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Disseminated Cytomegalovirus Infection


Presentation

  • The present case illustrates that disseminated cytomegalovirus infection with atypical clinical features should be included in the spectrum of the hyper-IgM syndrome.[ncbi.nlm.nih.gov]
  • In contrast, samples enriched for mononuclear cells yielded infectious CMV in culture in only 7/15 (47%) instances; nonetheless, viral DNA was present in 16/17 samples probed.[ncbi.nlm.nih.gov]
  • He presented with prolonged fever, weight loss of 8 kg, anicteric hepatitis, upper digestive tract bleeding from gastric ulcers, acute polyneuritis and bilateral retinitis.[ncbi.nlm.nih.gov]
  • HIV1 p24 antigenaemia was present in all patients with CMV retinitis (at a high concentration), but in only 28% of patients without retinitis (at a low concentration).[ncbi.nlm.nih.gov]
  • We describe a patient with a history of chronic myelogenous leukemia (treated with chemotherapy) who presented with recurrent unexplained fevers and an acute abdomen.[ncbi.nlm.nih.gov]
Fever
  • He presented with prolonged fever, weight loss of 8 kg, anicteric hepatitis, upper digestive tract bleeding from gastric ulcers, acute polyneuritis and bilateral retinitis.[ncbi.nlm.nih.gov]
  • We describe a patient with a history of chronic myelogenous leukemia (treated with chemotherapy) who presented with recurrent unexplained fevers and an acute abdomen.[ncbi.nlm.nih.gov]
  • Camus F, Henzel D, Janowski M, Raguin G, Leport C, Vildé JL Unexplained fever and chronic fatigue: abnormal circadian temperature pattern. European Journal of Medicine 1992, 1: 30–36. PubMed Google Scholar 4.[link.springer.com]
  • Physical exmination: The patient has intermittent fever with peak-temperature of 38.5 C (axillary). General appearance: cachexic and moderately dehydrated.[med.cmu.ac.th]
Weight Loss
  • He presented with prolonged fever, weight loss of 8 kg, anicteric hepatitis, upper digestive tract bleeding from gastric ulcers, acute polyneuritis and bilateral retinitis.[ncbi.nlm.nih.gov]
  • Symptoms include fever, diarrhea, weight loss, pain in the abdomen (or belly) and general feeling of being unwell. diseases of the central nervous system (CNS) —when CMV infects the brain and spinal cord.[catie.ca]
  • 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]
  • However, many patients suffer from systemic symptoms such as fever and weight loss. Diagnosis Diagnosis is made by fundoscopy. Assessment of the usually peripheral, whitish exudates is dependent on the experience of the ophthalmologist.[hivbook.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]
Chills
  • Some of these patients had non-specific symptoms, such as fever, myalgia, asthenia, chills, or cough. The virus affected the eyes in 16 immunocompetent patients, who developed uveitis, retinitis, corneal endothelitis, or papillitis.[virologyj.biomedcentral.com]
Malaise
  • 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]
Diarrhea
  • Abstract A 48-yr-old man with profuse diarrhea for about 9 mo was found to have intestinal cryptosporidiosis. Treatment with antibacterial, antimalarial, and other antiprotozoal agents failed to control the disease.[ncbi.nlm.nih.gov]
  • Falchuk, K.R. et al. intestinal cryptosporidiosis, man with persistent, profuse diarrhea, case report, complicated by disseminated cytomegalovirus infection, organisms identified in duodenal biopsy specimen by light and electron microscopy: Massachusetts[agris.fao.org]
