Clinical features

Three important clinical manifestations are described.

1. Perinatal disease

Intrauterine infection may cause serious abnormalities in the foetus including CNS involvement (microcephaly, hearing defects, motor disturbances), jaundice, hepatosplenomegaly, haemolytic anaemia and thrombocytopenia. Up to 30% of CMV-affected infants have mental retardation. 5

2. Acquired CMV infection

In healthy adults CMV produces an illness similar to Epstein-Barr mononucleosis with fever, malaise, arthralgia and myalgia, generalised lymphadenopathy and hepatomegaly. However, cervical lymphadenopathy and exudative pharyngitis are rare.

The infection may be spread by blood transfusion, and CMV should be suspected on clinical grounds in a patient with a febrile illness resembling EBM following major surgery such as open heart surgery or renal transplantation and where extensive transfusion has been necessary. The fever often manifests as quotidian intermittent fever spiking to a maximum in the mid-afternoon and falling to normal each day (Fig 25.2). There is often a relative lymphocytosis with atypical lymphocytes but the heterophil antibody test is negative. Liver function tests are often abnormal. Specific diagnosis can be made by demonstrating rising antibody titres. The virus can be isolated from the urine and blood.

Days

Fig. 25.2 Cytomegalovirus infection: typical quotidian intermittent fever pattern

3. CMV disease in the immunocompromised host

Disseminated CMV infection occurs in the immune-deficient person, notably HIV infection causing opportunistic severe pneumonia, retinitis (a feature of AIDS), encephalitis and diffuse involvement of the gastrointestinal tract.

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