis and myocarditis have been described inimmunocompetent patients with acute CV in!ection. hought to be under%diagnosed due to it3s milder presentation.

/hen it is !ound" it is o!ten an incidental !inding on +74 or+CH.



8euro:

) 4uillain%,arr9 syndrome:CV%related 4,* are generally younger and experience moreprominent sensory de!icits" respiratory insu!!iciency" and cranialnerve impairments.

) +ncephalitis:*ymptoms can include: motor de!icits 0localied wea'ness"paraplegia" sensory abnormalities 0numbness" hypoaesthesia"

paraesthesia" dysaesthesia" anaesthesia" disorientation"con!usion.

) ransverse myelitis



-ulm:

-neumonia: ccurs at a rate o! approximately $%6; in CVin!ections. !ten see ground%glass appearance on C scan.



<enal: Collapsing !ocalglomerulosclerosis

5n!ections that Can Cause =*4* H5V" CMV " HV%1"parvovirus ,1>" polyomavirus" pulmonary ," leishmaniasis.



cular:

Anterior uveitis 0also called iritis is more commonly seen inimmunocompetent 0versus the retinitis seen in A5?* patients. -resenting symptoms include loss or blurring o! vision" as well

as redness o! the a!!ected eyes.



4ancyclovir

) he drug o! choice !or treatment o! cytomegalovirus 0CVdisease is ganciclovir.

) 4anciclovir is a nucleoside analogue that inhibits DNA

synthesis in the same manner as acyclovir. he ma@ordi!!erence is that CM does not contain a thymidine!inase.

)

a@or adverse e!!ects o! ganciclovir therapy areneutro"enia and thrombocyto"enia.



CV: most common congenitalin!ection

A woman who contracts CV !or the !irst time duringpregnancy has about a 1-in-# chance o! passing the virus onto her !etus.

A woman can pass CV on to her baby at any stage o!pregnancy. However" studies suggest that babies are moreli'ely to develop serious complications when their mother isin!ected in the first $0 %ee!s of "regnancy.

nly about 1 percent o! !etuses become in!ected when theirmother has a recurrent infection. /hen these babies dobecome in!ected" they rarely develop any serious CV%relatedproblems.



,abies w CV:

) About 1$ percent show temporary symptoms li'e liver orspleen problems that eventually resolve.

) A very small percentage o! babies born do su!!er severe

complications: seiures" loss o! hearing and vision" mentaland physical disabilities" delayed development and evendeath.

) *ome in!ected children don3t demonstrate any o! these

symptoms !or months or years a!ter birth" or experienceworse symptoms later in li!e a!ter showing initially mildsymptoms.

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ips !or pregnant women:

/ash handsBB

Avoid secretions !rom small children.

Healthcare wor'ers%%may want to be tested to 'now statushowever" this is not a general recommendation.



a'e home points...

ost common presentation o! CV in immunocompetent ismononucleosis%li'e illness. 5t can have some !eatures that mayhelp distinguish it !rom +,V.

CV in!ection can also be localied to a single organ. CV is an important congenital in!ection that is under%recognied. onitor C,C with di!! in patients on ganciclovir. 5t is spread via bodily !luids" so hand%washing is an importantway to avoid in!ection.



/or's Cited

-etros 5 <a!ailidis et al. *evere cytomegalovirus in!ection in apparentlyimmunocompetent patients: a systematic review. Virol D. 2$$E F: &(. 2$$E arch2(. =ernande%<ui et al. Cytomegalovirus myopericarditis and hepatitis in animmunocompetent adult: success!ul treatment with oral valganciclovir.

5ntern ed. 2$$E&(022:1>6#%6. +pub 2$$E 8ov 1(.

Gptodate.

http://docs.google.com/present/edit?id=0AXnTJJdDz1UIZGdkNjl4cjdfMmNuOGdyZmYy&hl=en#

http://docs.google.com/present/edit?id=0AXnTJJdDz1UIZGdkNjl4cjdfMmNuOGdyZmYy&hl=en#

8.5.09 wilson cmv in immunocompetent host

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