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Cytomegalovirus


Presentation

  • Time from DMEK to presentation ranged from 5 to 15 weeks. Presenting features included corneal edema, pigmented keratic precipitates, mild anterior chamber inflammation, and raised intraocular pressure.[ncbi.nlm.nih.gov]
  • This illustrates a very late presentation of posttransplant CMV myocarditis and the usefulness of myocardial biopsy in diagnosis of CMV carditis.[ncbi.nlm.nih.gov]
  • The classic severe presentation is hemophagocytic lymphohistiocytosis.[ncbi.nlm.nih.gov]
  • We present this case with literature review for the CMV infection associated morbidity and mortality among immunocompetent children.[ncbi.nlm.nih.gov]
  • We present a case of cytomegalovirus (CMV) native kidney nephritis and prostatitis in a CMV D /R- kidney transplant recipient who had completed six months of CMV prophylaxis four weeks prior to the diagnosis of genitourinary CMV disease.[ncbi.nlm.nih.gov]
Splenomegaly
  • Hemophagocytic lymphohistiocytosis was diagnosed because our patient had elevated levels of serum ferritin, bicytopenia, splenomegaly, fever (  38.5 C), and hemophagocytosis shown in a bone marrow sample.[ncbi.nlm.nih.gov]
  • In 95% of cases this occurs without symptoms, but some neonates may present jaundice, hepato-splenomegaly and retarded psycho-motorial development.[diesse.it]
  • CMV may also produce a mononucleosis syndrome similar to Epstein-Barr virus (causing a febrile illness with splenomegaly, impaired liver function and abnormal lymphocytes in the blood) but without characteristic pharyngitis and lymphadenopathy.[patient.info]
  • It is generally indistinguishable from Epstein-Barr virus (EBV) mononucleosis, although it is more common for splenomegaly to be associated with CMV mononucleosis.[clinicaladvisor.com]
  • The clinical syndrome of congenital cytomegalic inclusion disease includes jaundice, splenomegaly, thrombocytopenia, intrauterine growth retardation, microcephaly, and retinitis.[emedicine.medscape.com]
Cervical Lymphadenopathy
  • EBV Mononucleosis syndrome associated with CMV infection differs from that caused by EBV. 13% – 17% patients with CMV-mononucleosis present with cervical lymphadenopathy, vs. 80% with EBV-associated mononucleosis.[pedclerk.bsd.uchicago.edu]
Generalized Lymphadenopathy
  • When clinical manifestations are present, they include: malaise, fever, generalized lymphadenopathy, and hepatosplenomegaly.[perinatology.com]
Fever
  • Hematochezia was more common in IBD patients (84.0% vs. 35.1%; p .001), but fever and positive CMV antigenemia were more common in non-IBD patients (50.9% vs. 12.0%; p .001; 54.4% vs. 28.0; p .027).[ncbi.nlm.nih.gov]
  • A 2-year-old white boy who had no medical history presented with respiratory distress and fever. His Pediatric Risk of Mortality and Pediatric Logistic Organ Dysfunction scores were 20 and 11, respectively.[ncbi.nlm.nih.gov]
  • We present the case of a 77-year-old man with end-stage renal disease who was admitted to the emergency department for a decreased level of consciousness and fever.[ncbi.nlm.nih.gov]
  • We describe a case of an adult with dermatomyositis (DM) who presents with a rash, high fevers, tachycardia and hypotension, initially concerning for an infectious aetiology or a DM flare.[ncbi.nlm.nih.gov]
  • Hereby, we report a twelve-year-old boy who presented with tachycardia, tachypnea, fever and leukocytosis, which progressed to hypoxemic respiratory failure and severe acute respiratory distress syndrome (ARDS).[ncbi.nlm.nih.gov]
Malaise
  • These may include: Enlarged lymph nodes, especially in the neck Fever Fatigue Loss of appetite Malaise Muscle aches Rash Sore throat CMV can cause infections in different parts of the body. Symptoms vary depending on the area that is affected.[nlm.nih.gov]
  • Primary CMV infection in immunocompetent individuals may also manifest as a mononucleosis-type syndrome, similar to primary Epstein-Barr virus infection, with fever, malaise and lymphadenopathy.[mayomedicallaboratories.com]
  • In such cases, symptoms may include: Fever Malaise, tiredness and a general feeling of unwellness Muscle and joint pain These symptoms are sometimes confused with Epstein-Barr-virus-related mononucleosis.[ada.com]
