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.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Preview
Unable to display preview. Download preview PDF.
Literature Cited
Arvin, A. M. 1985. Cytomegaloviruses, p. 227. InE. H. Lennette (ed.), Laboratory diagnosis of viral infections. Marcel Dekker, Inc., New York.
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.
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.
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.
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.
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.
Carney, W. P., et al. 1981. Analysis of T lymphocyte subsets in cytomegalovirus mononucleosis. J. Immunol. 126: 2114 – 2116.
Cheeseman, S. H., et al. 1979. Controlled clinical trial of prophylactic human-leukocyte interferon in renal transplantation. N. Engl. J. Med. 300: 1345 – 1349.
Chien, L. T., et al. 1974. Effect of adenine arabinoside on cytomegalovirus infections. J. Infect. Dis. 130: 32 – 39.
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.
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.
Chretien, J. H., C. G. McGinnis, and A. Muller. 1977. Venereal causes of cytomegalovirus mononucleosis. J. Am. Med. Assoc. 238: 1644 – 1645.
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.
Conchie, A. F., B. W. Barton, and J. O. Tobin. 1968. Congenital cytomegalovirus infection treated with idoxuri- dine. Br. Med. J. 4: 162 – 163.
Drew, W. L., and R. C. Miner. 1982. Transfusion-related cytomegalovirus infection following non-cardiac surgery. J. Am. Med. Assoc. 247: 2389 – 2391.
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.
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.
Drew, W. L., et al. 1985. Cytomegalovirus infection and abnormal T-lymphocyte subset ratios in homosexual men. Ann. Intern. Med. 103: 61 – 63.
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.
Elek, S. D., and H. Stern. 1974. Development of a vaccine against mental retardation caused by cytomegalovirus infection in utero. Lancet 1: 1 – 5.
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.
Feldman, R. A. 1968. Cytomegalovirus in stored urine specimens. J. Pediatr. 73: 611 – 614.
Felsenstein, D., et al. 1985/ Treatment of cytomegalovirus retinitis with 9-[2-hydroxy-l-(hydroxymethyl) ethoxy- methyl]guanine. Ann. Intern. Med. 103:377–380.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Handsfield, H. H., et al. 1985. Cytomegalovirus infection in sex partners: Evidence for sexual transmission. J. Infect. Dis. 151: 344 – 348.
Haneberg, B., E. Bertnes, and G. Haukenes. 1980. Antibodies to cytomegalovirus among personnel at a children’s hospital. Acta Paediatr. Scand. 69: 407 – 409.
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.
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.
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.
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.
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.
Keller, R., R. Peitchel, J. N. Goldman, and M. Goldman. 1976. An IgG-Fc receptor induced in cytomegalovirus- infected human fibroblasts. J. Immunol. 116: 772
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.
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.
Lipscheutz, B. 1921. Unterschungen uber die aetiologie der krankheiten der Herpes genitalis. Arch. Dermatol. Syph. 136: 428 – 482.
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.
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.
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.
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.
McCracken, G. J., Jr., and J. P. Luby. 1972. Cytosine arabinoside in the treatment of congenital cytomegalic inclusion disease. J. Pediatr. 80: 488 – 495.
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.
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.
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.
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.
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.
Myerson, D., R. C. Hackman, and J. D. Meyers. 1984. Diagnosis of cytomegaloviral pneumonia by in situ hybridization. J. Infect. Dis. 150: 272 – 277.
Peterson, P. K., et al. 1983. Risk factors in the development of cytomegalovirus-related pneumonia in renal transplant recipients. J. Infect. Dis. 148: 1121.
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.
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.
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.
Plotkin, S. A., and H. Stetler. 1969. Treatment of congenital cytomegalic inclusion disease with antiviral agents. Antimicrob. Agents Chemother. 9: 372 – 379.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
Stagno, S., et al. 1975. Cervical cytomegalovirus excretion in pregnant and nonpregnant women: Suppression in early gestation. J. Infect. Dis. 131: 522 – 527.
Stagno, S., et al. 1980. Comparative study of diagnostic procedures for congenital cytomegalovirus infection. Pediatrics 65: 251 – 257.
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.
Starr, J. G., D. Calafiore, and H. L. Casey. 1967. Experience with a human cytomegalovirus complement fixing antigen. Am. J. Epidemiol. 86: 507 – 512.
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.
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.
Tocci, M. J., et al. 1984. Effects of the nucleoside analogue 2;NDG on cytomegalovirus replication. Antimicrob. Agents Chemother. 25: 247 – 252.
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.
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.
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.
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.
Weller, T. H., and J. B. Hanshaw. 1962. Virologic and clinical observations on cytomegalic inclusion disease. N. Engl. J. Med. 266: 1233 – 1244.
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.
Whitley, R., et al. 1980. Vidarabine: A preliminary review of its pharmacological properties and therapeutic use. Drugs 20: 267 – 282.
Yeager, A. S. 1975. Longitudinal, serological study of cytomegalovirus infections in nurses and in personnel without patient contact. J. Clin. Microbiol. 2: 448 – 452.
Yeager, A. S., et al. 1981. Prevention of transfusion-ac- quired cytomegalovirus infections in newborn infants. J. Pediatr. 98: 281 – 287.
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.
Rights and permissions
Copyright information
© 1988 Springer-Verlag New York Inc.
About this chapter
Cite this chapter
Drew, W.L. (1988). Herpesviridae: Cytomegalovirus. In: Laboratory Diagnosis of Infectious Diseases Principles and Practice. Springer, New York, NY. https://doi.org/10.1007/978-1-4612-3900-0_13
Download citation
DOI: https://doi.org/10.1007/978-1-4612-3900-0_13
Publisher Name: Springer, New York, NY
Print ISBN: 978-1-4612-8394-2
Online ISBN: 978-1-4612-3900-0
eBook Packages: Springer Book Archive