CASE PRESENTATION: Case 1: A 33-year-old Gravida II Para I was referred for primary CMV infection at 15 weeks gestation presenting with a history of fever. HIG therapy was performed resulting in good neonatal outcome. [ncbi.nlm.nih.gov]

• Splenomegaly

  Ultrasound confirmed massive splenomegaly with a span of 21 cm in the long axis. Serological tests confirmed the presence of both primary Epstein-Barr virus and cytomegalovirus infections. [ncbi.nlm.nih.gov]

  Children born with congenital CMV infection may present with hepatomegaly, splenomegaly, jaundice, pneumonitis, fetal growth retardation, petechiae, purpura, and thrombocytopenia. [orpha.net]

  Possible signs and symptoms include: jaundice / hepatomegaly / splenomegaly microcephaly sensorineural deafness chorioretinitis petechiae mental retardation seizures The degree of neurological impairment is variable, from mild learning and behavioral [radiopaedia.org]

• Fever

  CONCLUSION: CMV co-infection should be considered in patients with acute Q fever when they do not respond to standard antimicrobial agents. [ncbi.nlm.nih.gov]

  Acute cytomegalovirus infection related to the immunosuppressive therapy, resulting in hemophagocytosis syndrome and neutropenic fever was diagnosed. [hungary.pure.elsevier.com]

• Fatigue

  RATIONALE: Herein, we present a case of seemingly unprovoked portal vein thrombosis (PVT) occurring in the context of an acute cytomegalovirus (CMV) infection and prolonged debilitating fatigue. [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]

• Malaise

  After 28 months she developed bloody diarrhoea, abdominal pain, fever, nausea and general malaise suggesting severe pouchitis. Antibiotic treatment reduced humoral inflammation, but failed to resolve her fever. [ncbi.nlm.nih.gov]

  The most frequent symptoms were malaise (67%), fever (46%), and sweats (46%), and the most frequent finding was abnormal liver function test results (69%). [academic.oup.com]

  In immunocompetent patients > 90%: asymptomatic course < 10%: CMV mononucleosis Fever, malaise, myalgia/arthralgia, fatigue, headache Less common: sore throat, cervical lymphadenopathy, hepatomegaly, splenomegaly Differential diagnosis: infectious mononucleosis [amboss.com]

  This syndrome is similar to infectious mononucleosis (caused by Epstein-Barr virus) and is characterized by fever, malaise, and muscle and joint pain but without sore throat. [healthcentral.com]

  Symptoms Enlarged lymph nodes, especially in the neck Fever Fatigue Loss of appetite Malaise Muscle aches Rash Sore throat Less common symptoms include: Chest pain Cough Headache Hives Irregular heartbeat Jaundice Neck stiffness Rapid heart rate Sensitivity [nicklauschildrens.org]

• Anorexia

  The symptoms observed in patients with CMV involvement of the GIT included fever, diffuse abdominal pain, or pain located in the lower abdominal quadrants, anorexia, nausea, vomiting, weight loss, watery or bloody diarrhoea, haematochezia, and melaena [virologyj.biomedcentral.com]

  Clinical features are low grade fever, weight loss, anorexia, malaise, and abdominal pain, or diarrhea [ 5 ]. It may be responsible for severe complications, such as GI bleeding or perforation [ 24 ]. [omicsonline.org]

  The clinical manifestation of CMV colitis is associated with low-grade fever, weight loss, anorexia, malaise, and abdominal pain. Watery diarrhea and hematochezia are common. [karger.com]

• Pneumonia

  In this paper, we present the case of a renal transplant recipient with aortic aneurysm infection/dissection and pneumonia associated with CMV infection. [go.gale.com]

  […] testing) to represent pneumonia in HSCT recipients (M. [academic.oup.com]

  Immunocompromised individuals (e.g., AIDS, post-transplantation) are especially at risk of illness following reactivation or initial infection, which can include severe manifestations such as CMV retinitis (risk of blindness) or life-threatening CMV pneumonia [amboss.com]

  Pneumonia Immunocompetent: Pneumonia may occasionally occur with CMV mononucleosis. Usually, pneumonia is found on the CXR but is of no clinical significance and rapidly resolves with the disappearance of the primary infection. [patient.info]

• Sore Throat

  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]

