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]
If ventriculitis is also present then enhancement of the ependymal surface and hydrocephalus may also be seen. high T2 white matter change most prominent in a periventricular distribution no enhancement (unless ventriculitis present, in which case 30% [radiopaedia.org]
Special techniques help to confirm the presence of multiple organisms, especially if more than one virus is present. [histopathology-india.net]
Immune System
- Splenomegaly
Children born with congenital CMV infection may present with hepatomegaly, splenomegaly, jaundice, pneumonitis, fetal growth retardation, petechiae, purpura, and thrombocytopenia. [orpha.net]
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]
Infection in a Normal Person Common Less common Rare Asymptomatic* Exudative pharyngitis Icteric hepatitis Mononucleosis syndrome Splenomegaly Guillain-Barré syndrome Fever Cervical adenopathy Encephalitis Malaise Nonspecific rash Myocarditis Sore throat [aafp.org]
- Cervical Lymphadenopathy
Cervical lymphadenopathy is less commonly seen in heterophile-negative mononucleosis.The results of liver function tests are abnormal. [atsu.edu]
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]
Fatigue and malaise may persist for 4 weeks or longer. 12 Physical examination shows cervical or generalized lymphadenopathy. Rarely, hepatomegaly, splenomegaly, or rash may develop. Jaundice is uncommon. [glowm.com]
Entire Body System
- 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]
Both CMV and EBV mononucleosis cause fever and fatigue. But EBV also causes a severe sore throat. CMV does not. [msdmanuals.com]
Symptoms may include: Fever Headache Fatigue Muscle aches Enlarged glands Sore throat Enlarged spleen. [southerncross.co.nz]
- Disability
Congenital CMV is a leading infectious cause of deafness, learning disabilities, and intellectual disability. Copyright © 2020, StatPearls Publishing LLC. [ncbi.nlm.nih.gov]
Infected babies may, but not always, be born with a disability. [health.nsw.gov.au]
Abstract One in 150 infants is born with cytomegalovirus (CMV) and one in 750 will have lifelong disabilities due to CMV. [digitalcommons.usu.edu]
Permanent symptoms/disabilities include: hearing loss, vision loss, mental disability, small head, lack of coordination, seizures, and sometimes death. In some children, symptoms do not appear until months or years after birth. [ok.gov]
- Fatigue
Both CMV and EBV mononucleosis cause fever and fatigue. But EBV also causes a severe sore throat. CMV does not. [msdmanuals.com]
A few people will have symptoms such as sore throat, fever, headache and fatigue. People who have weakened immune systems may develop severe symptoms, such as pneumonia or infections of the eyes, liver, or intestinal tract. [cincinnatichildrens.org]
If the mother has symptoms similar to mononucleosis (fever, swollen glands, constant fatigue, tonsillitis, liver malfunction) while pregnant, she may be given a test to screen for CMV. [childrenshospital.org]
- Infectious Mononucleosis
These cells are seen in viral infections, most commonly caused by the Epstein-Barr virus (infectious mononucleosis), cytomegalovirus diseases, and occasionally infectious hepatitis. This is an example of a type I Downy cell. [mountsinai.org]
This study aimed to evaluate the cause of EBV and CMV IgM dual positivity to determine whether it represents a false-positive finding or a true coinfection.A total of 494 children diagnosed with primary EBV infection, manifesting as infectious mononucleosis [ncbi.nlm.nih.gov]
Those who develop symptoms may experience an illness resembling infectious mononucleosis and have fever, swollen glands and feel tired. [www1.nyc.gov]
Infection with CMV, like that with Epstein-Barr virus (EBV, a type 4 herpesvirus), can cause a type of infectious mononucleosis in adolescents and young adults. Both CMV and EBV mononucleosis cause fever and fatigue. [msdmanuals.com]
- 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]
The major symptoms of the disease in organ transplant recipients include fever, myalgia, malaise, arthralgia, leucopenia, thrombocytopenia, and hepatitis. [canada.ca]
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. [mayocliniclabs.com]
Respiratoric
- Sore Throat
A few people will have symptoms such as sore throat, fever, headache and fatigue. People who have weakened immune systems may develop severe symptoms, such as pneumonia or infections of the eyes, liver, or intestinal tract. [cincinnatichildrens.org]
In teenagers and young adults, there is frequently a sore throat and red tonsils with whitish spots (exudate), as seen in this picture. Enlarged lymph nodes and fatigue are also common. [mountsinai.org]
In some cases, infection in healthy people can cause mild illness that may include: Fever Sore throat Fatigue Swollen glands Occasionally, CMV can cause mononucleosis or hepatitis (liver problem). [cdc.gov]
Symptoms may include: Fever Headache Fatigue Muscle aches Enlarged glands Sore throat Enlarged spleen. [southerncross.co.nz]
- Pharyngitis
