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Herpesviridae: Cytomegalovirus

Chapter

Abstract

Disease: Cytomegalic inclusion disease, congenital; cytomegalovirus mononucleosis; cytomegalovirus infection in the immunosuppressed.

Etiologic Agent: Human cytomegalovirus (HCMV), a member of the herpesvirus family.

Source: Human, by 1) direct contact, including sexual and parturition; 2) vertical; 3) breast milk; 4) blood or organ transplantation.

Clinical Manifestations: Clinical manifestations depend on the syndrome.

Congenital: hepatosplenomegaly, petechial rash, microcephaly, intracerebral calcifications, hearing loss.

Mononucleosis: fever, malaise.

Reactivation or primary infection in immunosuppressed: pneumonia, hepatitis (chemical), retinitis, encephalitis, colitis, esophagitis, adrenalitis.

Pathology: Cytomegalic cells containing a dense central intranuclear inclusion with or without associated mononuclear cell inflammatory response.

Laboratory Diagnosis: Viral isolation from urine, blood, lung, semen, or tissue. Serocon-version is diagnostic, but increase in immunoglobulin G antibody may not be significant. Immunoglobulin M antibody indicates active infection. Detection of antigen or genome may provide rapid diagnosis of infection.

Epidemiology: Worldwide, especially underdeveloped countries where infection is universal by childhood. In developed areas, approximately one-half of adults are infected. Rates of antibody prevalence increase with age and with lowering of socioeconomic status. Spread by close personal contact, including sexual. Also spread vertically, by natal exposure to infected cervix, by breast milk, and by blood transfusion or organ transplantation. Virus remains latent in host and can be reactivated, especially by immunosuppression.

Treatment: DHPG [9-(l,3-dihydroxy-2-propoxymethy)guanine] is an effective antiviral agent that suppresses CMV during treatment, but does not eradicate it.

Prevention and Control: Infection can be prevented by avoiding close personal contact (including sexual) with an actively infected individual. Transmission by blood transfusion or organ transplantation can be avoided by using blood or organs from seronegative donors.

Keywords

Acquire Immune Deficiency Syndrome Human Cytomegalovirus Cytomegalovirus Infection Complement Fixation Test Acquire Immune Deficiency Syndrome Patient 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Literature Cited

