Cytomegalovirus

Cytomegalovirus (CMV) is a very common virus. A majority of adults will be infected with the virus by the age of 40. Most of those infections will occur during childhood, and in most infected people the virus will lie dormant and cause no symptoms. When symptoms do occur in healthy people, they are usually mild and can be confused with other illnesses’ symptoms. People with weakened immune systems and babies born with CMV (congenital CMV) can have severe complications from it.

CMV is a member of the herpes virus family. It can be transmitted through infected body fluids and has no cure. It can however be treated and slowed down with antiviral drugs.

Reporting

According to the Center for Disease and Control (CDC), in the United States cytomegalovirus (CMV) infected 50 to 80% of adults and 1 in 150 children (babies) are born with CMV (congenital CMV). About 8,000 children develop (suffer) permanent disability from congenital CMV each year. (source)
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Transmission

Cytomegalovirus (CMV) can be found in the saliva, blood, breast milk, tears, urine, semen, and vaginal fluids of people who have been infected with CMV. However, unless the infected person is experiencing a reoccurrence of CMV, it usually is not found in these body fluids.

Coming into contact with infected body fluids during kissing and sexual activity can cause transmission. Transmission can also be caused when people get saliva or urine on their hands, then touch their eyes or the inside of their mouth or nose.

Infants can be infected by drinking the breast milk of an infected woman. Pregnant woman can pass CMV on to their babies during pregnancy or during birth if they had been infected by CMV recently or are experiencing a reoccurrence of CMV.

Blood transfusions and organ transplants can also be a cause of transmission. In the United States this rarely occurs, because blood and organ donations are screened.

CMV can not be transmitted through casual physical contact, unless there are body fluids somehow involved.
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Symptoms

Most people infected with cytomegalovirus (CMV) will not have any symptoms. When adults are first infected and have symptoms, they can experience muscle aches, joint pain or stiffness, swollen glands, prolonged fever, night sweets, appetite loss, weakness, fatigue (feeling tired all the time), sore throat, weight loss, or malaise (feeling of ill-health). These symptoms are usually mild and do not last long, and since they are common to other illnesses, a lot of people will not know they were infected with CMV.

Adults who have a weakened immune system could have more severe symptoms. In them CMV can attack their organs. Symptoms of this occurring include behavioral changes, seizures, coma, pneumonia with hypoxemia (low blood oxygen), unexplained prolonged fever, visual impairments or blindness, diarrhea, or bloody stool.

Most babies born with CMV (congenital CMV) will not have any symptoms. For the small percentage that do, immediate symptoms could include pneumonia, enlarged spleen, poorly functioning and enlarged liver, jaundice (yellowing of the skin and eyes), rash, purple skin splotches, or seizures. Some babies will not have any symptoms for months or even years after birth. To see the complications babies and children experience, see complications.
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Testing / Diagnosis

Cytomegalovirus (CMV) infection can be diagnosed by testing a blood sample for antibodies created by the immune system. It can also be diagnosed by testing the blood, body fluids, or a tissue biopsy for the virus. It may be helpful to speak to a health care provider to find out what testing options are available.

Pregnant women who think they may be having a reoccurrence of CMV or are infected by it during pregnancy should be tested for it. If tests show signs of infection, pregnant women may wish to consider amniocentesis (surgically inserting a needle through the abdominal wall and into the uterus to obtain a sample of amniotic fluid to examine). Consulting with a health care provider is recommended to find out if he or she feels amniocentesis is needed.

In determining if a baby was born with CMV (congenital CMV) infection, it is important to have the baby tested within three weeks after birth. Waiting longer can cause the test to be inconclusive for congenital CMV because the baby could be infected by a sibling or during nursing, and tests can not identify between congenital CMV and CMV infections acquired after birth.

It is also important for people with a weakened immune system to be tested for CMV. Those who test positive for being infected will need to be regularly monitored for any complications that could arise.
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Treatment

There are no cures for cytomegalovirus (CMV) infection. There are treatments available that can help people who are experiencing symptoms of CMV infection. However, treatment is not recommended for normally healthy children and adults. It is recommended for adults who have weakened immune systems. The type of treatment administered depends on the symptoms and their severity.

The most common forms of treatment are the antiviral drugs ganciclovir and valganciclovir. These drugs prevent CMV from dividing and creating more of itself, slowing it down. They will not cure it. Babies with congenital CMV (born with CMV) should only be treated with antiviral drugs if their symptoms are severe, because antiviral drugs can have strong side effects in babies.
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Complications

Complications of cytomegalovirus (CMV) infection are rare for healthy adults. They are more likely to develop in adults who have a weakened immune system. These complications can target one or more specific organs in the body. In the gastrointestinal system, CMV infection can cause diarrhea, bloody stool, inflammation of the colon, fever, or abdominal pain. In the nervous system, it can cause encephalitis (inflammation of the brain), which can result in behavioral changes, seizures, and coma.

CMV infections can also cause complication in the eyes (visual impairment, blindness), liver (abnormal liver function, unexplained fever), and lungs (pneumonia, low blood oxygen levels).

Most babies with congenital CMV (born with CMV), will never develop any complications. Those who do have complications could have liver problems, lung problems, spleen problems, low birth weight, or seizures. Fortunately, their complications may only be temporary. Permanent complications from congenital CMV include mental disability, a small head, vision impairments or blindness, hearing loss, lack of coordination, seizures, or death.

Some babies with congenital CMV may not develop any complications for months or years after birth. When they do occur, they are most commonly vision loss or hearing loss. This can happen to babies who were healthy or unhealthy and showed no symptoms at birth.
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Prevention

To avoid the transmission of cytomegalovirus (CMV) from sexual contact, abstaining from sexual contact is the surest way. A mutual monogamous relationship with a trusted partner known to be uninfected is another.

Using a latex condom during vaginal or anal sex can reduce the risk of transmission of CMV. Correctly using a condom can also reduce the risk of transmission during oral sex (mouth to penis). For other forms of oral sex (mouth to vulva, the outer female genital area, or oral to anal, also known as rimming) using a dental dam, plastic wrap, or a latex condom cut up and opened flat are risk reducers. However, it is important to remember CMV can be in the body fluids on the outside of the condom. So hands should be washed immediately after handling and disposing of it.

Health care professionals who come in contact with or have to handle body fluids should follow standard precautions. People who come in contact with young children or their diapers, drool, or other body fluids should make sure to wash their hands because young children are more likely to have CMV in their body fluid than adults. For this reason, people should avoid coming in contact with a young child’s tears or saliva (kissing on the mouth or cheek). A kiss on the head or a hug should not cause transmission.

Drinking out of the same glass or sharing eating utensils can cause transmission.

People who handle disposable items like tissues, condoms, diapers, and other items that could have infected body fluids on them should thoroughly wash their hands before touching their face. If they do not, they could be infected.
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