Pharyngitis is an uncommon manifestation of CMV infection, and vocal cord immobility (VCI) following CMV pharyngitis is quite rare. [ncbi.nlm.nih.gov]
The agents are apparently related to those recovered in other laboratories from a human salivary gland, from a fatal case of cytomegalic disease, and from spontaneously degenerating tissue cultures of human pharyngeal tonsillar tissue. [doi.org]
Anemia Pneumonitis Headache Increased levels on liver function tests Lymphocytosis Antibiotic rash TABLE 1 Presentations of Acute Cytomegalovirus Infection in a Normal Person Common Less common Rare Asymptomatic* Exudative pharyngitis Icteric hepatitis [aafp.org]
Patients infected with CMV who have symptoms of mononucleosis (i.e., fever, cervical lymphadenopathy, pharyngitis) do not have a heterophile antibody response. [atsu.edu]
When symptoms are present, they are non-specific and include rhinitis, pharyngitis, myalgia, arthralgia, headache and fatigue. Infections in pregnant woman are classified as Primary and nonprimary infections. [pedclerk.bsd.uchicago.edu]
Gastrointestinal
- 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]
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]
Symptoms can include painful and difficult swallowing, nausea, vomiting, abdominal pain, yellow skin and watery or bloody diarrhea. [drugs.com]
Meanwhile, she failed to thrive and was occasionally having abdominal distention and vomiting. On the 32nd day of admission, vomiting attacks increased and she developed diarrhea. [tepecikdergisi.com]
She had suffered from vomiting and diarrhea for the last two weeks. [scielo.isciii.es]
Liver, Gall & Pancreas
- Jaundice
The first derived from a liver biopsy from a 3-months-old child (Davis) with microcephaly, persistent jaundice, and hepatosplenomegaly; cytomegalic cells were demonstrated in the liver specimen. [doi.org]
Children born with congenital CMV infection may present with hepatomegaly, splenomegaly, jaundice, pneumonitis, fetal growth retardation, petechiae, purpura, and thrombocytopenia. [orpha.net]
Symptomatic infections in 10 percent of congenital cases cause jaundice, fever, and enlargement of the spleen and liver. [britannica.com]
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]
- Hepatomegaly
On examination, the neonate was found to have respiratory distress, an extensive rash (Panel A), and hepatomegaly. [doi.org]
Children born with congenital CMV infection may present with hepatomegaly, splenomegaly, jaundice, pneumonitis, fetal growth retardation, petechiae, purpura, and thrombocytopenia. [orpha.net]
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]
Olgunun fizik muayenesinde dismorfik yüz görünümü ve 3 cm hepatomegali tespit edildi. [sislietfaltip.org]
Ears
- Hearing Problem
Some babies appear healthy at birth but develop problems, such as hearing problems, later on. [healthnavigator.org.nz]
In half of these children, just one ear will be affected, but the rest will have hearing loss in both ears. Hearing loss in both ears can lead to a higher risk of speech and communication problems later on. [medicalnewstoday.com]
Eyes
- Visual Impairment
Most infants will have no permanent health consequences, but a small number will have at birth or will develop long-term neurological conditions, such as hearing loss, visual impairment, seizures, or disabilities f mental or physical function. [ninds.nih.gov]
Even children born without any of these defects can still be adversely affected later with partial hearing loss, visual impairment, and some developmental and learning problems. Learn more about CMV below: CDC – Cytomegalovirus (CMV) [birthdefects.org]
Congenital CMV infection represents a significant health risk to new-borns, as children with CMV infection may experience physical disability, learning difficulties, visual impairment and deafness. [thenativeantigencompany.com]
Of these, over 90 percent will have serious complications including hearing loss, visual impairment, mental retardation, autism, attention deficit/hyperactivity disorder, epilepsy, or sometimes death. [childrenshospital.org]
- Visual Impairment
Most infants will have no permanent health consequences, but a small number will have at birth or will develop long-term neurological conditions, such as hearing loss, visual impairment, seizures, or disabilities f mental or physical function. [ninds.nih.gov]
Even children born without any of these defects can still be adversely affected later with partial hearing loss, visual impairment, and some developmental and learning problems. Learn more about CMV below: CDC – Cytomegalovirus (CMV) [birthdefects.org]
Congenital CMV infection represents a significant health risk to new-borns, as children with CMV infection may experience physical disability, learning difficulties, visual impairment and deafness. [thenativeantigencompany.com]
Of these, over 90 percent will have serious complications including hearing loss, visual impairment, mental retardation, autism, attention deficit/hyperactivity disorder, epilepsy, or sometimes death. [childrenshospital.org]
Skin
- Yellow Discoloration of the Skin
