Cytomegalovirus infection natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]
Overview
Primary CMV infection takes place in childhood and early adolescence is asymptomatic. After the resolution of the primary infection CMV is latent in the mononuclear leukocytes. Reactivation in immunocompetent patients presents with mononucleosis like syndrome, but severe infection can occur in elderly and critically ill patients. Common complications of CMV infection in immunocompromised patients include CMV retinitis, CMV colitis, CMV encephalitis, CMV pneumonia and CMV myocarditis. CMV is associated with increased risk of graft versus host disease, myelosuppression, and invasive bacterial and fungal infections increasing morbidity and mortality of the patients.
Natural History, Complications and Prognosis
Natural History
Primary CMV infection which occurs in childhood and early adolescence is asymptomatic. After the resolution of the primary infection, CMV is latent in the mononuclear leukocytes. Reactivation of the virus can occur during states of stress and immunosuppression. Reactivation in immunocompetent patients presents with a mononucleosis like syndrome. If left untreated, severe infection can occur in elderly and critically ill patients. They present with clinical manifestations affecting the gastrointestinal tract and the central nervous system. Retinitis and pneumonitis are uncommon in immunocompetent patients when compared to immunocompromised patients. Reactivation of CMV infection in immunocompromised patients results in CMV end organ infection affecting multiple organs.[1]
Complications
Common complications of CMV infection in immunocompromised patients include:[1]
- CMV retinitis can result in blindness
- CMV colitis can progress to bowel perforation and fatal diverticular bleeding[2]
- CMV encephalitis is a rapidly progressive condition leading to death
- CMV pneumonia
- CMV myocarditis
- CMV hepatitis
- Increased risk of secondary bacterial and fungal infections
- Increased risk of cardiovascular related mortality[3]
Complications in critically ill immunocompetent patients include:
- Increased mortality rate
- Prolonged intensive care unit and hospital length of stay
- Prolonged mechanical ventilation
- Nosocomial infections
- Endothelial cell dysfunction can cause portal or femoropopliteal vascular thrombosis
Complications of CMV infection in organ transplant patients:[4]
- Acute allograft rejection and failure
- Death
Prognosis
CMV disease is common in patients with solid organ transplantation causing significant morbidity and mortality. CMV is associated with increased risk of graft versus host disease, myelosuppression, and invasive bacterial and fungal infections increasing morbidity and mortality of the patients.[5][6]
References
- ↑ 1.0 1.1 Al-Omari A, Aljamaan F, Alhazzani W, Salih S, Arabi Y (2016). "Cytomegalovirus infection in immunocompetent critically ill adults: literature review". Ann Intensive Care. 6 (1): 110. doi:10.1186/s13613-016-0207-8. PMC 5095093. PMID 27813024.
- ↑ Makker J, Bajantri B, Sakam S, Chilimuri S (2016). "Cytomegalovirus related fatal duodenal diverticular bleeding: Case report and literature review". World J Gastroenterol. 22 (31): 7166–74. doi:10.3748/wjg.v22.i31.7166. PMC 4988300. PMID 27610026.
- ↑ Rezaee-Zavareh MS, Tohidi M, Sabouri A, Ramezani-Binabaj M, Sadeghi-Ghahrodi M, Einollahi B (2016). "Infectious and coronary artery disease". ARYA Atheroscler. 12 (1): 41–9. PMC 4834180. PMID 27114736.
- ↑ Luscalov S, Loga L, Dican L, Junie LM (2016). "Cytomegalovirus infection in immunosuppressed patients after kidney transplantation". Clujul Med. 89 (3): 343–6. doi:10.15386/cjmed-587. PMC 4990428. PMID 27547053.
- ↑ Ariza-Heredia EJ, Nesher L, Chemaly RF (2014). "Cytomegalovirus diseases after hematopoietic stem cell transplantation: a mini-review". Cancer Lett. 342 (1): 1–8. doi:10.1016/j.canlet.2013.09.004. PMID 24041869.
- ↑ de la Cámara R (2016). "CMV in Hematopoietic Stem Cell Transplantation". Mediterr J Hematol Infect Dis. 8 (1): e2016031. doi:10.4084/MJHID.2016.031. PMC 4928522. PMID 27413524.