  Acquired CMV Most people with acquired CMV have no noticeable symptoms, but if symptoms do occur, they may include: fever night sweats tiredness and uneasiness sore throat swollen glands joint and muscle pain low appetite and weight loss Symptoms will [medicalnewstoday.com]

  Symptoms may include: Fever Headache Fatigue Muscle aches Enlarged glands Sore throat Enlarged spleen. [southerncross.co.nz]

  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]

  Occasionally, symptoms similar to glandular fever such as fever, sore throat, swollen glands, abdomen pain and jaundice (yellow skin and eyes) can occur. [sahealth.sa.gov.au]

• Pharyngitis

  On examination, he had obvious splenomegaly but no lymphadenopathy or pharyngitis. Full blood count revealed mild neutropenia and significant lymphocytosis, with a blood film showing atypical lymphocytes. [ncbi.nlm.nih.gov]

  A syndrome of infectious mononucleosis that lacks severe pharyngitis is common. Severe focal disease, including retinitis, can develop in HIV-infected patients and in organ transplant recipients and other immunocompromised patients. [merckmanuals.com]

  A clinical entity named mononucleosis-like syndrome with no heterophile antibody titers or positive monospot tests is characterized by fever, fatigue, pharyngitis, adenopathy (especially cervical adenopathy), and hepatitis. [intechopen.com]

  Patients infected with CMV who have symptoms of mononucleosis (i.e., fever, cervical lymphadenopathy, pharyngitis) do not have a heterophile antibody response. [atsu.edu]

• Abdominal Pain

  CASE PRESENTATION: We report the case of an 81-year-old Caucasian male presenting with idiopathic membranous nephropathy who developed fever, cough, dyspnea, pulmonary infiltrates, and abdominal pain shortly after the initiation of treatment with chlorambucil [ncbi.nlm.nih.gov]

  pain, bloody diarrhea: Endoscopic examination of the GI tract typically shows linear ulcers. [amboss.com]

• Diarrhea

  CASE PRESENTATION: M.E., 6-weeks-old, born small for gestational age, was admitted in our Hospital for gastrointestinal signs: diarrhea, abdominal distension, observed three days earlier. [ncbi.nlm.nih.gov]

  Patients with CMV enterocolitis most often present with diarrhea, fever and weight loss, abdominal pain and hematochezia 2. It is important to note that in up to a third of patients, diarrhea is not a prominent feature 4. [radiopaedia.org]

  Symptoms may include: fever diarrhea, gastrointestinal ulcerations, and gastrointestinal bleeding shortness of breath pneumonia with hypoxemia, or low blood oxygen mouth ulcers that can be large problems with vision, including floaters, blind spots, and [medicalnewstoday.com]

  Hepatitis-like symptoms and signs may include appetite loss, yellow eyes (jaundice), nausea, and diarrhea. [medicinenet.com]

• Loss of Appetite

  […] individual experiencing constitutional symptoms (fever, chills, fatigue, loss of appetite, etc) should seek medical attention immediately. [physio-pedia.com]

  Symptoms Enlarged lymph nodes, especially in the neck Fever Fatigue Loss of appetite Malaise Muscle aches Rash Sore throat Less common symptoms include: Chest pain Cough Headache Hives Irregular heartbeat Jaundice Neck stiffness Rapid heart rate Sensitivity [nicklauschildrens.org]

  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. [medlineplus.gov]

• Hematochezia

  Patients with CMV enterocolitis most often present with diarrhea, fever and weight loss, abdominal pain and hematochezia 2. It is important to note that in up to a third of patients, diarrhea is not a prominent feature 4. [radiopaedia.org]

  Among patients complaining of diarrhea, grossly hematochezia was seen in 53%. [karger.com]

  Infection of the gastrointestinal tract can result in CMV colitis with symptoms of diarrhea, hematochezia, and abdominal pain that may progress to perforation of bowel. CMV esophagitis presents with odynophagia. [renalandurologynews.com]

  […] mucosal lesions visible on endoscopy, and detection of CMV via culture, histopathology, immunohistochemistry, or in situ hybridization. [7] CMV colitis was first described in 1985 in two homosexual men who presented with abdominal pain, diarrhea, and hematochezia [emedicine.medscape.com]