  1. Arvin, A. M. 1985. Cytomegaloviruses, p. 227. InE. H. Lennette (ed.), Laboratory diagnosis of viral infections. Marcel Dekker, Inc., New York.Google Scholar
  2. Bach, M. C., S. P. Bagwell, N. P. Knapp, K. M. Davis, and P. S. Hedstrom. 1985. 9-(l,3-Dihydroxy-2-proppoxy- methyl)guanine for cytomegalovirus infections in patients with the acquired immunodeficiency syndrome. Ann. Intern. Med. 103:381–382.Google Scholar
  3. Ballard, R. B., W. L. Drew, K. G. Hufnagle, and P. A. Riedel. 1979. Acquired cytomegalovirus infection in pre-term infants. Am. J. Dis. Child. 133: 482 – 485.PubMedGoogle Scholar
  4. Barton, B. W., and J. Tobin. 1970. The effects of idoxuri- dine on the excretion of cytomegalovirus in congenital infection. Ann. N.Y. Acad. Sci. 173: 90 – 95.CrossRefGoogle Scholar
  5. Bowden, R. A., et al. 1986. Cytomegalovirus immune globulin and seronegative blood products to prevent primary cytomegalovirus infection after bone marrow transplantation. N. Engl. J. Med. 314: 1006 – 1010.PubMedCrossRefGoogle Scholar
  6. Brodie, H., W. L. Drew, and S. Maayan. 1984. Prevalence of Kaposi’s sarcoma in AIDS patients reflects differences in rates of cytomegalovirus infection in high risk groups. AIDS Memorandum (NIAID) 1: 12.Google Scholar
  7. Carney, W. P., et al. 1981. Analysis of T lymphocyte subsets in cytomegalovirus mononucleosis. J. Immunol. 126: 2114 – 2116.PubMedGoogle Scholar
  8. Cheeseman, S. H., et al. 1979. Controlled clinical trial of prophylactic human-leukocyte interferon in renal transplantation. N. Engl. J. Med. 300: 1345 – 1349.PubMedCrossRefGoogle Scholar
  9. Chien, L. T., et al. 1974. Effect of adenine arabinoside on cytomegalovirus infections. J. Infect. Dis. 130: 32 – 39.CrossRefGoogle Scholar
  10. Chou, S., J. Dylewski, M. Gaynon, P. Egbert, and T. C. Merigan. 1984. Alpha-interferon administration in cytomegalovirus retinitis. Antimicrob. Agents Chemother. 25: 25 – 28.PubMedGoogle Scholar
  11. Chou, S., and T. C. Merigan. 1983. Rapid detection and quantitation of human cytomegalovirus in urine through DNA hybridization. N. Engl. J. Med. 308: 921 – 925.PubMedCrossRefGoogle Scholar
  12. Chretien, J. H., C. G. McGinnis, and A. Muller. 1977. Venereal causes of cytomegalovirus mononucleosis. J. Am. Med. Assoc. 238: 1644 – 1645.CrossRefGoogle Scholar
  13. Collaborative DHPG Treatment Study Group. 1986. Treatment of serious cytomegalovirus infections using 9-(l,3- dihydroxy-2-propoxymethyl)guanine in patients with AIDS and other immunodeficiencies. N. Engl. J. Med. 314: 801 – 805.CrossRefGoogle Scholar
  14. Conchie, A. F., B. W. Barton, and J. O. Tobin. 1968. Congenital cytomegalovirus infection treated with idoxuri- dine. Br. Med. J. 4: 162 – 163.PubMedCrossRefGoogle Scholar
  15. Drew, W. L., and R. C. Miner. 1982. Transfusion-related cytomegalovirus infection following non-cardiac surgery. J. Am. Med. Assoc. 247: 2389 – 2391.CrossRefGoogle Scholar
  16. Drew, W. L., L. Mintz, R. C. Miner, M. Sands, and B. Ketterer. 1981. Prevalence of cytomegalovirus infection in homosexual men. J. Infect. Dis. 143: 188 – 192.PubMedCrossRefGoogle Scholar
  17. Drew, W. L., E. S. Mocarski, E. Sweet, and R. C. Miner. 1984. Multiple infections with CMV in AIDS patients: Documentation by southern blot hybridization. J. Infect. Dis. 150: 952 – 953.PubMedCrossRefGoogle Scholar
  18. Drew, W. L., et al. 1985. Cytomegalovirus infection and abnormal T-lymphocyte subset ratios in homosexual men. Ann. Intern. Med. 103: 61 – 63.PubMedGoogle Scholar
