Cytomegalovirus infection commonly occurs in adults during their fourth decade of life. The retina can be affected when the virus spreads via the bloodstream [1]. People infected with the human immunodeficiency virus (HIV) are at a higher risk of acquiring cytomegalovirus retinitis, as the former organism compromises the endothelial integrity of vasculature, and blood flow, in the retina [2]. Retinitis may involve inflammation as well as bleeding of the retina, often in the ocular fundus. Lesions such as cotton wool spots can be visualized on the retina.

HIV further predisposes individuals to cytomegalovirus retinitis due to its immunosuppressive effects. This results in activation of latent infection after the host immunity decreases [3]. Various conditions, such as diabetes mellitus, malignancy, and organ transplantation, impart the same effect [4] [5]. Although cytomegalovirus retinitis in immunocompetent individuals is rare, cases have been reported. It has also been described in patients with systemic lupus erythematosus and other autoimmune diseases, with concomitant use of immunosuppressive drugs [6].

Cytomegalovirus retinitis can be asymptomatic. In symptomatic infection, patients may experience various visual disturbances, including floaters, photopsia, narrowed visual fields, blurred vision, and scotoma [7]. They do not usually complain of red or painful eyes. Blindness can ensue within months of symptom onset. Furthermore, cytomegalovirus retinitis is often initially unilateral before becoming bilateral.

Notably, immunocompromised children do not seem to have increased susceptibility to this disease [8]. Cytomegalovirus retinitis can also be congenital, occurring in 25% of babies already exhibiting other features of CMV infection, and does not usually worsen after birth.

• Asymptomatic

  Cytomegalovirus retinitis can be asymptomatic. In symptomatic infection, patients may experience various visual disturbances, including floaters, photopsia, narrowed visual fields, blurred vision, and scotoma. [symptoma.com]

  Although the ophthalmic infection may initially be asymptomatic, the retinal necrosis it produces may result in both loss of visual field and decreased visual acuity. Routine screening of these patients is required for early diagnosis. [annals.org]

  Most patients are asymptomatic unless the optic nerve or macula is involved. Symptoms : Symptoms of CMV retinitis may include floaters or painless loss of central or peripheral vision. [retinacare.net]

  Disorders › Most common ocular opportunistic infection in immunocompromised or immunosuppressed patients, i.e. patients with AIDS or organ transplant recipients In AIDS patients, it usually seen in patients with CD4+ Clinical features: Symptoms: May be asymptomatic [dro.hs.columbia.edu]

  Presentation This depends on the condition: asymptomatic (HIV retinopathy) to a rapidly progressive bilateral visual loss - PORN. [patient.info]

• Chills

  Signs and symptoms of prostatitis include painful or difficulty urinating, fever, chills, body aches, blood in the urine, pain in the rectum, groin, abdomen, or low back, and painful ejaculation or sexual dysfunction.Acute prostatitis happens when your [temynexu.co.nf]

  The fever was intermittently present for the last 5 months, without any chill or rigor. [omicsonline.org]

  […] immunocompetent patients with this syndrome who present to a physician's office will have acute CMV infection. 6 CMV-induced mononucleosis can be symptomatically indistinguishable from EBV-induced mononucleosis. 7 Malaise, fever up to 39.4°C (103.0°F), chills [aafp.org]

  […] virus-1 (HIV) and having a history of homosexual behavior, the prevalence of CMV seropositivity exceeds 90%.3 Healthy individuals infected with CMV frequently remain asymptomatic, although some develop an influenza-like syndrome characterized by fever, chills [ncbi.nlm.nih.gov]

• Developmental Delay

  The most common of these late-occurring signs are hearing loss and developmental delay. A small number of babies may also develop vision problems. [mayoclinic.org]

  Multisystem features of the disease include epiphora, developmental delay or mental retardation, pulmonary disease, periodontal disease, esophageal stricture, premature hair graying or loss, hyperhidrosis, or development of malignant lesions. [meajo.org]

  In Menkes disease, patients are born without the ability to absorb copper from diet, leading to severe developmental delays and significant neurological symptoms. Without treatment, Menkes disease could lead to death by three years of age. [fortressbiotech.com]

