Common Illnesses & Injuries

Cytomegalovirus (CMV)

CMV, or Cytomegalovirus, is found all over the world. Three quarters of people in the world have had it by the time they are 40.

Most people who get CMV after birth have few symptoms and no long-term health consequences. Some people may have symptoms similar to mononucleosis, with fever and a mild hepatitis. Once a person becomes infected, the virus remains alive, but usually dormant, within that person’s body for life. Another episode of the disease is unusual unless the person’s immune system is weakened (immunosuppression) due to medication or disease. For most people, CMV infection is not a serious problem. However, it can be transmitted to a child before birth, which may cause problems for the baby.

How it is Spread

CMV is transmitted from person to person. Infection requires close contact with a person excreting the virus in their saliva, urine, or other bodily fluids. CMV can be sexually transmitted and can also be spread through breast milk, transplanted organs, and blood transfusions.

Although the virus is not highly contagious, it can spread in households and among young children in day care centers. Simple hand washing with soap and water is effective in removing the virus from the hands and preventing the spread.

CMV infection without symptoms is so common in babies and young children, that there is no point in excluding children we know are infected. Instead, good infection prevention and hygiene practices are advised in caring for all children.

CMV in Pregnancy

Healthy pregnant women are not at special risk to catch CMV infection, but if a woman gets CMV for the first time during pregnancy, her unborn baby gets CMV disease. CMV remains the most important cause of congenital (meaning “from birth”) viral infection in the United States. For babies who are infected by their mothers before birth, it can affect them in two ways:

The baby may get a general infection before birth. This may cause enlargement of the liver and spleen (with jaundice), and may be fatal. With good treatment most babies with CMV disease survive. However, from 80 to 90 percent will have complications within the first few years of life that may include hearing loss, vision impairment, and mental retardation.
Some babies who are infected but do not have any symptoms at birth may later have hearing and mental or coordination problems.
The virus can also be transmitted to the infant at delivery from contact with genital secretions or later in infancy through breast milk. However, these infections usually are harmless and not even detectable.

Recommendations for Pregnant Women Regarding CMV Infection:

Practice good personal hygiene, especially hand washing with soap and water, after contact with diapers or oral secretions (particularly with a child who is in day care).
Women who develop a mononucleosis-like illness during pregnancy should tell their doctor.
Laboratory testing for antibody to CMV can be performed to determine if a woman has already had CMV infection.
The benefits of breastfeeding outweigh the minimal risk of acquiring CMV from a breastfeeding mother.

CMV and People with Weakened Immune Systems (Immunocompromised Patients)

Primary (first time) CMV infection in the immunocompromised patient can cause serious disease. However, the more common problem is the reactivation of the dormant virus. Infection with CMV is a major cause of disease and death in immunocompromised patients, including organ transplant recipients, patients undergoing hemodialysis, patients with cancer, patients receiving immunosuppressive drugs, and HIV-infected patients. Pneumonia, retinitis (an infection of the eyes), and gastrointestinal disease are the common manifestations of disease. Because of this risk, exposing immunosuppressed patients to outside sources of CMV should be minimized. Whenever possible, patients without CMV infection should be given organs and/or blood products that are free of the virus.

How it is Diagnosed

A number of laboratory tests that detect the antibodies to CMV have been developed to determine if infection has occurred. These are widely available from commercial laboratories. In addition, the virus can be cultured from specimens obtained from urine, throat swabs, and tissue samples to see if there is an active infection.

How it is Treated

There is no treatment for CMV infection in the healthy individual. Antiviral drug therapy is now being evaluated in babies. Ganciclovir treatment is used for patients with depressed immunity who have either sight-related or life-threatening illnesses. Vaccines are still in the research and development stage.