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56 Cards in this Set

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HCMV Classification:

- family
- subfamily
- genus
herpesviridae

betaherpesvirinae

cytomegalovirus
HCMV Epidemiology:

- natural host
- prevalence
- transmission
humans

worldwide

person-to-person (body fluid)
Associate HCMV's involvement as an agent of the following:

- congenital
- opportunistic
- complications
#1 viral infectious cause of congenital CNS damage (TORCH agent)

Leading opportunistic pathogen in AIDS patients

Leading cause of complications in transplant patients
HCMV can cause what disease?
Mononucleosis
(Heterophile-negative)
List the populations at risk with CMV infections. x7
Fetus
Neonates / Young children
Sexually active
Pregnant
Immunocompromised
Blood product recipient
Health care workers
Describe the transmission of HCMV in fetuses.
Intrauterine transmission
What poses the greatest risk of CMV to fetuses?
Primary infection of seronegative mothers
What is associated with the MOST severe CMV disease?
Intrauterine infection
If an immune pregnant mothers had a CMV infection, what symptoms would the new-born baby manifest?
Asymptomatic
Describe how neonates/young children become CMV infected:

- perinatally
- postnatally
Birth

Breast-feeding
Prior to conception, 45% - 91% of pregnant women are what?
CMV seropositive
What puts pregnant others at risk? x2
Contact with young children <24 months of age.

Going to day care centers
Sexually active populations are at risk b/c HCMV can be found and shed from where? x2
Cervix

Semen
List the involvement of HCMV in two types of immunocompromised patients.
In transplant patients, all major transplantations are associated with an increased risk of this infection or this disease.

It is one of the most common opportunistic infections in AIDS patients.
What percent of transplant patients show signs of HCMV infection?
50%
100% of homosexual men with HCMV are also co-infected with what?
HIV-1
CMV infections associated with recipients of blood products are also associated with these two diseases.
Postperfusion syndrome

Transfusion Associated disease
What are three possible outcomes of someone who becomes seropositive with HCMV following a blood transfusion.
Asymptomatic

Posttransfusion CMV Mononucleosis

CMV hepatitis
For immunocompetent individuals, describe the pathogenicity of CMV.
Low pathogenicity.
What 2 things about the patient affects the pathogenesis profoundly?
Age

Immune status
Primary infection during what time for the pregnant mother would most likely cause in utero infection?
First six months of pregnancy
Majority of congenital infections are symptomatic of what?
Asymptomatic
For babies with congenital infection, 80% of symptomatic infants exhibit what?
lasting neurological abnormalities
Neonates with full CID (Cytomegalic Inclusion Disease) exhibit what 3 most common symptoms?
Jaundice

Petechiae

Hepatosplenomegaly
What is the worst case scenario for neonates with full CID in terms of symptoms?
End stage organ disease
What is the radiographical evidence supporting the diagnosis of a CMV congenital infection?
Paraventrical calcification
What are the symptoms associated with perinatal CMV infection?
Usually asymptomatic
What are some ways that perinatal CMV infection can occur? x4
Delivery
Breast milk consumption
Blood transfusion
Nursery spread
50% of infants born to mothers with this condition will acquire HCMV.
Cervical infection
Childhood CMV infection:

- prevalence
- symptoms
Common

Asymptomatic
CMV mononucleosis:

- severity
- limitation
Mild

Self-limiting
CMV mononucleosis symptoms. x7
Fever
Malaise
Rash

Tonsilitis
Abnormal liver functions
Lymphadenopathy
Leukocytosis
What antibody difference exists with CMV and EBV mononucleosis?
CMV is heterophil-negative
In terms of Cardiovascular Diseases, HCMV seropositivity correlates with what medical conditions? x3
RESTONOSIS following balloon angioplasty

more severe ATHEROSCLEROTIC symptoms

TRANSPLANT VASCULAR SCLEROSIS
In CVDs, HCMV antigens and nucleic acid sequences have been demonstrated in what tissues?
Smooth muscle cells
Endothelial cells
Monocytes/macrophages
What percentage of individuals with AIDS are seropositive for CMV?
>90%
What are the 2 arguments supporting the fact that HCMV may contribute to AIDS progression?
1. CMV is able to infect the same cell type as HIV.

2. CMV has genes that are capa ble of increasing the expression of long terminal repeat regions of HIV.
With HIV-infected patients living longer, what is the consequence to HCMV's?
HCMV induced diseases in these patients may rise as the virus acquires various drug resistance.
What would a fundoscopic exam reveal for a person with HCMV retinitis?
Retinal necrosis

Hemorrhage
What is the MOST important infectious agent affecting organ transplantation?
CMV
T/F - HCMV diseases varies with each type of transplantation.
True
The severity of end-organ disease is related to severity of what?
immunosuppression
What status can affects the outcome of transplantations?
CMV Seropositivity
What is the most common life-threatening complication of allogeneic bone marrow transplant? x4

What are the symptoms?
Interstitial pneumonia

Fever
NON-productive cough
Dyspnea
Hypoxia
CMV is the most common pathogen isolated from what?
Solid organ transplantation
What is the leading cause of morbidity during the first 14 weeks after liver transplantation?

What are the symptoms? x3
Hepatitis

Elevated liver enzymes
Liver failure
Fever
CMV morbidity lowest in what type of transplant?

What are the symptoms? x4

Are antivirals helful to CMV kidney transplant infections?
Kidney

Fever
Malaise
Leukopenia
Hepatosplenomegaly

Yes, well responding
CMV should be suspected in? x3
Newborns with microencephaly, jaundice, hepatosplenomegaly

Mononucleosis syndrome with heterophil antibody negative

Immunocompromised
T/F - CMV infections can be diagnosed on clinical manifestations alone.
False
What is the most DEFINITIVE lab diagnosis for HCMV?
Tissue CULTURE
(isolate virus from body secretions or tissue homogenates)
Besides the definitive lab technique in diagnosing HCMV, what other alternative lab methods are there for diagnosis?
1. Viral marker by Immunofluorescence, ELISA, or EM (viral particles)

2. Vrius genome by DNA hybridization

3. PCR

4. Serology to detect seroconversion or rise in CMV Ab antitier (paired sera)
What is the positive sign seen in cultured cells for HCMV?
HCMV inclusions known as "Owl Eye"
What is the treatments for HCMV retinitis in AIDS patients?
Cidofovir
Foscarnet
Formivirsen
What is the vaccine name for HCMV?
There is none.
What is the treatment for Tranplant patients with AIDS? x2
Valciclovir
Ganciclovir
What drug is controversial for use in treating HCMV?

When would you use this drug?
Immune globulins (IgG)

(controversial, but warrented as immunoprophylaxis in bone marrow transplant)