  • Patients present with protracted fever, fatigue or malaise. Lab values show increased WBC with absolute lymphocytosis 50% mononuclear cells and 10% atypical lymphocytes.[pedclerk.bsd.uchicago.edu]
Nausea
  • We describe a 88-year-old male presenting with a week-long history of intractable abdominal discomfort, bloating, nausea and diarrhea. Flexible sigmoidoscopy revealed significant ulceration with yellowish slough.[ncbi.nlm.nih.gov]
  • A 56-year-old man was admitted to the hospital reporting 5 months of progressive ascending lower extremity weakness and numbness, inability to walk, bowel incontinence,urinary retention and several episodes of nausea and vomiting.[ncbi.nlm.nih.gov]
  • Subsequently, the patient developed pyrexia, accompanying headache, nausea, and vomiting with no abnormal brain imaging. Despite receiving antimicrobial treatment, his febrile status and headache persisted.[ncbi.nlm.nih.gov]
  • Gastrointestinal symptoms include nausea and epigastric pain when the infection is in the stomach or duodenum, and severe diarrhea and cramps when it is located in the lower gastrointestinal tract.[hematologyandoncology.net]
  • Symptoms include sore throat, swollen glands, swollen tonsils, tiredness, and nausea. It can cause liver inflammation, or hepatitis, and spleen enlargement. CMV mononucleosis is similar to classic mononucleosis, caused by the Epstein-Barr Virus.[medicalnewstoday.com]
Vomiting
  • A 56-year-old man was admitted to the hospital reporting 5 months of progressive ascending lower extremity weakness and numbness, inability to walk, bowel incontinence,urinary retention and several episodes of nausea and vomiting.[ncbi.nlm.nih.gov]
  • Subsequently, the patient developed pyrexia, accompanying headache, nausea, and vomiting with no abnormal brain imaging. Despite receiving antimicrobial treatment, his febrile status and headache persisted.[ncbi.nlm.nih.gov]
  • Symptoms can include painful and difficult swallowing, nausea, vomiting, abdominal pain, yellow skin and watery or bloody diarrhea.[drugs.com]
  • Symptoms of CMV-related upset in the upper and lower GI tract include: Difficulty swallowing Inflammation of the esophagus Nausea Vomiting Diarrhea Jaundice/hepatitis Pancreatitis, i.e. inflammation of the pancreas Colitis; inflammation of the colon Cholecystitis[ada.com]
  • Here a case of normal nonimmunocompromised host is discribed; the patient was 43 years old male complaining abdominal pain, vomitting, and fever with mononucleosis and hepatitis, and had revealed multiple gastric ulcers in upper gastrointestinal endoscopy[petit.lib.yamaguchi-u.ac.jp]
Heart Block
  • However, our patient developed transient heart block as a rare complication for Ganciclovir therapy throughout his course.[ncbi.nlm.nih.gov]
Periodontitis
  • KEYWORDS: HCMV; cytomegalovirus; herpes; keratinocyte; lytic; oral; pentamer; periodontal[ncbi.nlm.nih.gov]
  • Jørgen Slots , Human viruses in periodontitis , Periodontology 2000 , 53 , 1 , (89-110) , (2010) .[doi.org]
Hepatomegaly
  • On examination, the neonate was found to have respiratory distress, an extensive rash (Panel A), and hepatomegaly.[doi.org]
  • Babies who are infected with CMV before birth are at higher risk of several defects such as microcephaly (small head size), hepatomegaly (enlarged liver), jaundice (yellow color of skin and eyes), anemia (low blood count), pneumonia, seizures, vision[birthdefects.org]
  • Symptomatic newborns present with a variety of abnormalities including low birth weight, microcephaly, seizure, chorioretinitis hepatomegaly, hepatitis, jaundice, thrombocytopenia, petechiae, and characteristic “blueberry muffin” rash due to increased[pedclerk.bsd.uchicago.edu]
Guillain-Barré Syndrome
  • Complications of infection are uncommon in immunocompetent hosts but include: Guillain-Barré syndrome. Meningoencephalitis. Pericarditis. Myocarditis. Thrombocytopenia. Haemolytic anaemia.[patient.info]
  • Rarer manifestations of CMV infections in immunocompetent individuals include Guillain-Barré syndrome, meningoencephalitis, pericarditis, myocarditis, thrombocytopenia, and hemolytic anemia.[emedicine.medscape.com]