  Other specific symptoms are: retinitis pigmentosa, polydactyly, syndactyly, hypogonadotrophic hypogonadism, developmental delay, cognitive deficit, genitourinary malformations, cardiovascular abnormalities, dental abnormalities, Hirschprung’s disease, [journals.viamedica.pl]

• Rigor

  The fever was intermittently present for the last 5 months, without any chill or rigor. [omicsonline.org]

• Aspiration

  […] not been established against pneumonia or acute otitis media lt Šaldytuvas moką šnekėtį en Persistent pulmonary hypertension of the newborn (PPHN) occurs as a primary developmental defect or as a condition secondary to other diseases such as meconium aspiration [lt.glosbe.com]

  Cytopathologic analysis of vitreous aspirate and choroidal biopsy did not show evidence of malignancy. At this stage, no sample was sent for polymerase chain reaction (PCR) analysis to exclude intraocular infection. [nature.com]

  Bone marrow aspiration and cerebrospinal fluid cytology were performed and were negative for any malignant cell. CD4 count was 79/μL. [ojoonline.org]

  Blood and tracheal aspirate cultures were negative. The patient continued to be feverish during her stay in the ICU and after. This fever of unknown cause was thought to be of central origin. [ncbi.nlm.nih.gov]

  […] with a physician, physical and occupational therapists, nurses, and social workers); it should involve strategies to enhance mobility and range of motion, treat pain and discomfort, prevent skin breakdown, ameliorate incontinence, and minimize risk of aspiration [merckmanuals.com]

• Dyspnea

  […] 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) Clinical findings: fever, nonproductive cough, dyspnea [amboss.com]

  CMV pp65 antigen levels or quantification of CMV DNA from leukocytes should be assessed in symptomatic patients with clinical signs such as visual impairment, cough and dyspnea, or diarrhea, which can indicate end-organ manifestations of CMV infection [academic.oup.com]

  […] counts may have positive cultures in the absence of clinical disease. 13 The diagnosis of CMV pneumonitis is difficult and requires consistent clinical and radiological findings (i.e., diffuse pulmonary interstitial infiltrates, fever, and cough or dyspnea [aidsinfo.nih.gov]

• Polydipsia

  • hypogonadism • precocious puberty, • central hypothyroidism and Hyperthyrotropinemia. 12. manifestation % Rapid-onset obesity 100 % Failed growth hormone 60 % stimulation test Hyperphagia 53% Polydipsia 53% Hypernatremia 46-100% Hyperprolactinemia [slideshare.net]

  These previous records included presence of hypernatremia in the laboratory tests and a diagnosis of diabetes insipidus (DI) despite absence of polyuria and polydipsia. [ncbi.nlm.nih.gov]

  Other specific symptoms are: retinitis pigmentosa, polydactyly, syndactyly, hypogonadotrophic hypogonadism, developmental delay, cognitive deficit, genitourinary malformations, cardiovascular abnormalities, dental abnormalities, Hirschprung’s disease, polydipsia [journals.viamedica.pl]

• Hypotension

  After discharge from the haematological ward, he was assessed by the local ophthalmologists who diagnosed bilateral panuveitis and secondary glaucoma and treated him with a 4-month course of oral steroids and topical hypotensives. [nature.com]

  Intraoperative (meperidine, long-acting benzodiazepines, anticholinergics such as atropine; however, medications such as glycopyrrolate can be used because, in contrast to atropine, they do not cross the blood brain barrier) Postoperative (hypoxia, hypotension [emedicine.medscape.com]

  Other causes were vertebrobasilar insufficiency, hypoglycemia, severe coughing, retinitis pigmentosa, and one case each of metastatic adenocarcinoma to the brain, hyperglycemia >400 mg/dL, digitalis toxicity, the Charles Bonnet syndrome, and orthostatic hypotension [centrefellowship.com]

• Dermatitis

  Learn More Fungal Infections 93% Journey Medical Corporation Preclinical Phase complete Ceracade® Ceracade® is formulated for the treatment of dry skin conditions and to manage and relieve the burning and itching associated with various types of dermatitis [fortressbiotech.com]

  Other common opportunistic infections reported in these nine patients with Good syndrome and CMVR included respiratory infections (77.8 %), non-ocular CMV (22.2 %), and herpes zoster dermatitis (33.3 %), whereas other autoimmune diseases (Table 3 ) included [joii-journal.springeropen.com]

