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| ==Overview==
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| | {{CMG}}:{{AE}}{{DAMI}} |
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| ==Classification==
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| Cytomegalovirus infection can be classified based on the organ system involved into the following:
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| ===CMV retinitis===
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| *It is the most common clinical manifestation of cytomegalovirus infection.
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| *Retinitis is initially unilateral but progress to affect the contralateral side in the absence of therapy and immunosuppression.
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| *In patients with CD4 < 50cells/mm³ bilateral retinal involvement is high.
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| *Peripheral retinitis can be asymptomatic or present with floaters, scotomata, or peripheral visual field defects whereas central retinal lesions or lesions impinging on the macula or optic nerve are result in decreased visual acuity and central field defects.
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| *On fundus examination the following findings can be demonstrated:
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| **Fluffy yellow-white retinal lesions, with or without intraretinal hemorrhage.
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| **Inflammation of the vitreous can be demonstrated in patients with severe immunosuppression.
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| **Blood vessels appear sheathed.
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| **If left untreated, retinitis is a rapidly progressive condition and on fundus examination it demonstrates a characteristic brushfire pattern, with a granular, white leading edge advancing before an atrophic gliotic scar.
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| ===CMV colitis===
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| *Colitis is seen in 5 to 10% of patients with AIDS and cytomegalovirus end organ disease.
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| *Colitis presents with weight loss, anorexia, abdominal pain, debilitating diarrhea, fever and malaise. Patients with perforation of the bowel present with acute abdominal pain.
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| *CT abdomen in patients with cytomegalovirus colitis demonstrates colonic thickening.
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| *Complications of cytomegalovirus colitis include bowel perforation and hemorrhage.
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| *Colonoscopy demonstrates mucosal lesions and the diagnosis is confirmed by the presence of characteristic intranuclear and intracytoplasmic inclusions on microscopic examination of the colonic biopsy.
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| ===CMV esophagitis=== | | ==[[Roseola overview|Overview]]== |
| *Cytomegalovirus esophagitis can be seen in few patients with AIDS and cytomegalovirus end organ disease.
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| *Patients present with symptoms of odynophagia, nausea, mid-epigastric or retrosternal discomfort and fever.
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| *Endoscopy will reveal ulcers in the distal esophagus and diagnosis is confirmed by the demonstration of characteristic intranuclear inclusion bodies in the endothelial cells of the biopsy specimen.
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| *Culture of cytomegalovirus from the esophageal biopsy is not sufficient to confirm the diagnosis in the absence of microscopic findings as majority of patients with low CD4 counts have positive culture.
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| ===CMV pneumonitis=== | | ==[[Roseola historical perspective|Historical Perspective]]== |
| *Cytomegalovirus pneumonitis is a uncommon condition and is usually asymptomatic.
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| *It is usually diagnosed on bronchoalveolar lavage and co-exists with an underlying pulmonary infection.
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| *Chest X-Ray demonstrates diffuse pulmonary interstitial infiltrates and diagnosis confirmation requires a correlation of the clinical features to imaging findings.
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| ===Neurologic disease=== | | ==[[Roseola classification|Classification]]== |
| Cytomegalovirus infection of the neurological system includes dementia, ventriculoencephalitis and polymyeloradiculopathies. Diagnosis of neurological disease requires correlation between the clinical symptoms and a positive PCR for cytomegalovirus of the cerebrospinal fluid.
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| *'''CMV Encephalitis'''
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| **Patients with cytomegalovirus encephalitis presents with fever, lethargy and confusion.
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| **Cerebrospinal fluid demonstrates lymphocytic pleocytosis, low-to-normal glucose levels, and normal-to-elevated protein levels.
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| *'''CMV Ventriculoencephalitis'''
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| **Patients have an acute onset of symptoms with focal neurological deficits, cranial nerve palsies, nystagmus and rapid progression to death.
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| **Presence of periventricular enhancement on CT or MRI is highly suggestive of CMV infection.
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| *'''CMV polyradiculomyelopathy'''
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| **Patients present with similar features of Guillian Barre Syndrome.
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| **Patients with bladder incontinence and paraplegia with gradual worsening of symptoms over weeks.
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| **Cerebrospinal fluid analysis demonstrates neutrophilic pleocytosis, low glucose levels and elevated protein levels.
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| ==Pathogenesis== | | ==[[Roseola pathophysiology|Pathophysiology]]== |
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| | ==[[Roseola causes|Causes]]== |
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| | ==[[Roseola differential diagnosis|Differentiating Any Disease from other Diseases]]== |
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| | ==[[Roseola epidemiology and demographics|Epidemiology and Demographics]]== |
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| | ==[[Roseola risk factors|Risk Factors]]== |
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| | ==[[Roseola screening|Screening]]== |
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| | ==[[Roseola natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ==Epidemiology and Demographics==
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| Cytomegalovirus (CMV) infects approximately 40-90% of the world population.<ref name="pmid27526428">{{cite journal| author=Pytka D, Czarkowska-Pączek B| title=[CMV infection in elderly]. | journal=Przegl Lek | year= 2016 | volume= 73 | issue= 4 | pages= 241-4 | pmid=27526428 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=27526428 }} </ref>
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| ==Diagnosis== | | ==Diagnosis== |
| ===Serological Tests===
| | [[Roseola history and symptoms|History and Symptoms]] | [[Roseola physical examination|Physical Examination]] | [[Roseola laboratory findings|Laboratory Findings]] | [[Roseola electrocardiogram|Electrocardiogram]] | [[Roseola chest x ray|Chest X Ray]] | [[Roseola CT|CT]] | [[Roseola MRI|MRI]] | [[Roseola echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Roseola other imaging findings|Other Imaging Findings]] | [[Roseola other diagnostic studies|Other Diagnostic Studies]] |
| *Serological tests are not useful for the diagnosis of cytomegalovirus infection, however absence of CMV IgG excludes the presence of infection.
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| ===Polymerase Chain Reaction===
| | ==Treatment== |
| *In patients with cytomegalovirus retinitis CMV DNA is detected in the vitreous in majority of patients.
| | [[Roseola medical therapy|Medical Therapy]] | [[Roseola surgery|Surgery]] | [[Roseola primary prevention|Primary Prevention]] | [[Roseola secondary prevention|Secondary Prevention]] | [[Roseola cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Roseola future or investigational therapies|Future or Investigational Therapies]] |
| *PCR for demonstration of CMV DNA is useful for the diagnosis of retinitis and neurologic disease.
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| *PCR of blood for demonstration of viremia is not useful for diagnosis of cytomegalovirus end organ disease as a negative result is not consistent with the absence of disease.
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| ===Microscopic Pathology=== | |
| *Demonstration of characteristic intranuclear inclusion bodies in the biopsy from esophagus and colon confirms the diagnosis of esophagitis and colitis.
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| ===CT Scan===
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| *In patients with cytomegalovirus ventriculoencephalitis periventricular enhancement is suggestive of CMV infection.
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| *Colonic thickening can be demonstrated in patients with cytomegalovirus colitis.
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| ==References== | | ==Case Studies== |
| {{Reflist|2}}
| | [[Roseola case study one|Case #1]] |