Workup

  • A negative pulmonary workup led to an endomyocardial biopsy and the diagnosis of cytomegalovirus (CMV) myocarditis. The patient was treated with ganciclovir and intravenous immunoglobulin.[ncbi.nlm.nih.gov]
  • After extensive workup and lack of improvement with broad-spectrum antimicrobial therapy, intravenous immunoglobulin and steroids, the patient was diagnosed with macrophage activation syndrome after bone marrow biopsy and levels of soluble CD25 (soluble[ncbi.nlm.nih.gov]
  • The aim of this case report is to discuss diagnostic workup and clinical management of cytomegalovirus reactivation in a critically ill immunocompetent pediatric patient.[ncbi.nlm.nih.gov]
  • See Workup for more detail. Management Healthy people who are infected with CMV but who have no symptoms usually do not require medical treatment.[emedicine.medscape.com]
Colitis
  • CONCLUSIONS: In active CMV colitis, the specificity and negative predictive value of blood PCR are high, while the sensitivity grows with the intensity of colon infection.[ncbi.nlm.nih.gov]
  • CMV gastrointestinal infection should be considered as a differential diagnosis in patients with colonoscopy findings similar to ischemic colitis and Clostridium difficile infections.[ncbi.nlm.nih.gov]
  • PubMed Search: CMV colitis[TI] OR cytomegalovirus colitis[TI] colon Advertisement Page views in 2018: 8,804 Page views in 2019 to date: 1,926 Cite this page: Bansal N. Cytomegalovirus (CMV) colitis. PathologyOutlines.com website. .[pathologyoutlines.com]
  • The most common organ affected in CMV disease is the gastrointestinal tract, causing esophagitis, gastritis, enteritis or colitis.[ncbi.nlm.nih.gov]
Viral Inclusion Body
  • Histological examination of the gallbladder wall was positive for multiple viral inclusion bodies.[ncbi.nlm.nih.gov]
  • The pathologic hallmark of CMV infection is an enlarged cell with viral inclusion bodies. Cells that exhibit cytomegaly are also seen in infections caused by other Betaherpesvirinae.[emedicine.medscape.com]

Treatment

  • Antibiotic treatment was started; he was intubated and artificially ventilated. Norepinephrine infusion was started.[ncbi.nlm.nih.gov]
  • Despite a subsequent isolated episode of right heart thrombosis that resolved with heparin treatment, the patient showed a favourable response to eculizumab (300 mg/15 days), with improved renal function, normal haematological values, and no treatment[ncbi.nlm.nih.gov]
  • Strong clinical acumen combined with appropriate handling of these modern technologies are proving invaluable for rapid diagnosis and treatment of this virulent pathogen.[ncbi.nlm.nih.gov]
  • Higher median HCMV IgG titers were observed among patients with immunological treatment success.[ncbi.nlm.nih.gov]
  • We report a case of a man who had unilateral cytomegalovirus anterior uveitis with refractory glaucoma during the process of treatment.[ncbi.nlm.nih.gov]

Prognosis

  • HCMV is detected in the breast tumor tissue where macrophages, especially tumor associated macrophages, are associated with a poor prognosis.[ncbi.nlm.nih.gov]
  • The syndrome mainly affects children and young adults; the prognosis is favorable with complete or nearly complete neurological and radiological resolution within days or weeks.[ncbi.nlm.nih.gov]
  • In CRC, changes in the tumor microenvironment are closely related to cancer behavior and prognosis, while the underlying mechanism driving these changes remains unclear.[ncbi.nlm.nih.gov]
  • Abstract Patients diagnosed with high grade serous ovarian adenocarcinoma have a poor prognosis. Recently human cytomegalovirus (HCMV) has been detected in several tumors.[ncbi.nlm.nih.gov]
  • HCMV also infects macrophages and induces an atypical M1/M2 phenotype, close to the tumor-associated macrophage phenotype, which is associated with the release of cytokines involved in cancer initiation or promotion and breast cancer of poor prognosis[ncbi.nlm.nih.gov]