  • Chiang Mai University, Thailand Patient : 7-month-old male infant CC: fever and diarrhea for 2 months PI: 2 months PTA, he has been repeatedly hospitalized at a primary care hospital with a diagnosis of "infectious diarrhea".[med.cmu.ac.th]
  • Intestinal necrosis and ulceration can develop and be extensive, leading to the formation of pseudomembranes and debilitating diarrhea.[humpath.com]
  • Symptoms include fever, diarrhea, weight loss, pain in the abdomen (or belly) and general feeling of being unwell. diseases of the central nervous system (CNS) —when CMV infects the brain and spinal cord.[catie.ca]
Nausea
  • Symptoms of this complication can include fever, nausea, painful swallowing and swollen lymph nodes. colitis —when CMV infects the colon (the longest part of the large intestine).[catie.ca]
  • 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 manifestations are dysphagia, odynophagia, substernal discomfort, nausea and vomiting [ 24 - 26 ].[omicsonline.org]
  • Other less common adverse effects associated with foscarnet therapy include nausea, genital ulcers, anemia, nephrogenic diabetes insipidus, hypokalemia, hypomagnesemia, and central nervous system abnormalities, including seizure.[hivinsite.ucsf.edu]
Vomiting
  • 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 manifestations are dysphagia, odynophagia, substernal discomfort, nausea and vomiting [ 24 - 26 ].[omicsonline.org]
  • CMV hepatitis Is defined by findings such as fever, vomiting, with hepatomegaly with hepatalgia, and atypical lymphocytosis may be approximately 50%, elevated bilirubin and/or enzyme levels, and detection of CMV by histopathologic analysis within the[intechopen.com]
Acute Abdomen
  • We describe a patient with a history of chronic myelogenous leukemia (treated with chemotherapy) who presented with recurrent unexplained fevers and an acute abdomen.[ncbi.nlm.nih.gov]
Gastropathy
  • Less frequently, CMV may also be the cause of gastritis, Ménétrier’s disease (protein-losing hypertrophic gastropathy) and ileitis [ 19 ].[omicsonline.org]
Retinal Lesion
  • The spectrum of illness included symptomatic esophagitis and hepatic dysfunction associated with the appearance of CMV inclusion bodies, retinal lesions, and bone marrow suppression.[ncbi.nlm.nih.gov]
  • The signs are whitish retinal lesions, which look granular (not fluffy, cotton-wool spots). These lesions progress into retinal necrosis with absolute visual field loss in that area. The lesions are usually accompanied by haemorrhages.[medical-dictionary.thefreedictionary.com]
  • Retinal lesions in cytomegalovirus infection. Ann Intern Med 1986; 104:132. 14. Meiselman MS, Cello JP, Margaretten W. Cytomegalovirus colitis.[hivinsite.ucsf.edu]
Skin Ulcer
  • The case of an immunocompetent woman who died of disseminated cytomegalovirus infection with encephalitis and skin ulcerations is reported. The duration of the disease, from onset to death, was five months.[ncbi.nlm.nih.gov]
  • Vildé Abstract The case of an immunocompetent woman who died of disseminated cytomegalovirus infection with encephalitis and skin ulcerations is reported. The duration of the disease, from onset to death, was five months.[link.springer.com]
  • ulcer due to CMV Skin ulcer due to cytomegalovirus Skin ulcer due to cytomegalovirus (CMV) infection ulcerative CMV lesion Ulcerative cytomegalovirus lesion 078.5 Excludes congenital cytomegalovirus infection ( 771.1 ) Applies To Cytomegalic inclusion[icd9data.com]
Petechiae
  • The rash consisted of purple-to-magenta, nonblanching macules that were 0.5 to 1.0 cm in diameter, as well as papules and petechiae covering her entire body.[nejm.org]

