CYTOMEGALOVIRUS DISEASE____

Cytomegalovirus (CMV) is the largest herpes virus, present in body fluids of an infected person, (e.g. saliva, urine, milk, stool and blood) and transmitted by close person­person contact.

While primary infection in early childhood is very common and almost always asymptomatic, it persists life­long with potential risk of reactivation. CMV infection in newborn (Ch. 12.15.4) or immunocompromised states is associated with high mortality and morbidity.

Clinical presentation of CMV infection varies with age and immune status.

• In immunocompetent children, CMV infection is almost always asymptomatic, rarely presenting as mild infectious mononucleosis-like illness.

• Perinatal CMV or postnatal infection in immuno­compromised host, may present with serious systemic illnesses, e.g. pneumonitis, hepatitis, chorioretinitis, leukopenia/thrombocytopenia, enteritis, or pro­gressive encephalitis.

Diagnosis of active infection rests on: (a) detection of virus in urine, saliva or other secretions/ infected sites by PCR or DNA hybridization techniques, or (b) serology,

i. e. elevated anti-CMV IgM titers or rising IgG titers after 4 weeks.

Treatment with IV ganciclovir (2.5 mg/kg/dose TDS for 3-6 weeks), is indicated only in infected newborns or immunocompromised host with severe disease. PO valganciclovir may be more effective and less toxic than IV ganciclovir, if available.

Prolonged prophylaxis with ganciclovir or valganci- clovir is indicated in cases of transplant recipients and AIDS with CD4 count lt;100 cells/mm³.

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