  19. Dworsky, M. E., K. Welch, G. Cassady, and S. Stagno. 1983. Occupational risk for primary cytomegalovirus infection among pediatric health-care workers. N. Engl. J. Med. 309: 950 – 953.PubMedCrossRefGoogle Scholar
  20. Elek, S. D., and H. Stern. 1974. Development of a vaccine against mental retardation caused by cytomegalovirus infection in utero. Lancet 1: 1 – 5.PubMedCrossRefGoogle Scholar
  21. Emanuel, D., et al. 1986. Rapid immunodiagnosis of cytomegalovirus pneumonia by bronchoalveolar lavage using human and murine monoclonal antibodies. Ann. Intern. Med. 104: 476 – 481.PubMedGoogle Scholar
  22. Feldman, R. A. 1968. Cytomegalovirus in stored urine specimens. J. Pediatr. 73: 611 – 614.PubMedCrossRefGoogle Scholar
  23. Felsenstein, D., et al. 1985/ Treatment of cytomegalovirus retinitis with 9-[2-hydroxy-l-(hydroxymethyl) ethoxy- methyl]guanine. Ann. Intern. Med. 103:377–380.Google Scholar
  24. Fetterman, G. H., F. E. Sherman, N. S. Fabazio, and F. M. Studnicki. 1968. Generalized cytomegalic inclusion disease of the newborn: Localization of inclusions in the kidney. Arch. Pathol. 86: 86 – 94.PubMedGoogle Scholar
  25. Field, A. K., et al. 1983. 9-([2-Hydroxy-l-(hydroxymethyl) ethoxymethyljguanine: A selective inhibitor of herpes group virus replication. Proc. Natl. Acad. Sci. USA 80:4139–4143.Google Scholar
  26. Follansbee, S. E., D. F. Busch, C. B. Wofsy, D. L. Coleman, J. Gullett, G. P. Aurigemma, T. Ross, W. K. Had- ley, and W. L. Drew. An outbreak of Pneumocystis carinii pneumonia in homosexual men. Ann. Intern. Med. 1982;96(part 1):705–713.Google Scholar
  27. Freitas, V. R., et al. 1985. Activity of 9-(l,3-dihydroxy-2- propoxymethyl)guanine compared with that of acyclovir against human, monkey and rodent cytomegalovirus. Antimicrob. Agents Chemother. 28: 240 – 245.Google Scholar
  28. Gleaves, C. A., T. F. Smith, E. A. Shuster, and G. R. Pearson. 1984. Rapid detection of cytomegalovirus in MRC-5 cells inoculated with urine specimens by using low-speed centrifugation and monoclonal antibody to an early antigen. J. Clin. Microbiol. 19: 917 – 919.PubMedGoogle Scholar
  29. Goldstein, L. C., et al. 1982. Monoclonal antibodies to cytomegalovirus: Rapid identification of clinical isolates and preliminary use in diagnosis of cytomegalovirus pneumonia. Infect. Immun. 38: 273 – 281.PubMedGoogle Scholar
  30. Goodpasture, E. W., and F. B. Talbot. 1921. Concerning the nature of “protozoan-like” cells in certain lesions of infancy. Am. J. Dis. Child. 21: 415 – 425.Google Scholar
  31. Griffiths, P. D., K. J. Buie, and R. B. Heath. 1980. Persistence of high titre antibodies to the early antigens of cytomegalovirus in pregnant women. Arch. Virol. 604: 303 – 309.CrossRefGoogle Scholar
  32. Hackman, R. C., et al. 1985. Rapid diagnosis of cytomega- loviral pneumonia by tissue immunofluorescence with a murine monoclonal antibody. J. Infect. Dis. 151: 325 – 329.PubMedCrossRefGoogle Scholar
  33. Handsfield, H. H., et al. 1985. Cytomegalovirus infection in sex partners: Evidence for sexual transmission. J. Infect. Dis. 151: 344 – 348.PubMedCrossRefGoogle Scholar
  34. Haneberg, B., E. Bertnes, and G. Haukenes. 1980. Antibodies to cytomegalovirus among personnel at a children’s hospital. Acta Paediatr. Scand. 69: 407 – 409.PubMedCrossRefGoogle Scholar
  35. Howell, C. L., M. J. Miller, W. J. Martin. 1979. Comparison of rates of virus isolation from leukocyte populations separated from blood by conventional and Ficoll-Paque/Macrodex methods. J. Clin. Microbiol. 10: 533 – 537.PubMedGoogle Scholar
  36. Huang, E. S., S. M. Huong, G. E. Tegtmeier, and C. A. Alford, Jr. 1980. Cytomegalovirus: Genetic variation of viral genomes. Ann. N.Y. Acad. Sci. 354: 332 – 346.PubMedCrossRefGoogle Scholar
