Sandbox: Reddy

Classification

Cytomegalovirus infection can be classified based on the organ system involved into the following:

CMV retinitis

• It is the most common clinical manifestation of CMV infection.
• Retinitis is initially unilateral but progress to affect the contralateral side in the absence of therapy and immunosuppression.
• In patients with CD4 < 50cells/mm³ bilateral retinal involvement is high.
• 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.
• On fundus examination the following findings can be demonstrated:
  • Fluffy yellow-white retinal lesions, with or without intraretinal hemorrhage.
  • Inflammation of the vitreous can be demonstrated in patients with severe immunosuppression.
  • Blood vessels appear sheathed.
  • If left untreated, retinitis is a rapidly progressive condition and results in characteristic brushfire pattern, with a granular, white leading edge advancing before an atrophic gliotic scar on fundus examination.

CMV colitis

• Colitis is seen in 5 to 10% of patients with AIDS and cytomegalovirus end organ disease.
• Colitis presents with weight loss, anorexia, abdominal pain, debilitating diarrhea, fever and malaise. CMV can cause perforation of the bowel and the patient presents with acute abdomen.
• CT abdomen in patients with CMV colitis demonstrates colonic thickening.
• Complications of CMV colitis include bowel perforation and hemorrhage.

CMV esophagitis

• CMV esophagitis can be seen in few patients with AIDS and CMV end organ disease.
• Patients present with symptoms of odynophagia, nausea, mid-epigastric or retrosternal discomfort and fever.

CMV pneumonitis

• CMV pneumonitis is a uncommon condition and is usually asymptomatic.
• It is usually diagnosed on bronchoalveolar lavage and co-exists with an underlying pulmonary infection.

Neurologic disease

CMV infection of the neurological system includes dementia, ventriculoencephalitis and polymyeloradiculopathies.

• CMV Encephalitis
  • Patients with CMV encephalitis presents with fever, lethargy and confusion.
  • Cerebrospinal fluid demonstrates lymphocytic pleocytosis, low-to-normal glucose levels, and normal-to-elevated protein levels.
• CMV Ventriculoencephalitis
  • Patients have an acute onset of symptoms with focal neurological deficits, cranial nerve palsies, nystagmus and rapid progression to death.
  • Presence of periventricular enhancement on CT or MRI is highly suggestive of CMV infection.
• CMV polyradiculomyelopathy
  • Patients presents with similar features of Guillian Barre Syndrome.
  • Patients with bladder incontinence and paraplegia with gradual worsening of symptoms over weeks.
  • Cerebrospinal fluid analysis demonstrates neutrophilic pleocytosis, low glucose levels and elevated protein levels.

Epidemiology and Demographics

Cytomegalovirus (CMV) infects approximately 40-90% of the world population.