Acute cytomegalovirus (CMV) infection

Definition

Acute cytomegalovirus (CMV) infection is a condition caused by a member of the herpesvirus family.

See also: Mononucleosis

Alternative Names

CMV mononucleosis; Cytomegalovirus (CMV)

Causes, incidence, and risk factors

Infection with cytomegalovirus (CMV) is very common. The infection is spread by:

• Blood transfusions
• Organ transplants
• Respiratory droplets
• Saliva
• Sexual contact
• Urine

Most people are exposed to CMV in their lifetime, but typically only individuals with weakened immune systems become ill from CMV infection. Some people with this condition develop a mononucleosis-like syndrome.

In the U.S., CMV infection most commonly develops between ages 10 - 35. Most people are exposed to CMV early in life and do not realize it because they have no symptoms. People with a compromised immune system can have a more severe form of the disease.

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 heart beat
• Jaundice
• Neck stiffness
• Rapid heart rate
• Sensitivity to light
• Shortness of breath
• Swollen spleen and liver

Signs and tests

Your health care provider will perform a physical exam and feel your belly area. The liver and spleen may be tender when they are gently pressed (palpated). There may be a skin rash.

Special lab tests may be done to check for substances in your blood that are produced by CMV. Other tests will be done to check your body?s response to the CMV infection. This includes a CMV ELISA antibody test and CMV serum PCR test.

Other tests include:

• Blood tests for platelets and white blood cells
• Chemistry panel
• Liver function tests
• Monospot test

Treatment

Most patients recover in 4 - 6 weeks without medication. Rest is needed, sometimes for a month or longer to regain full activity levels. Painkillers and warm salt water gargles can help relieve symptoms.

Antiviral medications are usually not used in people with normal immune function.

Support Groups

Expectations (prognosis)

Fever usually goes away in 10 days, and swollen lymph glands and spleen return to normal in 4 weeks. Fatigue may linger for 2 to 3 months.

Complications

Throat infection is the most common complication. Rare complications include:

• Colitis
• Guillain-Barré syndrome
• Neurologic complications
• Pericarditis or myocarditis
• Pneumonia
• Rupture of spleen

Calling your health care provider

Call for an appointment with your health care provider if you have symptoms of acute CMV infection.

Go to the emergency room or call the local emergency number (such as 911) if you have sharp, sudden pain in your left upper abdomen. This could indicate a ruptured spleen, which requires emergency surgery.

Prevention

CMV infection can be contagious if the infected person comes in close or intimate contact with another person. You should avoid kissing and sexual contact with an infected person.

The virus may also spread among young children in day care settings.

When planning blood transfusions or organ transplants, the CMV status of the donor can be checked to avoid passing CMV to a recipient who has not had CMV.

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References

Crumpacker CS, Wadhwa S. Cytomegalovirus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 134.

Drew WL. Cytomegalovirus. In: Goldman L, Ausiello D, eds. Cecil Medicine. 23rd ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 399.