  37. Jordan, M. C., W. E. Rousseau, G. R. Noble, J. A. Stewart, and T. D. Y. Chinn. 1973. Association of cervical cytomegaloviruses with venereal disease. N. Engl. J. Med. 288: 932 – 934.PubMedCrossRefGoogle Scholar
  38. Kangro, H. O., J. C. Booth, T. M. F. Bakir, Y. Tryhorn, and S. Sutherland. 1984. Detection of IgM antibodies against cytomegalovirus: Comparison of two radioimmunoassays, enzyme-linked immunosorbent assay and immunofluorescent antibody test. J. Med. Virol. 14: 73 – 80.PubMedCrossRefGoogle Scholar
  39. Katznelson, S., W. L. Drew, and L. Mintz. 1984. Efficacy of the condom as a barrier to the transmission of cytomegalovirus. J. Infect. Dis. 150: 155 – 157.PubMedCrossRefGoogle Scholar
  40. Keller, R., R. Peitchel, J. N. Goldman, and M. Goldman. 1976. An IgG-Fc receptor induced in cytomegalovirus- infected human fibroblasts. J. Immunol. 116: 772PubMedGoogle Scholar
  41. Kettering, J. D., N. J. Schmidt, D. Gallo, and E. H. Lennette. 1977. Anti-complement immunofluorescence test for antibodies to human cytomegalovirus. J. Clin. Microbiol. 6: 627 – 632.PubMedGoogle Scholar
  42. Kraybill, E. N., J. L. Sever, G. B. Avery, and N. Movassaghi. 1972. Experimental use of cytosine arabinoside in congenital cytomegalovirus infection. J. Pediatr. 80: 485 – 487.PubMedCrossRefGoogle Scholar
  43. Lipscheutz, B. 1921. Unterschungen uber die aetiologie der krankheiten der Herpes genitalis. Arch. Dermatol. Syph. 136: 428 – 482.CrossRefGoogle Scholar
  44. Mar, E. C., Y. C. Cheng, and E.-S. Huang. 1983. Effect of 9-(l,3-dihydroxy-2-propoxymethyl)guanine on human cytomegalovirus replication in vitro. Antimicrob. Agents Chemother. 24: 518 – 521.PubMedGoogle Scholar
  45. Marker, S. G., R. J. Howard, K. E. Groth, A. R. Mastry, R. L. Simmons, and H. H. Balfour. 1980. A trial of vidarabine for cytomegalovirus infection in renal transplant patients. Arch. Intern. Med. 140: 1441 – 1444.PubMedCrossRefGoogle Scholar
  46. Martin, W. J., and T. F. Smith. 1986. Rapid detection of cytomegalovirus in bronchoalveolar lavage specimens by a moncolonal antibody method. J. Clin. Microbiol. 23: 1006 – 1008.PubMedGoogle Scholar
  47. Masur, H., et al. 1986. Effect of 9-(l,3-dihydroxy-2-pro- poxymethyl)guanine on serious cytomegalovirus disease in eight immunosuppressed homosexual men. Ann. Intern. Med. 104: 41 – 46.PubMedGoogle Scholar
  48. McCracken, G. J., Jr., and J. P. Luby. 1972. Cytosine arabinoside in the treatment of congenital cytomegalic inclusion disease. J. Pediatr. 80: 488 – 495.PubMedCrossRefGoogle Scholar
  49. McKeating, J. A., S. Stagno, P. R. Stirk, and P. D. Griffiths. 1985. Detection of cytomegalovirus in urine samples by enzyme-linked immunosorbent assay. J. Med. Virol. 16: 367 – 373.PubMedCrossRefGoogle Scholar
  50. Meyers, J. D., R. McGuffin, Y. Bryson, K. Cantell, and E. Thomas. 1982. Treatment of cytomegalovirus pneumonia after marrow transplant with combined vidarabine and human leukocyte interferon. J. Infect. Dis. 146: 80 – 84.PubMedCrossRefGoogle Scholar
  51. Meyers, J. D., R. McGuffin, P. Neiman, J. Singer, and E. Thomas. 1980. Toxicity and efficacy of human leukocyte interferon for the treatment of cytomegalovirus pneumonia after marrow transplantation. J. Infect. Dis. 141: 555 – 562.PubMedCrossRefGoogle Scholar
  52. Mintz, L., W. L. Drew, R. C. Miner, and E. H. Braff. 1983. Cytomegalovirus infections in homosexual men: An epidemiological study. Ann. Intern. Med. 99: 326 – 329.PubMedGoogle Scholar