• Eczema

  We report two cases of CMV retinitis associated with immunosuppression for eczema and pemphigus vulgaris. In both cases, patients were receiving corticosteroid and a second-line immunosuppressive agent (cyclosporine or mycophenolate mofetil). [ncbi.nlm.nih.gov]

  Learn More Eczema 93% Journey Medical Corporation Preclinical Phase complete Luxamend® Luxamend® wound cream is a water-based emulsion formulated for the treatment of superficial wounds, minor abrasions, dermal ulcers, donor sites, first- and second-degree [fortressbiotech.com]

• Retinal Hemorrhage

  The retinitis begins as small, white perivascular retinal infiltrates or dot-blot hemorrhages. The classic lesion is a hemorrhagic necrotizing retinitis that follows the retinal vasculature. [eyerounds.org]

  The retinitis is detected with ophthalmoscopy as either a perivascular yellow-white retinal lesion frequently associated with retinal hemorrhage or as a focal white granular infiltrate, often without hemorrhage. [annals.org]

  The patient was diagnosed to have acute onset unilateral CMV retinitis. Retinal examination uncovered classical appearance of retinal whitening and retinal hemorrhages with extensive macular involvement. [ncbi.nlm.nih.gov]

• Scotoma

  In the initial phase of the disease most patients are usually asymptomatic while those with symptoms will complain of floaters, blurred vision, photopsia, scotomas, metamorphopsia, etc. In some cases, retinal detachment follows the disease. [medical-dictionary.thefreedictionary.com]

  In symptomatic infection, patients may experience various visual disturbances, including floaters, photopsia, narrowed visual fields, blurred vision, and scotoma. They do not usually complain of red or painful eyes. [symptoma.com]

  Participants with CMV retinitis were more likely to complain of visual symptoms compared to those without CMV retinitis (p = 0.01), including scotoma (p = 0.0002), itchy or watery eyes (p < 0.0001), and eye pain (p = 0.003); they were also more likely [ncbi.nlm.nih.gov]

  Presentation Men are more commonly affected than women, presenting in their 20s and 30s with visual loss (mild initially, then becoming severe), scotoma, floaters and an uncomfortable red eye. [patient.info]

  The vision is generally depressed, with no discrete scotomas. Past Ocular History: None known to the patient. [eyerounds.org]

• Retinal Pigmentation

  (n = 3 eyes) characterized by inner retinal hyperreflectivity, large empty spaces in outer nuclear layer, and bridges of retinal tissue but retinal pigment epithelium and choriocapillaris sparing. [ncbi.nlm.nih.gov]

• Strabismus

  [J Pediatr Ophthalmol Strabismus. 2016;53:e58-e60.]. [ncbi.nlm.nih.gov]

  J Paediatr Ophthalmol Strabismus 1993; 30 : 159–162. 13 Hammond CJ, Evans JA, Shah SM, Acheson JF, Walters MDS. [nature.com]

  Anterior Chamber Brain Choroid Congenital Syndromes Conjunctiva Cornea Glaucomas Hypertensive Retinopathy iPod Beiträge Iris and Ciliary Body Lacrimal System Lens Lids Neuro-Ophthalmology Optic Nerve Orbit Retina Sclera Strabismus Systemerkrankungen Darmerkrankungen [atlasophthalmology.net]

• Retinal Scar

  Fibrovascular changes occurred in the CMV retinitis scar, were misdiagnosed as CMV retinitis reactivation, and were treated with anti-CMV medication. [ncbi.nlm.nih.gov]

  Two patients were not treated (patients 1 and 8), one of whom (patient 8) had received an autologous transplant and was diagnosed with atrophic retinal scarring compatible with previous CMV active retinitis after spontaneous resolution of the acute retinitis [academic.oup.com]

  Clinical manifestations of CMV retinitis had altered after treatment comparing to clinical signs pre-treatment. In recovered patients, hemorrhage and exudation were disappeared completely and yellow-white retinal scars were formed in 10 eyes. [bmcinfectdis.biomedcentral.com]

• Irritability

  […] sl poziva k nadaljnjemu in stalnemu sodelovanju med agencijo FRONTEX ter nacionalnimi organi in agencijami en Retinal haemorrhage, visual disturbance NOS, blurred vision, photophobia, chromatopsia, cyanopsia, eye irritation, blood shot eyes/red eyes en [glosbe.com]