• Abdominal Distension

  CASE PRESENTATION: M.E., 6-weeks-old, born small for gestational age, was admitted in our Hospital for gastrointestinal signs: diarrhea, abdominal distension, observed three days earlier. [ncbi.nlm.nih.gov]

• Jaundice

  RATIONALE: Septo-optic dysplasia (SOD) is a rare congenital disorder that may cause jaundice in infants. [ncbi.nlm.nih.gov]

  The most frequent clinical signs are: Hepatosplenomegaly (60%), microcephaly (53%), Jaundice (67%), petechiae (76%), at least one neurological abnormality (68%) [ 20 ]. [panafrican-med-journal.com]

• Hepatosplenomegaly

  We report a case of a term neonate with ventriculomegaly on prenatal ultrasound who presented with low birth weight, small head circumference, hepatosplenomegaly, and purpuric rash on physical exam. [ncbi.nlm.nih.gov]

  Konjenital CMV enfeksiyonu primer veya tekrarlayan maternal enfeksiyonu takiben gelişebilir ve intrauterin gelişme geriliği, mikrosefali, koryoretinit, sensorinoral işitme kaybı, anemi, trombositopeni, sarılık ve hepatosplenomegali gibi bir veya birden [egetipdergisi.com.tr]

• Hepatomegaly

  Radiologic examinations were carried out, and the computed tomography scan revealed a hepatomegaly and a chest X-ray showed evidence of a unilateral pleural effusion. [ncbi.nlm.nih.gov]

  Possible signs and symptoms include: jaundice / hepatomegaly / splenomegaly microcephaly sensorineural deafness chorioretinitis petechiae mental retardation seizures The degree of neurological impairment is variable, from mild learning and behavioral [radiopaedia.org]

  Children born with congenital CMV infection may present with hepatomegaly, splenomegaly, jaundice, pneumonitis, fetal growth retardation, petechiae, purpura, and thrombocytopenia. [orpha.net]

  Olgunun fizik muayenesinde dismorfik yüz görünümü ve 3 cm hepatomegali tespit edildi. [sislietfaltip.org]

• Liver Dysfunction

  Due to the risk for other confounders such as acute and chronic allograft rejection in liver transplant recipients or GVHD in HSCT recipients, as well as the common occurrence of drug-associated liver dysfunction, a probable CMV hepatitis category is [academic.oup.com]

• Hearing Impairment

  Neonatal cytomegalovirus infection remains a common cause of congenital infection worldwide with effects ranging from hearing impairment to significant neurological morbidity. [ncbi.nlm.nih.gov]

  Of the 40,000 infants born each year with congenital CMV infection, more than 8,000 develop mental retardation, cerebral palsy, or, most commonly, hearing impairment. [neoreviews.aappublications.org]

  Unfortunately, about 20 percent later develop severe hearing impairments and mental retardation. [encyclopedia.com]

  However, youngsters who contract a CMV infection at birth may develop a hearing impairment or mental retardation. Prevention Good personal hygiene habits, particularly regular hand washing, can lower the risk of spreading CMV. [healthychildren.org]

  Hearing loss A small number of babies born with asymptomatic congenital CMV may later develop some degree of hearing impairment during their first few years of life. This is usually permanent and can range from mild to total. [your.md]

• Small Head

  We report a case of a term neonate with ventriculomegaly on prenatal ultrasound who presented with low birth weight, small head circumference, hepatosplenomegaly, and purpuric rash on physical exam. [ncbi.nlm.nih.gov]

  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 babies may also have a small head size (microcephaly) and may have problems with their blood cell counts and low platelets. [nationalcmv.org]

  These can include deafness, poor eyesight, intellectual disability, an enlarged liver or spleen, and a small head. [betterhealth.vic.gov.au]

  Those who do may have: premature delivery small size or low birth weight jaundice an enlarged liver and spleen microcephaly (small head) feeding difficulties These babies are also at risk for hearing, vision, neurological, and developmental problems. [kidshealth.org]

• Myalgia

  A 64-year-old woman (Case 1) and a 65-year-old man (Case 2), who had each received a kidney from a living unrelated donor, were admitted with complaints of weakness in both legs and myalgia. [ncbi.nlm.nih.gov]