Hepatitis B can cause inflammation of the liver, and in the earliest stage of the disease, infected people may feel ill or even have yellow discoloration of the skin or eyes, a condition known as jaundice. [web.archive.org]
Musculoskeletal
- Myalgia
When symptoms are present, they are non-specific and include rhinitis, pharyngitis, myalgia, arthralgia, headache and fatigue. Infections in pregnant woman are classified as Primary and nonprimary infections. [pedclerk.bsd.uchicago.edu]
The major symptoms of the disease in organ transplant recipients include fever, myalgia, malaise, arthralgia, leucopenia, thrombocytopenia, and hepatitis. [canada.ca]
[…] testing, is low in these circumstances.10 Presentation and diagnosis In healthy adults, the primary CMV infection will often be asymptomatic.11 Individuals may develop a viral-type syndrome, similar to mononucleosis, which can include fever, fatigue, myalgia [journals.lww.com]
Of those women who do experience symptoms, those symptoms include asthenia, myalgia and a flu-like syndrome consisting of fever and other symptoms. [cancertherapyadvisor.com]
Neurologic
- Headache
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]
A few people will have symptoms such as sore throat, fever, headache and fatigue. People who have weakened immune systems may develop severe symptoms, such as pneumonia or infections of the eyes, liver, or intestinal tract. [cincinnatichildrens.org]
Symptoms of CMV can include: sore throat swollen lymph nodes fever headache fatigue weakness muscle aches loss of appetite. Newborns infected with CMV while in the womb can be very sick when they are born. [familydoctor.org]
If you've been infected with the virus, you may have these signs and symptoms: Prolonged high fever Fatigue Loss of appetite Muscle and joint pain or stiffness Headache Sore throat Swollen lymph nodes Swollen liver and spleen You may also have this test [urmc.rochester.edu]
- Guillain-Barré Syndrome
Rare complications include: Colitis Guillain-Barré syndrome Nervous system (neurologic) complications Pericarditis or myocarditis Pneumonia Rupture of the spleen Inflammation of liver (hepatitis) When to Contact a Medical Professional Call for an appointment [ufhealth.org]
Cytomegalovirus Infection in a Normal Person Common Less common Rare Asymptomatic* Exudative pharyngitis Icteric hepatitis Mononucleosis syndrome Splenomegaly Guillain-Barré syndrome Fever Cervical adenopathy Encephalitis Malaise Nonspecific rash Myocarditis [aafp.org]
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]
- Ataxia
Forty days after symptom onset, despite an initial positive response to this therapy, he developed dysarthria and truncal ataxia. [ncbi.nlm.nih.gov]
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]
"Cytomegalovirus (CMV) Workup." Medscape.com. May 5, 2018. <http://emedicine.medscape.com/article/215702-workup>. Azevedo, L.S., et al. "Cytomegalovirus infection in transplant recipients." [medicinenet.com]
The infectious disease team was consulted, and a thorough workup was completed. JD tested negative for syphilis, influenza, Epstein-Barr virus, herpes simplex virus, and Lyme disease. [journals.lww.com]
Skin Test
- Anergy
PD-1 expression and IL-2 loss of cytomegalovirus- specific T cells correlates with viremia and reversible functional anergy. Am J Transplant, 8 (2008), pp. 1486-1497 [6.] A.A. Rahman, M. Teschner, K.K. Sethi, H. Brandis. [elsevier.es]
PD-1 expression and IL-2 loss of cytomegalovirus- specific T cells correlates with viremia and reversible functional anergy. Am. J. [frontiersin.org]
Colonoscopy
- 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]
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]
Clinical Characteristics of CMV Colitis in the Immunocompetent Host Klauber et al. [39] reported 15 immunocompetent adults with CMV colitis. [karger.com]
The patient was treated with mesalamine for suspected ulcerative colitis, with minimal effect. A positive faecal occult blood test result raised the suspicion of ischaemic colitis. [mja.com.au]
Other Pathologies
- 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]
H&O Is there a viral threshold for treatment of CMV reactivation? MB The exact threshold for treatment is still an area of controversy. [hematologyandoncology.net]
Prognosis
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]
HCMV and tumor-infiltrating T cells Using immunohistochemical staining, quantitative PCR, and large-scale flowcytometry, recent studies have demonstrated the critical role of localized adaptive immune reaction in the prognosis of cancer behavior and prognosis [doi.org]
Etiology
Etiology and causality of HCMV infection with IBC now needs to be rigorously examined. [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]
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]
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 [mayocliniclabs.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]
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]
Scientists are working on CMV vaccines and are looking for other ways to prevent congenital CMV infection. [sites.google.com]