CONTINUING EDUCATION :: CYTOMEGALOVIRUS INFECTION
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Cytomegalovirus infection: When and why to detect antibodies
By Ilana Heckler, PhD and Maite Sabalza, PhD C
ytomegalovirus (CMV) is a beta-herpesvirus that causes viral inclusion bodies and enlarges infected cells. It is the largest herpesvirus known to infect humans, with a sero- prevalence of 60–90% worldwide. 1,2
in lower socioeconomic groups in developing countries. 2
Higher prevalence occurs In the
United States, nearly one-third of children have CMV by age of five, and more than half of adults have it by the age of forty.3 CMV is transmitted from person to person by direct contact.
The virus is shed in body fluids — with main transmission via saliva and urine of young children to other children or adults. Other forms of transmission include sexual contact, blood transfusions, and organ transplants. In healthy individuals,
Earning CEUs
See test on page 14 or online at
www.mlo-online.com under the CE Tests tab. Passing scores of 70 percent or higher are eligible for 1 contact hour of P.A.C.E. credit.
LEARNING OBJECTIVES Upon completion of this article, the reader will be able to:
1. Discuss the viral family, prevalence, and transmission route of cytomegalovirus (CMV).
2. List the vulnerable populations and complications of CMV transmission.
3. Describe CMV testing currently used in prenatal, fetal, and newborn testing.
4. Discuss future suggestions for the screening of newborns for CMV and its utility worldwide.
8 DECEMBER 2022
MLO-ONLINE.COM
CMV infection is often asymptomatic, but it may be fatal in immunocompromised patients.4
Symptoms of CMV in mild
cases are described as flu-like and include fever, sore throat, fatigue, and swollen glands. More serious cases, such as those occurring in people with weakened immune systems, exhibit symptoms affecting the eyes, lungs, liver, esophagus, stomach, and intestines.
Primary infection occurs in those who have never been in-
fected before. As with other herpes viruses, CMV remains latent in the host after the first infection and may reactivate at a later period. Reinfection occurs when a person is infected with a different viral strain.
CMV is the leading viral cause of congenital defects. CMV can cross the placenta and infect the fetus after primary infection, reactivation, or reinfection of the mother. The transmission is most likely in women with a primary CMV infection, and the risk of transmission increases throughout the third trimester.5,6 Infection occurs in 0.5% to 2.5% of neonates, and most babies with symptoms at birth (5%) have long-term effects includ- ing sensorineural hearing loss, microcephaly, chorioretinitis, and motor disabilities.7
A large percentage of asymptomatic
newborns (15%) subsequently suffer impairments, most often hearing loss.7,8
and dangerous opportunistic infection following solid organ transplantation (SOT) or hematopoietic stem cell transplanta- tion (SCT) and in HIV patients.2,9
CMV infection has also been
linked with atherosclerosis, glioblastoma, and other diseases.10,11 There is no vaccine available to prevent CMV infection
but there are antiviral drugs to treat immunocompromised individuals. Antiviral medication may improve hearing and developmental outcomes in infants with congenital cytomega-
Furthermore, CMV infection is the most prevalent
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