  In immunocompetent patients > 90%: asymptomatic course < 10%: CMV mononucleosis Fever, malaise, myalgia/arthralgia, fatigue, headache Less common: sore throat, cervical lymphadenopathy, hepatomegaly, splenomegaly Differential diagnosis: infectious mononucleosis [amboss.com]

  There were more local reactions (pain, erythema, induration, and warmth) and systemic reactions (chills, arthralgias, and myalgias) in the vaccine group than in the placebo group. [nejm.org]

• Arthralgia

  Therefore, HCMV infection should always be included in the differential diagnosis of patients with unspecific signs of disease like depletion, subfebrile fever, and arthralgia. © 2017 S. Karger AG, Basel. [ncbi.nlm.nih.gov]

  In immunocompetent patients > 90%: asymptomatic course < 10%: CMV mononucleosis Fever, malaise, myalgia/arthralgia, fatigue, headache Less common: sore throat, cervical lymphadenopathy, hepatomegaly, splenomegaly Differential diagnosis: infectious mononucleosis [amboss.com]

  A headache, abdominal pain with diarrhea, arthralgias, and rash can also be observed in mononucleosis-like syndrome in acquired CMV infection. [intechopen.com]

  There were more local reactions (pain, erythema, induration, and warmth) and systemic reactions (chills, arthralgias, and myalgias) in the vaccine group than in the placebo group. [nejm.org]

  The major symptoms of the disease in organ transplant recipients include fever, myalgia, malaise, arthralgia, leucopenia, thrombocytopenia, and hepatitis. [canada.ca]

• Skin Rash

  In a smaller number of cases, these babies have symptoms at birth such as low birth weight, jaundice (yellowing of the skin and eyes), swollen lymph nodes, and a skin rash. [healthychildren.org]

  You may have a skin rash. Special lab tests such as a CMV DNA serum PCR test may be done to check for substances in your blood that are produced by CMV. [nicklauschildrens.org]

  You may have a skin rash. Special lab tests such as a CMV DNA serum PCR test may be done to check for presence of substances in your blood produced by CMV. [medlineplus.gov]

  Continued Cytomegalovirus Complications It’s rare, but CMV can cause complications including: Mononucleosis Guillain-Barre syndrome Brain inflammation (encephalitis) Heart inflammation (myocarditis) In people with HIV, complications include: Pneumonia Skin [webmd.com]

• Eruptions

  A 22 old women without a history of systemic disease developed a cutaneous eruption with fever and myalgia persistant for 2 weeks. [ncbi.nlm.nih.gov]

  Similar to EBV infection, 80-100% of patients develop a maculopapular, morbilliform eruption when given ampicillin (or other penicillins) during the illness. [renalandurologynews.com]

  Morbiliform eruptions, purpura, vesiculobullous lesions, nodules, papular eruptions, verrucous lesions and ulcers were also reported [2, 6]. [symbiosisonlinepublishing.com]

  In addition, categories of CMV infections characterized as severe included any CMV infection causing vascular thrombosis; weight loss of over 10 kg; a vasculitic rash; perineal ulcers; or an eruption consisting of numerous vesicular or pustular lesions [virologyj.biomedcentral.com]

• 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]

  While receiving antiviral and corticosteroid therapy, the patient developed seizures related to a cerebral vasculitis. The outcome was favorable when intravenous immunoglobulins were associated. [ncbi.nlm.nih.gov]

  Congenital CMV infection can equally result in major neurological sequelae, including microcephaly, intracranial calcifications, sensorineural hearing loss, chorioretinitis, intellectual and motor disabilities, and seizure disorders. [orpha.net]

  Possible signs and symptoms include: jaundice / hepatomegaly / splenomegaly microcephaly sensorineural deafness chorioretinitis petechiae mental retardation seizures The degree of neurological impairment is variable, from mild learning and behavioral [radiopaedia.org]

• Paresthesia

  Lower extremity weakness with upper and lower extremity paresthesias developed progressively 11 months post transplantation, coinciding with immune control of CMV. [ncbi.nlm.nih.gov]

  One subject in the placebo group had peripheral neuropathy characterized by numbness and paresthesia affecting her feet and hands 10 weeks after the second dose of vaccine. An extensive neurologic evaluation was not able to identify a cause. [nejm.org]

Further workup exposed elevated transaminases consistent with mild hepatitis without synthetic dysfunction and colonoscopy revealed colitis. A comprehensive evaluation for liver disease was notable for a markedly elevated ferritin level. [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]

