Clinical picture depending on age
Manifestations of the disease are directly related to the time of infection:
- Early infection (during childbirth or immediately thereafter). The first symptoms usually appear in the 1st–2nd month of the child's life. The disease is prolonged, with frequent relapses. Both isolated salivary gland involvement and internal organ involvement are possible. Based on the leading syndrome, the following forms are distinguished: cerebral, respiratory, hepatobiliary, gastrointestinal, renal, and hematological. The endocrine system, thymus, eyes, and skin may also be affected.
- Infection in older children and adults. As a rule, it has a favorable outcome. Either a subclinical (inapparent) chronic infection or asymptomatic virus carriage develops. If the disease manifests, it often resembles infectious mononucleosis (characterized by an acute onset and fever).
Mononucleosis-like syndrome and reactivation
The mononucleosis-like form is characterized by signs of intoxication, fever, and upper respiratory catarrh. A systemic response develops: lymph nodes enlarge (generalized lymphadenopathy), along with the liver and spleen (hepatosplenomegaly). Blood tests reveal lymphomonocytosis and atypical mononuclear cells (up to 5–10%).
Reactivation of the infection occurs against the background of suppressed immunity. Risk factors include HIV infection, malignant tumors, severe burns, post-transplantation states, and prolonged use of immunosuppressants (cytostatics, glucocorticoids). Manifestations of reactivation range from localized (sialoadenitis) to severe disseminated processes:
- General infection syndrome: prolonged fever, night sweats, anorexia, weakness, muscle and joint pain.
- Hematological disorders: decreased white blood cell and platelet counts.
- Multiorgan lesions: hepatitis (often with cholestasis syndrome), interstitial pneumonia, GI tract lesions (esophagitis, enterocolitis, pancreatitis), CNS and eye lesions (encephalitis, retinitis).
Severe forms can mimic sepsis and be accompanied by multiorgan failure.
Diagnostics
Since there are no specific (pathognomonic) symptoms, a diagnosis cannot be made solely on clinical grounds. Laboratory methods are mandatory:
- Cytological — searching for giant epithelial cells with intranuclear inclusions ("owl's eye" sign).
- Virological — isolation of the virus on a fibroblast culture.
- Serological — assessment of antibody titer rise in paired sera (CFT, PHA), ELISA, and the rapid IFA method for antigen detection.
- Molecular biological — PCR and DNA hybridization. These are the most accurate methods for detecting viral DNA and assessing viral load.
Differential diagnosis of acquired CMV infection is carried out with classical infectious mononucleosis (caused by the Epstein–Barr virus) and human herpesvirus type 6 (HHV-6) infection.
Principles of treatment and prevention
Therapy includes:
- Antiviral drugs (acyclic nucleosides: ganciclovir, valganciclovir).
- Immunotherapy: non-specific (normal immunoglobulin) and specific (anti-cytomegalovirus immunoglobulin, which also exhibits cross-activity against herpes simplex viruses, Epstein–Barr virus, and varicella-zoster).
In case of complications, antibiotics and pathogenetic agents are added.
There is currently no CMV vaccine. Serological screening is mandatory for pregnant women. At-risk patients without antibodies are indicated administration of specific immunoglobulin.
Class and exam questions
What form does the infection take in the majority of adults?
Asymptomatic virus carriage or an inapparent (subclinical) form of infection is most commonly formed.
How to clinically differentiate CMV infection from infectious mononucleosis?
Clinically, they are very similar. Accurate differentiation requires laboratory diagnostics (PCR, ELISA).
What pathological sign is sought in cytological examination?
A specific sign is the presence of giant epithelial cells with intranuclear inclusions — the so-called "owl's eye" sign.
What else to study on this topic
- Features of clinical forms in infants of the first months of life
- Mechanisms of virus reactivation in various types of immunodeficiency
- Detailed interpretation of ELISA results (IgM, IgG, avidity)
- Differences between congenital and acquired CMV infection
Master the entire topic in the Pediatrics course
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- Complete study guide on "Acquired cytomegalovirus infection" and 3,738 more pages of the subject
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Other topics from the section «Chapter 12. Infectious and parasitic diseases»
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