Etiology

  • Etiology and causality of HCMV infection with IBC now needs to be rigorously examined.[ncbi.nlm.nih.gov]
  • Abstract Malignant gliomas are the most common primary brain tumors in adults, have no known etiology, and are generally rapidly fatal despite current therapies.[ncbi.nlm.nih.gov]
  • However, the etiology is still unknown. Epstein-Barr virus (EBV) genome was demonstrated in H/RS cells more than ten years ago and thereafter many studies supported the finding.[ncbi.nlm.nih.gov]
  • Year introduced: 1994 PubMed search builder options Subheadings: analysis anatomy and histology chemistry classification cytology drug effects enzymology etiology genetics growth and development immunology isolation and purification metabolism pathogenicity[ncbi.nlm.nih.gov]

Epidemiology

  • Abstract Purpose: Recent epidemiological data indicate that a history of increased exposure to sexually transmitted diseases is associated with an increased risk of prostate cancer.[doi.org]
  • 1 Department of Pediatrics, University of Alberta, Edmonton, AB, Canada. 2 DynaLife Medical Labs, Edmonton, AB, Canada. 3 Department of Medicine, University of Alberta, Edmonton, AB, Canada. 4 Canadian Blood Services, Ottawa, ON, Canada. 5 School of Epidemiology[ncbi.nlm.nih.gov]
  • The purpose of this review is to discuss recently published literature regarding the epidemiology, pathophysiology, diagnosis, and therapy of CMV keratitis.[ncbi.nlm.nih.gov]
  • Studies should be performed to identify the epidemiology and risk factors for CMV disease in AAV so that vulnerable patients may be risk-stratified for consideration of preventive strategies such as surveillance and pre-emptive therapy or anti-viral prophylaxis[ncbi.nlm.nih.gov]
  • PURPOSE: Recent epidemiological data indicate that a history of increased exposure to sexually transmitted diseases is associated with an increased risk of prostate cancer.[ncbi.nlm.nih.gov]
Sex distribution
Age distribution

Pathophysiology

  • The exact pathophysiology is unknown; however, infectious-related MERS (in particular virus associated MERS) remains the most common cause of reversible splenial lesions in childhood.[ncbi.nlm.nih.gov]
  • The purpose of this review is to discuss recently published literature regarding the epidemiology, pathophysiology, diagnosis, and therapy of CMV keratitis.[ncbi.nlm.nih.gov]
  • Useful For Suggests clinical disorders or settings where the test may be helpful Aiding in the diagnosis of acute or past infection with cytomegalovirus (CMV) Determination of prior exposure to CMV Clinical Information Discusses physiology, pathophysiology[mayomedicallaboratories.com]
  • […] can be acquired during birth, breast feeding, close contact, sexual contact, transfusion or with organ transplant ( Scand J Gastroenterol 2010;45:1295 ) Sites Most common sites of CMV related gastrointestinal involvement are the esophagus and colon Pathophysiology[pathologyoutlines.com]
  • Pathophysiology - Immunocompetent Hosts Immunocompetent hosts are usually asymptomatic but may present with mononucleosis syndrome. Patients present with protracted fever, fatigue or malaise.[pedclerk.bsd.uchicago.edu]

Prevention

  • Given the absence of evidence-based guidelines for prevention of CMV disease in patients with AAV receiving potent immunosuppressive therapy, further risk-benefit studies are required to ascertain if preventive strategies will reduce CMV-related morbidity[ncbi.nlm.nih.gov]
  • Although available anti-CMV therapies may be effective for the prevention of CMV, they are plagued by unacceptable toxicities that prohibit their use in the post-transplant period.[ncbi.nlm.nih.gov]
  • Decisions regarding prevention and treatment often lack pediatric-specific data to drive decision making.[ncbi.nlm.nih.gov]
  • Scientists are working on CMV vaccines and are looking for other ways to prevent congenital CMV infection.[sites.google.com]
  • Mutant pUL38 TFV/AAA protein did not bind to USP24 and failed to prevent cell death induced by pUL38-deficient HCMV infection.[ncbi.nlm.nih.gov]

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