• Pulmonary Infiltrate

  CONCLUSIONS: Cytomegalovirus infection should be considered in the differential diagnosis of respiratory symptoms and pulmonary infiltrates in patients treated with chlorambucil for nephrotic syndrome. [ncbi.nlm.nih.gov]

• Enlargement of the Spleen

  Older kids and teens who are infected may have mono-like symptoms, including tiredness, muscle aches, headache, fever, and an enlarged liver and spleen. These symptoms tend to be mild and usually last only 2 to 3 weeks. [kidshealth.org]

  Cytomegalic inclusion disease of the neonatal (newborn) period is characterized by variable severity ranging from an asymptomatic infection to a disease with fever, hepatosplenomegaly (enlarged liver and spleen), mental or motor retardation, and sometimes [healthcentral.com]

  Liver/Spleen Issues Yellow skin color, red skin lesions and/or enlarged liver and spleen will fade over time, usually within a few weeks to months. This rarely, if ever, causes permanent health problems. [nationalcmv.org]

  These can include deafness, poor eyesight, intellectual disability, an enlarged liver or spleen, and a small head. [betterhealth.vic.gov.au]

  Symptoms may include: Fever Headache Fatigue Muscle aches Enlarged glands Sore throat Enlarged spleen. [southerncross.co.nz]

• Enlargement of the Liver

  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]

  For infants who are infected by their mothers before birth, two potential problems exist: Generalised infection may occur, with symptoms ranging from moderate enlargement of the liver and spleen with jaundice, to stillbirth or neonatal/infant death. [ideas.health.vic.gov.au]

  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]

Treatment with double-dose ganciclovir and anti-CMV immunoglobulins did not decrease CMV viremia, so we diagnosed ganciclovir-resistant CMV infection. We decided to discontinue mycophenolic acid treatment and start leflunomide 20 mg BID. [ncbi.nlm.nih.gov]

The prognosis of individuals with CMV is highly variable, and the prognosis of individuals with congenital CMV can usually be determined based on the extent of infection at birth. [ncbi.nlm.nih.gov]

Conclusions: Liver cirrhosis at this age is very rare; the most frequent etiology is viral. The late diagnosis of this case led to the impossibility of etiological treatment. [ncbi.nlm.nih.gov]

One or more of the following clinical manifestations may be present: CMV mononucleosis CMV pneumonia: interstitial pneumonitis Etiology: immunocompromised patients (e.g., following bone marrow transplant or in HIV/AIDS patients with CD4 ≤ 50 cells/mm3 [amboss.com]

Further investigation of CMV as an etiologic agent for ALL is warranted. Submitted July 5, 2016. Accepted September 17, 2016. Copyright © 2016 American Society of Hematology [bloodjournal.org]

Understanding the epidemiology of this virus is a key element in the development of strategies for preventing CMV disease. However, a number of features of this virus complicate such understanding. [cmr.asm.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]

Epidemiology Epidemiological data refers to the US, unless otherwise specified. [amboss.com]

Etiology Pathogen: cytomegalovirus (CMV, human herpes virus 5, HHV-5) Transmission Blood transfusions Sexual transmission Droplet transmission Transplant-transmitted infection (e.g., bone marrow, lungs, kidneys) References:[1][2][3] Pathophysiology Clinical [amboss.com]

[…] damage Sites May infect all levels of the nervous system but classically, CMV encephalitis causes damage to subependymal regions of the cerebrum, cerebellum and brainstem Spinal cord and nerve root infection is also common in immunocompromised hosts Pathophysiology [pathologyoutlines.com]

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]

Welcome to PT 635 Pathophysiology of Complex Patient Problems This is a wiki created by and for the students in the School of Physical Therapy at Bellarmine University in Louisville KY. [physio-pedia.com]

Pathophysiology Upon infection of cells, CMV causes cytomegaly and condensation of the nuclear mass, while infection of organs results in inflammation and resultant organ dysfunction. [renalandurologynews.com]

The following concepts were tested in one or more of the three phases of research: CMV is severe, CMV is common, CMV is preventable, CMV preventive strategies are similar to other behavior changes women make during pregnancy, CMV preventive strategies [ncbi.nlm.nih.gov]