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Questions and Answers
What is the likelihood of symptomatic survivors of congenital CMV infection manifesting neuropsychomotor developmental delays?
What is the likelihood of symptomatic survivors of congenital CMV infection manifesting neuropsychomotor developmental delays?
What laboratory test can help determine the recency of a CMV infection?
What laboratory test can help determine the recency of a CMV infection?
Which clinical manifestation is associated with congenital CMV infection?
Which clinical manifestation is associated with congenital CMV infection?
What indicates a recent CMV infection in pregnant patients according to serological tests?
What indicates a recent CMV infection in pregnant patients according to serological tests?
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What percentage of congenital CMV infections are typically asymptomatic at birth?
What percentage of congenital CMV infections are typically asymptomatic at birth?
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Which diagnostic method can confirm congenital CMV infection in a newborn within the first 15 days after birth?
Which diagnostic method can confirm congenital CMV infection in a newborn within the first 15 days after birth?
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What is a possible laboratory change associated with congenital CMV infection?
What is a possible laboratory change associated with congenital CMV infection?
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Which condition is typically seen in symptomatic congenital CMV infections?
Which condition is typically seen in symptomatic congenital CMV infections?
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What is primarily used to detect CMV-DNA in blood during an active infection?
What is primarily used to detect CMV-DNA in blood during an active infection?
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Which of the following treatments is recommended for immunocompromised patients with active CMV infection?
Which of the following treatments is recommended for immunocompromised patients with active CMV infection?
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What is a characteristic histopathological feature of CMV infection in tissue samples?
What is a characteristic histopathological feature of CMV infection in tissue samples?
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What is the primary prophylactic measure for pregnant women regarding CMV exposure?
What is the primary prophylactic measure for pregnant women regarding CMV exposure?
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Which treatment option is not advisable for CMV infection during pregnancy?
Which treatment option is not advisable for CMV infection during pregnancy?
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For a CMV-negative transplant recipient with a CMV-positive donor, what is the recommended primary prophylaxis?
For a CMV-negative transplant recipient with a CMV-positive donor, what is the recommended primary prophylaxis?
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Which antiviral alternative may be used for patients resistant to ganciclovir?
Which antiviral alternative may be used for patients resistant to ganciclovir?
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Which method is least commonly used to confirm active CMV infection?
Which method is least commonly used to confirm active CMV infection?
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What is the typical cytopathic effect produced by Cytomegalovirus infection?
What is the typical cytopathic effect produced by Cytomegalovirus infection?
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Which immune response is primarily involved in combating Cytomegalovirus infection?
Which immune response is primarily involved in combating Cytomegalovirus infection?
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In immunocompetent individuals, what is the clinical manifestation of primary Cytomegalovirus infection often similar to?
In immunocompetent individuals, what is the clinical manifestation of primary Cytomegalovirus infection often similar to?
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Which of the following is a significant risk for maternal-fetal transmission of Cytomegalovirus?
Which of the following is a significant risk for maternal-fetal transmission of Cytomegalovirus?
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What role do leukocytes play following primary Cytomegalovirus infection?
What role do leukocytes play following primary Cytomegalovirus infection?
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How long can an individual excrete the Cytomegalovirus after infection, even if asymptomatic?
How long can an individual excrete the Cytomegalovirus after infection, even if asymptomatic?
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What is one of the primary sources of infection for Cytomegalovirus in young children?
What is one of the primary sources of infection for Cytomegalovirus in young children?
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Which cells are primarily affected by Cytomegalovirus infection at the tissue level?
Which cells are primarily affected by Cytomegalovirus infection at the tissue level?
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Study Notes
Cytomegalovirus (CMV) Infection
- CMV is a human herpesvirus, infecting various cells (monocytes, neutrophils, renal cells, etc.).
- Its cytopathic effect is characterized by "owl's eye" appearance of infected cells.
- Immunocompetent individuals may experience mild or asymptomatic infection similar to infectious mononucleosis.
- Reactivation in immunocompromised individuals can severely affect organs (liver, lungs, brain, etc.).
- CMV infection is widespread, with over 50% of adults in developed countries and nearly 100% in developing countries exhibiting anti-CMV IgG antibodies, indicating prior infection.
- Primary infection often occurs in childhood/adolescence/young adulthood, with possible reinfection.
- Sources of infection include infected individuals (clinical or inapparent), saliva, urine, sexual contact, blood transfusions, bone marrow/organ transplantation, and mother-to-fetus transmission (most often transplacental).
- Transmission can occur through breast milk.
- Women of reproductive age during pregnancy are at risk of transmitting CMV to the fetus.
- Immune response involves both humoral (IgM, IgG antibodies) and cellular (T lymphocytes).
Pathogenesis
- Following infection, CMV replicates in leukocytes, salivary glands, kidneys, and vascular endothelium.
- Characteristic cytopathic changes include giant cells with large eosinophilic intranuclear inclusions and a peripheral halo (typical "owl's eye").
- Immunosuppression (post-transplant, hematological malignancies, HIV) significantly increases risk of reactivation of latent CMV infection.
- Congenital CMV infection frequently arises from primary maternal infection during pregnancy, less commonly from reactivation.
Clinical Presentation
- Primary CMV infection in immunocompetent individuals can be asymptomatic or present as infectious mononucleosis-like syndrome (heterophile antibody negative).
- Clinical picture might include prolonged fever (2-3 weeks), lymphadenopathy, hepatosplenomegaly, pharyngitis (occasionally exudative), rash, and fatigue.
- Complications in immunocompetent individuals include meningoencephalitis, polyradiculoneuritis, myelitis, pneumonia, hemolytic anemia, pancytopenia, macrophage activation syndrome, splenic rupture, myocarditis, and pericarditis.
- CMV infection in immunocompromised individuals generally has severe manifestations.
- In HIV-positive individuals, CMV retinitis (potentially leading to blindness), colitis, esophagitis, and other complications are common.
- Congenital CMV infection can cause miscarriage, premature birth, intrauterine growth restriction; manifestations in newborns can include microcephaly, intracerebral calcifications, chorioretinitis, hearing loss, jaundice, and anemia.
Diagnosis
- Serologic testing: detecting IgM, IgG, and antibody avidity to determine infection timeline, with IgM in absence of IgG indicating acute infection. IgG in absence of IgM suggests prior or chronic infection. Both IgM and IgG indicate recent infection, reinfection, or reactivation of chronic infection
- Amniocentesis and PCR for CMV-DNA in amniotic fluid are used to diagnose congenital CMV infection.
- Detection of CMV-DNA in saliva or urine samples is used to diagnose congenital CMV infection in newborns.
###Treatment
- Immunocompetent individuals typically do not require specific treatment, but support care is given.
- Immunosuppressed individuals receive ganciclovir, foscarnet, or cidofovir depending on strain resistance and other factors.
- Intravitreal ganciclovir can treat CMV retinitis.
- Treatment does not eliminate chronic infection but controls its progression.
Prophylaxis
- No effective CMV vaccine exists.
- Prophylaxis measures include strict hygiene, avoidance of contact with infected individuals, protected sexual practices, screening of blood transfusions/transplant donors, and pre-emptive therapy with ganciclovir or valganciclovir for immunocompromised individuals.
- Immunosuppressed patients may require prophylaxis (3-6 months of valganciclovir after CMV positive donors)
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Description
This quiz delves into the essentials of Cytomegalovirus (CMV) infection, exploring its characteristics, transmission methods, and impact on different populations. Understand how CMV's cytopathic effects manifest and learn about the implications for immunocompromised individuals. Test your knowledge of this prevalent virus.
