A.43 CMV Flashcards
A.43 CMV
Epidemiology
- CMV Infection Prevalence: Ranges from 40% to 100% in the general population.
- Age-related Seroprevalence: Exceeds 90% in individuals over 80 years of age.
A.43 CMV
Etiology
Pathogen: Cytomegalovirus (CMV, HHV-5)
Transmission:
- Blood Transfusions
- Sexual Contact
- Transplacental Transmission (highest risk in the first trimester of pregnancy)
Perinatal Transmission
- Body Fluids (e.g., respiratory droplets, saliva, urine, genital secretions)
- Transplant Transmission (e.g., through bone marrow, lungs, kidneys)
A.43 CMV
pathophys
CMV Binding: CMV attaches to integrins, leading to the activation of integrins and resulting in cellular morphological changes.
Signal Activation: This triggers signal transduction pathways, including FAK (focal adhesion kinase) and pathways related to apoptosis, causing cell damage with varied clinical manifestations based on the affected organ or tissue.
Latency: After the resolution of primary infection, CMV persists in a latent state within mononuclear cells. Reactivation may occur if the individual becomes immunocompromised.
A.43 CMV
Clinical in Healthy patients
- Over 90% experience an asymptomatic course.
- Fewer than 10% develop CMV mononucleosis, which may present with:
- Fever, malaise, myalgia/arthralgia, fatigue, headache
- Less common symptoms include sore throat, cervical lymphadenopathy, hepatomegaly, and splenomegaly.
- Differential Diagnosis: Infectious mononucleosis.
A.43 CMV
Clinical in Immunocompromised Patients
CMV Pneumonia:
CMV Retinitis:
CMV Esophagitis and/or CMV Colitis:
Adrenal Insufficiency:
A.43 CMV
CMV Pneumonia:
Common in immunocompromised individuals (CD4 counts < 200 cells/mm³).
Clinical Findings: Cough, dyspnea.
Diagnostics:
Chest X-ray: May show bilateral interstitial infiltrates.
CT scan: Can reveal brochiolitis, lung involvement, and ground-glass opacities.
Differential Diagnoses: Pneumocystis pneumonia and other viral infections.
A.43 CMV
CMV Retinitis:
Characterized by “pizza-pie” appearance of the retina, with yellow-white opacities and retinal vessel sheathing.
Differential Diagnoses: HSV retinitis, VZV retinitis, toxoplasmosis.
A.43 CMV
CMV Esophagitis and/or CMV Colitis:
Commonly present in HIV/AIDS patients.
Symptoms may include:
Odynophagia, abdominal pain, diarrhea.
Endoscopic examination typically shows linear ulcers.
A.43 CMV
Adrenal Insufficiency:
Particularly seen in HIV-positive patients, manifestations of CMV disease typically occur when CD4 counts drop to around 50.
A.43 CMV
DX
Complete Blood Count (CBC):
Relative lymphocytosis with over 10% atypical lymphocytes and possible pancytopenia.
Blood Smear:
Presence of large atypical lymphocytes with intranuclear inclusion bodies exhibiting an “owl-eye” appearance.
Monospot Test:
May be unreliable in immunosuppressed patients.
Serological Tests:
Active Disease:
Detection of IgM antibodies.
Inactive Disease:
Identification of IgG antibodies, indicating a rise in levels.
Direct Evidence of Viremia:
Peripheral Blood Studies:
PCR to detect CMV DNA in bodily fluids.
Indirect immunofluorescence assay for pp-65 CMV antigens.
A.43 CMV
CMV Retinitis TX
Primary Treatment:
- Valganciclovir
- For Lesions Within 1.5 mm of the Fovea:
- Consider using Ganciclovir or Foscarnet.
- Duration:
- At least 3–6 months.
A.43 CMV
CMV Colitis TX
Mild Disease:
- Oral Valganciclovir
- Severe Disease:
- IV Ganciclovir or IV Foscarnet
- Treatment Duration:
- 21–42 days.
A.43 CMV
CMV Esophagitis TX
Mild Disease:
- Oral Valganciclovir
- Severe Disease:
- IV Ganciclovir or IV Foscarnet
- Treatment Duration:
- 21–42 days.
A.43 CMV
CMV Pneumonia TX
IV Ganciclovir (or IV Foscarnet) and IVIG.
Duration: Continue treatment until the CD4 count exceeds 100 cells/mm³ and symptoms show improvement.
A.43 CMV
CMV Esophagitis TX
- IV Ganciclovir and Foscarnet.
Duration: Continue treatment until the CD4 count exceeds 100 cells/mm³ and symptoms show improvement.
