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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.
KeywordsAcquire Immune Deficiency Syndrome Human Cytomegalovirus Cytomegalovirus Infection Complement Fixation Test Acquire Immune Deficiency Syndrome Patient
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