  53. Mintz, L., R. C. Miner, and A. S. Yeager. 1980. Anticomplement immunofluorescence test that uses isolated fibroblast nuclei for detection of antibodies to human cytomegalovirus. J. Clin. Microbiol. 12: 562 – 566.PubMedGoogle Scholar
  54. Myerson, D., R. C. Hackman, and J. D. Meyers. 1984. Diagnosis of cytomegaloviral pneumonia by in situ hybridization. J. Infect. Dis. 150: 272 – 277.PubMedCrossRefGoogle Scholar
  55. Peterson, P. K., et al. 1983. Risk factors in the development of cytomegalovirus-related pneumonia in renal transplant recipients. J. Infect. Dis. 148: 1121.PubMedCrossRefGoogle Scholar
  56. Phipps, P. H., L. Gregoire, E. Rossier, and E. Perry. 1983. Comparison of five methods of cytomegalovirus screening of blood donors. J. Clin. Microbiol. 18: 1296 – 1300.PubMedGoogle Scholar
  57. Plotkin, S. A., W. L. Drew, D. Felsenstein, and M. S. Hirsch. 1985. Sensitivity of clinical isolates of human cytomegalovirus to 9-(l,3-dihydroxy-2-propoxymethyl)- guanine. J. Infect. Dis. 152: 833 – 834.PubMedCrossRefGoogle Scholar
  58. Plotkin, S. A., et al. 1984. Prevention of cytomegalovirus disease by Towne strain live attenuated vaccine, p. 271–287. InS. A. Plotkin, et al (ed.), CMV: Pathogenesis and prevention of human infection. Alan R. Liss, Inc., New York.Google Scholar
  59. Plotkin, S. A., and H. Stetler. 1969. Treatment of congenital cytomegalic inclusion disease with antiviral agents. Antimicrob. Agents Chemother. 9: 372 – 379.PubMedGoogle Scholar
  60. Pollard, R. B., P. Egvert, J. Gallagher, and T. C. Merigan. 1980. Cytomegalovirus retinitis in immunosuppressed hosts. I. Natural history and effects of treatment with adenine arabinoside. Ann. Intern. Med. 93: 655 – 664.Google Scholar
  61. Rasmussen, L., P. T. Chen, J. G. Mullenax, and T. C. Merigan. 1984. Inhibition of human cytomegalovirus replication by 9-(l,3-dihydroxy-2-propoxymethyl)- guanine alone and in combination with human interferons. Antimicrob. Agents Chemother. 26: 441 – 445.PubMedGoogle Scholar
  62. Reynolds, D. W., S. Stagno, and C. A. Alford. 1979. Laboratory diagnosis of cytomegalovirus infections, InE. H. Lennette and N. J. Schmidt (ed.), Diagnostic procedures for viral, rickettsial, and chlamydial infections, ed. 5. American Public Health Association, Washington, D.C.Google Scholar
  63. Rice, G. P. A., R. D. Schrier, and M. B. A. Oldstone. 1984. Cytomegalovirus infects human lymphocytes and monocytes: Virus expression is restricted to immediate early gene products. Proc. Natl. Acad. Sci. USA 81: 6134 – 6138.PubMedCrossRefGoogle Scholar
  64. Rinaldo, C. R., Jr., W. P. Carney, B. S. Richter, P. H. Black, and M. S. Hirsch. 1980. Mechanisms of immunosuppression in cytomegalovirus mononucleosis. J. Infect. Dis. 141: 488 – 495.PubMedCrossRefGoogle Scholar
  65. Rowe, W. P., J. W. Hartley, S. Waterman, H. C. Turner, and R. J. Huebner. 1956. Cytopathogenic agent resembling human salivary gland virus recovered from tissue cultures of human adenoids. Proc. Soc. Exp. Biol. Med. 92: 418 – 424.PubMedGoogle Scholar
  66. Schrier, R. D., J. A. Nelson, and M. B. A. Oldstone. 1985. Detection of human cytomegalovirus in peripheral blood lymphocytes in a natural infection. Science 230: 1048 – 1051.PubMedCrossRefGoogle Scholar
  67. Shepp, D. H., et al. 1985. Activity of 9-[2-hydroxy-l-(hy- droxymethyl)ethoxymethyl]guanine in the treatment of cytomegalovirus pneumonia. Ann. Intern. Med. 103: 368 – 373.PubMedGoogle Scholar
  68. Smith, M. G. 1956. Propogation in tissue cultures of a cytopathogenic virus from human salivary gland virus (SGV) disease. Proc. Soc. Exp. Biol. Med. 92: 424 – 430.PubMedGoogle Scholar
