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CMV - immunocompromised host


Definition:

Cytomegalovirus (CMV) is a member of a group of herpes-type viruses that can cause disease in different parts of the body in people. This article discusses CMV in people with weakened immune systems.

Alternative Names:

Cytomegalovirus - immunocompromised host

Causes, incidence, and risk factors:

Most humans are exposed to CMV in their lifetime, but typically only individuals with weakened immune systems become ill from CMV infection. Usually, CMV produces no symptoms. However, serious CMV infections can occur in people with weakened immune systems due to AIDS, organ transplants, bone marrow transplant, chemotherapy, or medicines that suppress the immune system.

A CMV infection may affect different parts of the body. Infections include:

Once a person becomes infected, the virus remains alive, but usually dormant, within that person's body for life. Rarely does it cause recurrent disease, unless the person's immune system is suppressed due to medication or disease. Therefore, for most people, CMV infection is not a serious problem.

Primary CMV infection in pregnant women can cause harm to the developing fetus. See: Congenital cytomegalovirus

Symptoms:

The symptoms of CMV infection are similar to those of mononucleosis. In fact, in a small percentage of people with mononucleosis, CMV is the cause. The symptoms of primary CMV infection are:

  • Fatigue
  • General discomfort, uneasiness, or ill feeling (malaise)
  • Joint stiffness
  • Loss of appetite
  • Muscle aches or joint pain
  • Night sweats
  • Prolonged fever
  • Sore throat
  • Swelling of the lymph nodes
  • Weakness
  • Weight loss

In immunocompromised people, CMV can attack specific organs. The major symptoms of these organ-specific infections are:

Eye:

  • Blindness
  • Floaters in the eye
  • Visual impairment

Lung:

Gastrointestinal:

  • Diarrhea
  • Swallowing difficulties or pain
  • Ulcerations with bleeding

Brain:

Signs and tests:

Blood and urine tests can detect and measure substances specific to CMV. A tissue biopsy is often required to be certain of the diagnosis (except in the eye or nervous system).

Treatment:

Several antiviral medications are available to treat CMV. These medicines require close monitoring for side effects. Antiviral drugs can help stop the virus from copying itself within the body. However, the drugs do not eliminate the virus from the body.

Expectations (prognosis):

CMV infection in an immunocompromised person can be life threatening. The severity of the disease depends on the strength of the person's immune system. Research has shown that people who have had a bone marrow transplant have the highest mortality risk.

Any immunocompromised person, whether an HIV patient, organ transplant recipient, bone marrow transplant recipient, or other, should seek medical advice if any signs of infection occur.

Complications:
  • Blindness
  • Kidney impairment (from medications used to treat the condition)
  • Liver damage
  • Low white blood cell count (from medications used to treat the condition)
  • Meningitis
  • Pneumonia
Calling your health care provider:

Call your health care provider if you are immunosuppressed and you have symptoms of CMV infection.

Prevention:

The following should be tested for CMV:

References:

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


Review Date: 12/1/2009
Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine, University of Washington School of Medicine; Jatin M. Vyas, MD, PhD, Assistant Professor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Department of Medicine, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed physician should be consulted for diagnosis and treatment of any and all medical conditions. Call 911 for all medical emergencies. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. Copyright 2002 A.D.A.M., Inc. Any duplication or distribution of the information contained herein is strictly prohibited.

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