Types, symptoms, and treatments of cytomegalovirus

Cytomegalovirus is a typical herpes virus. Many people are unaware they have it since they show no signs or symptoms.

However, the virus can cause issues during pregnancy and in people with a compromised immune system because it remains dormant in the body.

The virus spreads through bodily fluids and can be passed on to an unborn child by a pregnant woman.

Cytomegalovirus, also known as HCMV, CMV, or human herpesvirus 5 (HHV-5), is the most frequent virus transmitted to a growing baby.

According to the Centers for Disease Control and Prevention (CDC), more than half of all people in the United States have contracted the virus by the age of 40. It affects both men and women equally, regardless of age or ethnicity.

Causes

consulting a doctor

Fluids such as saliva, sperm, blood, urine, vaginal fluids, and breast milk can spread acquired cytomegalovirus between people.

The virus can also be contracted by touching a virus-infected surface and then touching the interior of the nose or mouth.

The virus is most commonly contracted in childhood, at daycare centres, nurseries, and other places where children are in close proximity to one another. The immune system of a child at this age, on the other hand, is typically capable of dealing with an infection.

CMV can recur in people who have a compromised immune system as a result of HIV, organ transplantation, chemotherapy, or long-term use of oral steroids.

Congenital CMV develops when a female catches the virus for the first time during pregnancy or shortly before conception.

A dormant CMV infection might resurface during pregnancy, especially if the mother has a compromised immune system.

Symptoms

Depending on the type of CMV, the symptoms will vary.

Acquired CMV

The majority of people with CMV do not show any symptoms, however if they do, they may include:

  • swollen glands
  • joint and muscle pain
  • low appetite and weight loss
  • fever
  • night sweats
  • tiredness and uneasiness
  • sore throat

After two weeks, the symptoms should be gone.

Recurring CMV

The symptoms of recurrent CMV differ depending on which organs have been affected by the infection. The eyes, lungs, and digestive system are all likely to be affected.

Among the signs and symptoms are:

  • 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 blurred vision
  • hepatitis, or inflamed liver, with prolonged fever
  • encephalitis, or inflammation of the brain, leading to behavioral changes, seizures, and even coma.

Any of these symptoms should be reported to a doctor by someone with a reduced immune system.

Congenital CMV

According to the National CMV Foundation, approximately 90% of kids born with CMV show no symptoms, but 10–15% will develop hearing loss during their first 6 months of life. The degree of hearing loss varies from mild to complete deafness.

The infection will affect only one ear in half of these children, but the other half will experience hearing loss in both ears. Hearing loss in both ears can increase the risk of speech and communication issues in the future.

If congenital CMV is present at birth, symptoms may include:

  • enlarged spleen
  • seizures
  • jaundice
  • pneumonia
  • spots under the skin
  • low birth weight
  • Purple skin splotches, a rash, or both
  • enlarged liver

Some of these signs and symptoms can be treated.

In roughly 75% of babies born with congenital CMV, the virus will affect the brain. This could lead to difficulties later in life.

They may be exposed to the following conditions:

  • autism
  • central vision loss, scarring of the retina, and uveitis, or swelling and irritation of the eye
  • cognitive and learning difficulties
  • deafness or partial hearing loss
  • epilepsy
  • impaired vision
  • problems with physical coordination
  • seizures
  • small head

Treatments

Scientists have been looking for a CMV vaccine, however there is no cure as of yet.

People with acquired CMV who encounter the virus for the first time can ease symptoms with over-the-counter (OTC) pain relievers like Tylenol (acetaminophen), ibuprofen, or aspirin, and should stay hydrated.

Antiviral drugs, such as ganciclovir, can be used to inhibit the spread of CMV in people who have it congenitally or on a regular basis.

These drugs have the potential to cause side effects. Hospitalization may be required if there is substantial organ damage.

It’s possible that newborns will need to be admitted to the hospital until their organ functions return to normal.

Prevention

The following precautions may help minimise the risk of developing CMV:

  • Hands should be washed with soap and water on a frequent basis.
  • Kissing a small child should be avoided at all costs, including contact with tears and saliva.
  • When passing around a drink, avoid sharing glasses and kitchen equipment.
  • Diapers, paper handkerchiefs, and other such items should be disposed of with care.
  • To prevent CMV from spreading through vaginal secretions and sperm, use a condom.

The Centers for Disease Control and Prevention (CDC) advises parents and caregivers of children with CMV to seek treatment as soon as possible, whether that means taking medication or attending all appointments for services such as hearing tests.

Types

CMV infections are classified as either acquired, recurrent, or congenital.

  • When a person contracts CMV for the first time, it is known as acquired or primary CMV.
  • When a person already has CMV, it is referred to as recurrent CMV. The virus is dormant and then becomes active due to a weak immune system.
  • When a person contracts CMV while pregnant and passes it on to the foetus, this is known as congenital CMV.

Except when it affects an unborn child or a person with a weakened immune system, such as a recent transplant recipient or someone living with HIV, CMV is normally not an issue.

CMV infection can cause organ failure, eye damage, and blindness in HIV patients. In recent years, advances in antiviral treatment have lowered the risk.

Immunosuppressants are used by people who have had organ and bone marrow transplants to suppress their immune systems so that their bodies do not reject the new organs. In these people, dormant CMV can become active and cause organ damage.

Antiviral medications may be given to transplant recipients as a prophylactic against CMV.

The virus can be passed to the foetus by a pregnant woman. This is referred to as congenital CMV.

According to the Centers for Disease Control and Prevention, about one in every 200 newborns is born with the virus.

The majority of these babies will show no signs or symptoms, but about 20% will have symptoms or long-term health issues, such as learning challenges.

Vision and hearing loss, small head size, weakness, trouble using muscles, coordination issues, and seizures are all possible symptoms.

Diagnosis

A blood test can detect antibodies produced by the body as a result of the immune system’s response to the presence of CMV.

A pregnant woman faces a low risk of CMV reactivation affecting her unborn child. If a doctor suspects a pregnant woman has CMV, an amniocentesis may be recommended. To determine whether the virus is present, a sample of amniotic fluid is extracted.

The newborn will be tested within the first three weeks of life if the doctor suspects congenital CMV. Testing for congenital CMV after 3 weeks will not be definitive because the kid may have contracted the virus after birth.

Even if the virus is not active, anyone with a weaker immune system should get tested. Testing for vision and hearing issues will be done on a regular basis as part of the CMV complications monitoring.

Complications

CMV causes just a small percentage of healthy people to become very ill.

CMV mononucleosis, a condition in which too many white blood cells have a single nucleus, can occur in people with a weaker immune system.

Sore throat, swollen glands, swollen tonsils, fatigue, and nausea are some of the symptoms. It can cause hepatitis, or inflammation of the liver, as well as spleen enlargement.

Mononucleosis induced by the CMV is comparable to mononucleosis caused by the Epstein-Barr Virus (EBV). Glands fever is another name for EBV mononucleosis.

Other CMV problems include:

  • gastrointestinal problems, including diarrhea, fever, abdominal pain, colon inflammation, and blood in the feces
  • liver function problems
  • central nervous system (CNS) complications, such as encephalitis, or inflammation of the brain
  • pneumonitis, or inflammation of lung tissue.

Sources:

  • http://www.cdc.gov/cmv/index.html
  • https://www.nationalcmv.org/overview/outcomes
  • https://www.medicalnewstoday.com/articles/173811