  […] alertness (usually more alert in the morning, less at night) Changing levels of consciousness Confusion Disorganized thinking, talking in a way that doesn't make sense Disrupted sleep patterns, sleepiness Emotional changes: anger, agitation, depression, irritability [medlineplus.gov]

  Fecal transplant is used to treat gut infections and is now being studied as a treatment for obesity, urinary tract infections, irritable bowel syndrome and more. [nytimes.com]

  Photophobia Symptoms. photopsia: [ fo-top´se-ah ] an appearance as of sparks or flashes, in retinal irritation. [centrefellowship.com]

• Cognitive Disorder

  Transient cognitive disorders (delirium, acute confusional states) in the elderly. Am. J. Psychiatry. 1983;140:1426–1436. [PubMed] [Google Scholar] 50. McCusker J, Cole M, Abrahamowicz M, Primeau F, Belzile E. Delirium predicts 12-month mortality. [ncbi.nlm.nih.gov]

The ophthalmologic examination is the diagnostic procedure employed. This involves dilating the pupils to visualize internal ocular structures through ophthalmoscopy.

CMV infection can be detected through biochemical analysis of blood and urine samples. Furthermore, a biopsy would reveal viral organisms in the tissue, however, this is not a routine procedure.

It is good practice to screen all patients at risk of cytomegalovirus retinitis, including those that lack symptoms, because early stage diagnosis and treatment are uncomplicated, and in addition, a significant proportion of individuals are asymptomatic at the time of diagnosis. Furthermore, intervention prevents blindness, which is a highly debilitating sequela of cytomegalovirus retinitis. Screening via testing visual acuity of patients using a Snellen chart is insufficient, as only a small portion of the retina, the fovea, is assessed in this way. The use of questionnaires specifically tailored to detect or elicit signs and symptoms of cytomegalovirus retinitis can be a more effective screening tool.

HIV patients have a higher risk of cytomegalovirus retinitis, and it is reported that the latter is the most frequently encountered opportunistic viral infection in the above group, especially when CD4 (cluster of differentiation 4) cell count is extremely low, that is, less than 50 per cubic millimeter [9]. Immunocompetent individuals, especially those who have received steroid injections, make up the minority of cytomegalovirus retinitis patients [10] [11].

• Lymphocytes Increased

  Thereafter retinitis improved gradually as the number of CD4+ T-lymphocytes increased. The findings in this case suggest that stem cell transplantation for a leukemia patient with CMV disease may be effective. [ncbi.nlm.nih.gov]

• Viral Inclusion Body

  Two cells (centre-left) have the characteristic (cytoplasmic) viral inclusion bodies (small pink globules ). H&E stain. CMV infection can be demonstrated microscopically by the detection of intranuclear inclusion bodies. [en.wikipedia.org]

Patient was found to be HIV positive 8 years back but he has not taken any treatment. [mjdrdypu.org]

Because the disease is considered to be self-limiting and systemic treatment can be harmful, treatment remains controversial. [jamanetwork.com]

[…] could benefit from this auxiliary exam in their treatment. [scielo.br]

Patients assigned to immediate treatment underwent surgery to implant the ganciclovir device within 48 hours of enrollment and baseline photographs. [clinicaltrials.gov]

The goal of treatment is to retain present vision and to limit retinal damage. Unfortunately, individuals who do not receive or respond to treatment may progress to retinal detachment, severely limiting visual potential. [umkelloggeye.org]

CONCLUSION: The overall visual prognosis and the clinical features of CMV retinitis do not differ between HIV and non-HIV patients. The visual prognosis of CMV retinitis still remains quite poor despite advancements in antiviral treatment. [ncbi.nlm.nih.gov]

[…] infection of the eye, a common opportunistic infection in AIDS, a complication of disseminated CMV infection Clinical Retinal inflammation, blindness Management Antivirals–eg, foscarnet, cidofovir, gancyclovir, systemically and as a ganciclovir implant Prognosis [medical-dictionary.thefreedictionary.com]

There is no treatment but the prognosis is excellent. [patient.info]

SUMMARY The incidence and prognosis of CMV retinitis has improved remarkably since the introduction of HAART in 1996. Treatment is tailored to the individual, involving localized and systemic anti-CMV therapy. [retinalphysician.com]