  69. Spector, S. A., J. A. Rua, D. H. Spector, and R. McMillan. 1984. Detection of human cytomegalovirus in clinical specimens by DNA-DNA hybridization. J. Infect. Dis. 150: 121 - 126.PubMedCrossRefGoogle Scholar
  70. Stagno, S., et al. 1975. Cervical cytomegalovirus excretion in pregnant and nonpregnant women: Suppression in early gestation. J. Infect. Dis. 131: 522 – 527.PubMedCrossRefGoogle Scholar
  71. Stagno, S., et al. 1980. Comparative study of diagnostic procedures for congenital cytomegalovirus infection. Pediatrics 65: 251 – 257.PubMedGoogle Scholar
  72. Stagno, S., D. W. Reynolds, R. F. Pass, and C. A. Alford, Jr. 1980. Breast milk and the risk of cytomegalovirus infection. N. Engl. J. Med. 302: 1073 – 1074.PubMedCrossRefGoogle Scholar
  73. Starr, J. G., D. Calafiore, and H. L. Casey. 1967. Experience with a human cytomegalovirus complement fixing antigen. Am. J. Epidemiol. 86: 507 – 512.PubMedGoogle Scholar
  74. Starr, S. E., J. P. Glazer, H. M. Friedman, J. D. Farquhar, and S. A. Plotkin. 1981. Specific cellular and humoral immunity after immunization with live Towne strain cytomegalovirus vaccine. J. Infect. Dis. 143: 585 – 589.PubMedCrossRefGoogle Scholar
  75. The, T. H., G. Klein, and M. M. A. C. Langenhuysen. 1974. Antibody reactions to virus-specific early antigens (EA) in patients with cytomegalovirus (CMV) infection. Clin. Exp. Immunol. 16: 1 – 12.Google Scholar
  76. Tocci, M. J., et al. 1984. Effects of the nucleoside analogue 2;NDG on cytomegalovirus replication. Antimicrob. Agents Chemother. 25: 247 – 252.PubMedGoogle Scholar
  77. Unger, E. R., L. R. Budgeon, D. Myerson, and D. J. Brigati. 1986. Viral diagnosis by in situ hybridization. Description of a rapid simplified colorimetric method. Am. J. Surg. Pathol. 10: 1 – 8.PubMedCrossRefGoogle Scholar
  78. Volpi, A., R. J. Whitley, R. Ceballos, S. Stagno, and L. Pereira. 1983. Rapid diagnosis of pneumonia due to cytomegalovirus with specific monoclonal antibodies. J. Infect. Dis. 147: 1119 – 1120.PubMedCrossRefGoogle Scholar
  79. Waner, J. L., T. H. Weller, and S. V. Kevy. 1973. Patterns of cytomegalovirus complement-fixing antibody activity: A longitudinal study of blood donors. J. Infect. Dis. 127: 538 – 543.PubMedCrossRefGoogle Scholar
  80. Weller, T. H., et al. 1971. The cytomegaloviruses: Ubiquitous agents with protean clinical manifestations (first of two parts). N. Engl. J. Med. 285: 203 – 214.PubMedCrossRefGoogle Scholar
  81. Weller, T. H., and J. B. Hanshaw. 1962. Virologic and clinical observations on cytomegalic inclusion disease. N. Engl. J. Med. 266: 1233 – 1244.PubMedCrossRefGoogle Scholar
  82. Weller, T. H., J. C. Macauley, J. M. Craig, and P. Wirth. 1957. Isolation of intranuclear inclusion producing agents from infants with illnesses resembling cytomegalic inclusion disease. Proc. Soc. Exp. Biol. Med. 94: 4 – 12.PubMedGoogle Scholar
  83. Whitley, R., et al. 1980. Vidarabine: A preliminary review of its pharmacological properties and therapeutic use. Drugs 20: 267 – 282.PubMedCrossRefGoogle Scholar
  84. Yeager, A. S. 1975. Longitudinal, serological study of cytomegalovirus infections in nurses and in personnel without patient contact. J. Clin. Microbiol. 2: 448 – 452.PubMedGoogle Scholar
  85. Yeager, A. S., et al. 1981. Prevention of transfusion-ac- quired cytomegalovirus infections in newborn infants. J. Pediatr. 98: 281 – 287.PubMedCrossRefGoogle Scholar
  86. Yolken, R. H. 1982. Enzyme immunoassays for the detection of infectious antigens in body fluids: Current limitations and future prospects. Rev. Infect. Dis. 4: 35 – 68.PubMedCrossRefGoogle Scholar

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