Cytomegalovirus

Question 1

Another name

Answer 1

HHV 5

Memory aid:

• HSV 1, 2
• VE_C_ – HHV 3, 4 and 5

Question 2

Can it be cultured?

Answer 2

Yes, in shell tubes

Question 3

Transmission

Answer 3

• Congenital
• Transfusion
• Sexual contact
• Saliva
• Urine
• Organ transplant
• Breastmilk

Question 4

Disease (s) caused

Answer 4

• Usually asymptomatic
• Mononucleosis (⊝ Monospot) in immunocompetent patients
• Infection in immunocompromised, especially pneumonia in transplant patients
• Esophagitis
• AIDS retinitis
• Congenital CMV
• IUGR/IUFD

Memory aid:

• _Cyto_megalovirus – “_Sighto_megalovirus”
• ⊕ Monospot is seen in mononucleosis seen in EBV

Question 5

Histopath finding

Answer 5

• Infected cells have characteristic “owl eye” inclusions
  
  • intranuclear basophilic inclusions spanning half the nuclear diameter are usually set off from the nuclear membrane by a clear halo

Memory aid:

• _B_asophilic _i_ntra_n_uclear
• Where can you see the owl eye?
  
  • In the BIN!

Question 6

Blood finding/picture

Answer 6

• Lymphocytosis with a significant fraction of atypical lymphocytes
• Large cells with atypia

Question 7

Diagnosis

Answer 7

• Infected cells have characteristic “owl eye” inclusions
• Negative heterophil test

Question 8

DOC

Answer 8

Ganciclovir

• Note:*
• CMV is largely resistant to acyclovir

Question 9

Congenital CMV infection

• Neonatal manifestations
• When is it most common?

Answer 9

• Neonatal manifestations
  
  • Microcephaly
  • Hearing loss
  • Seizures
  • Petechial rash
  • Pblueberry muffin” rash
  • Periventricular calcifications
• When is it most common?
  
  • When mother is infected in 1^st trimester

Question 10

Which types of patients are particularly vulnerable to significant cytomegalovirus infection?

Answer 10

Immunosuppressed patients (especially transplant recipients) and the fetuses of infected mothers

Question 11

DOC for prevention of CMV disease in solid-organ transplant patients

Answer 11

Valganciclovir