This case provides further evidence implicating CMV infection in the etiology of hypertensive iridocyclitis. [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]

Wormser Elsevier, 18 feb. 2004 - 1000 páginas Extensively revised and updated, the new edition of AIDS and Other Manifestations of HIV Infection is an essential reference resource providing a comprehensive overview of the biological properties of this etiologic [books.google.es]

Division of Laboratory Medicine, University Hospital of Geneva and Medical School, University of Geneva, Geneva hDivision of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, Basel, Switzerland. [ncbi.nlm.nih.gov]

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

However, there is the lack of epidemiological report on the incidence of CMV retinitis in the AIDS patients in China. [bmcinfectdis.biomedcentral.com]

Herein, we describe the pathogenesis of CMVR and compare clinical features, epidemiology, and risk factors in HIV and non-HIV infected individuals with CMVR. [mdpi.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]

Offers the most comprehensive content available on retina, balancing the latest scientific research and clinical correlations, covering everything you need to know on retinal diagnosis, treatment, development, structure, function, and pathophysiology. [books.google.es]

Prevalence, pathophysiology and treatment of rhegmatogenous retinal detachment in treated cytomegalovirus retinitis. Am J Ophthalmol. 1987; 103: 527-536 Holland GN Sakamoto MJ Hardy J et al. [amjmed.com]

The pathophysiology of delirium is not fully understood, and the condition might arise through a variety of different pathogenic mechanisms. [ncbi.nlm.nih.gov]

However, the adverse effects of probenecid, including rash, headache, and fever, may be significant enough to prevent its use. [merckmanuals.com]

This study also examines the effectiveness of valganciclovir in preventing the recurrence of CMV retinitis. [clinicaltrials.gov]

Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: Recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of [journals.sbmu.ac.ir]

If you had CMV retinitis in the past, ask your provider if you need treatment to prevent its return. Cytomegalovirus retinitis Crumpacker CS. Cytomegalovirus (CMV). In: Bennett JE, Dolin R, Blaser MJ, eds. [medlineplus.gov]

An effective vaccine for the prevention of maternal CMV infection is requried. [patient.info]

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2. Glasgow BJ, Weisberger AK. A quantitative and cartographic study of retinal microvasculopathy in acquired immunodeficiency syndrome. Am J Ophthalmol. 1994;118(1):46-56.
3. Britt W. Manifestations of human cytomegalovirus infection: proposed mechanisms of acute and chronic disease. Curr Top Microbiol Immunol. 2008;325:417-470.
4. Bhat V, Joshi A, Sarode R, Chavan P. Cytomegalovirus infection in the bone marrow transplant patient. World J Transplant. 2015;5(4):287–291.
5. Vertes D, Snyers B, De Potter P. Cytomegalovirus retinitis after low-dose intravitreous triamcinolone acetonide in an immunocompetent patient: a warning for the widespread use of intravitreous corticosteroids. Int Ophthalmol. 2010;30(5):595-597.
6. Kelkar A, Kelkar J, Kelkar S, Bhirud S, Biswas J. Cytomegalovirus retinitis in a seronegative patient with systemic lupus erythematosus on immunosuppressive therapy. J Ophthalmic Inflamm Infect. 2011;1(3):129–132.
7. Wei LL, Park SS, Skiest DJ. Prevalence of visual symptoms among patients with newly diagnosed cytomegalovirus retinitis. Retina. 2002;22(3):278-282.
8. Baumal CR, Levin AV, Kavalec CC, Petric M, Khan H, Read SE. Screening for CMV retinitis in children. Arch Pediatr Adolesc Med. 1996;150(11):1186-1192.
9. Jabs DA. Ocular manifestations of HIV infection. Trans Am Ophthalmol Soc. 1995;93:623-683.
10. Gupta S, Vemulakonda GA, Suhler EB, et al. Cytomegalovirus retinitis in the absence of AIDS. Can J Ophthalmol. 2013;48(2):126-129.
11. Saidel MA, Berreen J, Margolis TP. Cytomegalovirus retinitis after intravitreous triamcinolone in an immunocompetent patient. Am J Ophthalmol. Am J Ophthalmol. 2005;140(6):1141-1143.