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]
- 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]
- Anemia
Dermal hematopoiesis can occur in utero as a result of severe anemia, congenital rubella, parvovirus infection, or CMV infection. [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]
Some babies who appear healthy at birth may develop problems as they grow.These may include the following: jaundice anemia lung infection vision problems hearing loss If you know your child was born with a CMV infection, make sure to have her hearing [childrenshospital.org]
However, in newborns who are premature or sick with another disorder, it may cause: Fever Swollen lymph glands, Pneumonia Hepatitis Blood clotting problems Hemolytic anemia Diagnosis Diagnosis of CMV is usually made by taking a blood or urine sample, [ada.com]
Clinical symptoms and findings in the positive cases were prematurity, anemia in 8% Jaundice in 5.6%, respiratory difficulty in 5.4%, pneumonia in and 1.3%, and hepatosplenomegaly in 4%. [scielo.iics.una.py]
- 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]
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]
Eyes
- Blurred Vision
CMV retinitis symptoms can begin with a slow onset of floaters with blurred vision over a few days. This can lead to a loss of peripheral (side) vision. [aao.org]
However, there are certain signs that may be indicative of the virus: Floaters in the eye Flashes in the eye Blurred vision Blind spot in vision Loss of peripheral vision These symptoms may appear in one eye first, then to the other eye. [bausch.com]
vision, visual field loss, or ‘floaters’ diagnosed fundoscopy by an opthalmologist Thrombocytopaenic Thrombotic Purpura (TTP) INVESTIGATIONS Investigations for CMV antigenemia direct detection of CMV protein pp65 in white blood cells (WBCs) using monoclonal [lifeinthefastlane.com]
blurred vision hepatitis, or inflamed liver, with prolonged fever encephalitis, or inflammation of the brain, leading to behavioral changes, seizures, and even coma. [medicalnewstoday.com]
Skin
- Erythema
Endoscopy findings range focal erythema to diffuse ulcers. The diagnosis is reached using optical microscopy on biopsies, which showed the intranuclear inclusions characteristic of cytomegalovirus infection (1). [scielo.isciii.es]
Many of the same clinical manifestations typical of EBV-induced mononucleosis (e.g., lymphadenopathy, splenomegaly, pharyngeal erythema) also can occur with CMV ( Table 1 ), although less frequently. 8 View/Print Table TABLE 1 Presentations of Acute Cytomegalovirus [aafp.org]
Endoscopic features of CMV colitis cannot be reliably distinguished from active IBD without CMV and can include erythema, exudate, erosions, and deep ulcers [66, 67]. [hindawi.com]
IBC was diagnosed according to the American Joint Committee on Cancer (AJCC) guidelines as a T4d designation where patients presented with diffuse erythema, edema of the breast, skin orange peel (pead’orange) and pathological diagnosis of skin biopsies [doi.org]
- 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]
Psychiatrical
- Psychomotor Retardation
Psychomotor retardation (development of motor defects and psychic abnormalities), spastic diplegia (spastic paralysis on both sides of body), blindness, deafness, or seizures may develop. [rarediseases.org]
Cytomegalovirus is the leading infectious agent causing congenital sensorineural hearing loss and psychomotor retardation. Contacts with young children have been identified as the main source of virus transmission to mothers. [thelancet.com]
Neurologic
- Seizure
The symptoms may be severe, and they include vision and hearing loss, vision loss, small head size, weakness and difficulty using muscles, problems of coordination, and seizures. [medicalnewstoday.com]
These signs include: Rash Jaundice (yellowing of the skin or whites of the eyes) Microcephaly (small head) Intrauterine growth restriction (low weight) Hepatosplenomegaly (enlarged liver and spleen) Seizures Retinitis (damaged eye retina) Some babies [cdc.gov]
- 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]
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]
Serum
- Lymphocytosis
Proportion positive for Epstein-Barr virus, cytomegalovirus, human herpesvirus 6, Toxoplasma, and human immunodeficiency virus types 1 and 2 in heterophil-negative patients with an absolute lymphocytosis or an instrument-generated atypical lymphocyte [aafp.org]
Symptoms of this disease include sore throat without exudative tonsillitis, fever, and atypical lymphocytosis. Fever is usually much higher than is seen with heterophile positive mononucleosis. [atsu.edu]
CMV infection in premature infants can result in hepatomegaly, thrombocytopenia, atypical lymphocytosis, or hemolytic anemia, and is associated with high mortality and morbidity. [canada.ca]
Effects on babies The effects on symptomatic babies vary and may include: growth restriction jaundice haemotological problems thrombocytopenia and purpura (common) anaemia, neutropenia, lymphocytosis (occasional) hepatosplenomegaly lymphandenopathy neurological [bettersafercare.vic.gov.au]
Ultrasound
- Enlargement of the Liver
Symptoms at birth can include: jaundice (yellowing of the skin) low birth weight seizures enlarged spleen enlarged liver pneumonia. [familydoctor.org]
The other 10 to 15 percent of newborns infected with CMV in the womb have serious complications that are present at birth, such as central nervous system abnormalities, growth restriction, an unusually small head, an enlarged spleen and liver, jaundice [babycenter.com]
The following potential problems can occur for infants who are infected from their mothers before birth (during pregnancy): Moderate enlargement of the liver and spleen, small red spots on the skin, problems with the eyes and seizures are potential complications [americanpregnancy.org]
poorly-functioning liver, with jaundice Low blood platelet count Abnormal white blood cell levels (high or low) Enlarged spleen Anemia Children affected by Cytomegalic Inclusion Disease are at high risk of developing complications such as hearing loss [ada.com]
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]