Workup

  • Sepsis workup revealed negative result. He recieved intravenous antibiotics for 7 days. At 2 month old (5 months PTA) he had another episode of "sepsis" with pneumonia. He was treated as bacterial and pneumocystis carrinii pneumonia.[med.cmu.ac.th]

Treatment

  • Disseminated infection with cytomegalovirus developed during treatment, and the patient died. Five other instances of intestinal cryptosporidiosis have been reported.[ncbi.nlm.nih.gov]
  • Transient T-cell dysfunction was demonstrated and returned to normal after treatment of CMV infection.[ncbi.nlm.nih.gov]
  • Disseminated cytomegalovirus (CMV) infection complicating active treatment of systemic lupus erythematosus: an emerging problem.[sclero.org]
  • Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization[books.google.com]
  • Successful treatment with vidarabine. Journal of the American Medical Association 1977, 238: 2299–2300. CrossRef PubMed Google Scholar 9.[link.springer.com]

Prognosis

  • However, recent studies imply positivity of this method in the disease prognosis[ 54 ].[wjgnet.com]
  • […] 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]
  • Positive CMV PCR is also independently associated with a poor prognosis for the patient (Deayton 2004, Jabs 2005, Wohl 2005).[hivbook.com]
  • The prognosis is extremely severe; hence a prompt diagnosis and an appropriate condition management are highly important [ 29 ].[omicsonline.org]
  • Earlier diagnosis may help improve patient prognosis. Acknowledgment The authors are grateful to Mrs. Y. Matsuka, Ms. W. Tanihata, and Mrs. M. Izumimoto for their technical assistance and to Ms. K. Matsushita and Ms. K.[alliedacademies.org]

Etiology

  • McKee's Pathology of the Skin is the most complete, in-depth resource on dermatopathology, covering etiology, pathogenesis, disease mechanisms, and recent genetic, molecular, and basic science data. Drs. J.[books.google.com]
  • CMV prevalence in CD Seropositivity in CD patients is as high as in other populations (70%)[ 64, 65 ], however CMV disease is rare in CD, making the virus an unlikely etiological factor in the novo development of IBD[ 27, 64, 66, 67 ].[wjgnet.com]

Epidemiology

  • CMV inclusions / CMV nuclear inclusions Epidemiology Transmission of CMV can occur by several mechanisms, depending on the age group affected.[humpath.com]
  • In Morocco, Data concerning epidemiologic profile of CMV disease are lacking; there is a huge need of cohort studies in this field [ 1 ].[omicsonline.org]
  • Introduction Early in the AIDS epidemic, cytomegalovirus (CMV) was a major cause of morbidity and mortality in patients with AIDS in the United States.(1) Epidemiologic studies indicated that through 1992 nearly half of HIV-infected patients eventually[hivinsite.ucsf.edu]
  • Epidemiology of tuberous sclerosis. Ann N Y Acad Sci 1991; 615:125. 5. Levy, M, Feingold, J. Estimating prevalence in single-gene kidney diseases progressing to renal failure. Kidney Int 2000; 58:925. 6. Rose, VM, Au, KS, Pollom, G, et al.[ispub.com]
Sex distribution
Age distribution

Pathophysiology

  • Hommes et al[ 94 ] proposed the following sequence to explain the pathophysiology of CMV disease in patients with active UC: (1) initiation phase, mucosal inflammatory response induces expression of cytokines and chemokines which activates latently infected[wjgnet.com]
  • Pathophysiology Causal agent CMV or HHV-5 (type 5 of Human Herpes Virus) is a double-stranded DNA virus. It is the largest of the human herpes viruses with a 230 kb genome encoding 165 genes [ 11 ].[omicsonline.org]
  • The pathophysiology of HPS is not completely understood there is an activation of lymphohistiocytic tissue secondary to hypercytokinemia derived from the activation of T lymphocytes and activated macrophages, causing fever, shock, and organ dysfunction[intechopen.com]

Prevention

  • The observation suggests that replicative CMV infection in organ-transplanted patients may be suppressed by relatively low dose ganciclovir, even when the patients are maintained on immunosuppressive regimens designed to prevent graft rejection.[ncbi.nlm.nih.gov]
  • Special attention is given to the prevention and treatment of these diseases found in developing countries as well as the latest findings about new antimicrobial agents, gram-negative infections and their management, and recommendations for immunization[books.google.com]
  • Good hygiene, including proper hand washing, may help prevent infections.[icdlist.com]
  • Preventing recurrence Once the CMV-related disease has subsided, your doctor will likely recommend that you take medication to prevent the infection from returning.[catie.ca]
  • A randomized trial comparing fluconazole with clotrimazole troches for the prevention of fungal infections in patients with advanced human immunodeficiency virus infection. ‎ Página 454 - Delaney KM, Moorman AC, et al.[books.google.es]

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