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Cytomegalovirus
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
CMV is usually asymptomatic or with symptoms so mild that it goes undiagnosed. The symptoms might include a mononucleosis-like or flu-like syndrome, malaise, fatigue, lymphadenopathy, or persistent fever, and abnormal laboratory values (lymphocytosis, or increased aminotransferase levels). Rarely, hepatosplenomegaly, cough, headache, rash, and gastrointestinal symptoms can occur [12]. The presence of symptoms or laboratory abnormalities is highly suggestive of primary infection [13].
Cytomegalovirus
Published in Avindra Nath, Joseph R. Berger, Clinical Neurovirology, 2020
The diagnosis of CMV disease in the nervous system must be based on a combination of clinical presentation and supportive imaging and laboratory findings [77]. Evidence of CMV by culture, serologic testing and CSF chemistries, and cell counts can provide important clues to the correct diagnosis. Antigen detection assays and PCR to demonstrate viral genome in peripheral blood samples, CSF, and tissues now facilitate the diagnosis (Table 8.2).
Oncogenic Properties Of Human Cytomegalovirus
Published in Fred Rapp, Oncogenic Herpesviruses, 2019
Human cytomegalovirus (CMV) is a species-specific agent, which can cause infections without visible symptoms or produce severe, occasionally fatal disease. The severity of congenital CMV infection ranges from principal or multiple organ involvement resulting in death to asymptomatic infection manifested only as viruria. The broad social significance of nonfatal CMV infections was first suggested by Weller and Hanshaw in 1962.1 Patients with clinical CMV infection developed growth retardation, cardiovascular anomalies, structural abnormalities in the derivatives of the first embryonic arch, and deafness.2 Unusual abnormalities of the central nervous system (microcephaly encephalomalacia, parietal lobe cyst, cerebellar aplasia, and dolichocephaly) have been observed, as well as microphthalmia, cataracts, blindness, and malformation of the interior eye chamber.3 Long-term follow-up of patients with CMV infection during infancy resulted in the description of “expanded syndrome”4 which noted eye abnormalities, hearing loss, developmental retardation, abnormal electroencephalograms, congenital heart disease, unusual dermatoglyphics, retarded bone development, hypoplastic lumbar spine, unusual urine chromatography, and inguinal hernia.
Optimizing the treatment of cytomegalovirus infection in allo-HSCT recipients
Published in Expert Review of Clinical Immunology, 2023
Yu-Qian Sun, Rui Ma, Xiao-Jun Huang
CMV infection is commonly seen after allo-HSCT and occasionally after autologous transplantation, which is mostly due to reactivation of latency. Incidences of CMV infection post allo-HSCT vary in different transplant modes, ranging from 11.2% to 25.7% in matched related donor (MRD) transplantations, 19.2% to 37.3% in unrelated donor (URD) transplantations, 27.3% to 69.2% in cord blood donor transplantations (CBT) [10], and 59.5% to 81% of patients receiving a haploidentical donor (HID) allo-HSCT [11–13]. It is important to note that there are usually no symptoms associated with CMV infection, and occasionally, they will present with end organ disease. The incidence of CMV disease is between 2.92% and 17% [4,14]. Despite most patients lacking overt symptoms, there is also evidence that CMV-infected individuals may have long-term adverse outcomes related to so-called indirect effects, such as increased graft-versus-host-disease (GVHD), poor graft function, and increased rates of other infections (such as invasive aspergillosis, coreactivation of herpes viruses, etc.) [15–17].
Prevention of viral infections in solid organ transplant recipients in the era of COVID-19: a narrative review
Published in Expert Review of Anti-infective Therapy, 2022
Paraskevas Filippidis, Julien Vionnet, Oriol Manuel, Matteo Mombelli
CMV has a seroprevalence rate of up to 70% in most developed countries, while up to 100% of adults may be seropositive in tropical regions [93]. In SOT recipients, CMV infection is classified into asymptomatic CMV infection (characterized by detection of viral replication in blood in the absence of symptoms), or CMV disease. CMV disease is further divided into CMV syndrome, characterized by fever and unspecific symptoms such as malaise and fatigue, leukopenia, thrombocytopenia or liver tests elevation, and CMV end-organ disease [94]. Donor positive/recipient negative (D+/R-) CMV serostatus, lung transplantation, and treatment with lymphocytes depleting agents are the main risk factors for the development of CMV disease [95–99]. Besides direct organ damage, CMV infection has been associated with an increased risk of acute rejection, graft dysfunction and graft loss, and other opportunistic infections [100–103]. In the absence of prophylaxis, CMV infection usually occurs within the first 3 months post-transplant, while when prophylaxis is used, CMV mostly manifest as a late-onset CMV infection or disease [104].
Individualized management of cytomegalovirus in solid organ transplant recipients
Published in Expert Review of Precision Medicine and Drug Development, 2021
Huma Saeed, Matthew Thoendel, Raymund R Razonable
Presence of viral replication, regardless of clinical symptoms or signs, as assessed by nucleic acid amplification testing (NAT), pp65 antigenemia or viral cultures, or identification of intracytoplasmic and intranuclear inclusions in tissue specimens using immunohistochemistry. 2. CMV disease:Presence of symptoms during active CMV infection, and these are characterized into two clinical syndromes:CMV syndrome – presence of detectable CMV in blood with at least two of the following clinical features: fever (temperature >38°C) for at least 2 days; new malaise; neutropenia or thrombocytopenia; increased atypical lymphocytes in blood (>5%); and elevated hepatic aminotransferases to twice the upper limit of normal [3].Tissue-invasive CMV disease – presence of end-organ specific symptoms along with histological findings showing cytopathic effect in the tissue. The most common end-organ manifestations are gastrointestinal disease (e.g. colitis), hepatitis and pneumonia, although nephritis, pancreatitis, myocarditis, retinitis, and other organ involvement have also been described [3].