Many viruses around the world impact society, from COVID-19 to respiratory syncytial virus (RSV) and influenza. But have you ever heard of cytomegalovirus (CMV)?
CMV is a common viral infection that belongs to the herpesviruses family. Typically, CMV is non-threatening, but for fetuses or immunocompromised individuals, it can cause lasting effects and may be life-threatening. It is suspected that many individuals in their lifetime will be infected with CMV.
Today, it is the most common type of congenital viral infection and the leading cause of congenital sensorineural hearing loss in infants. After an individual has been infected, the virus remains dormant and can be reactivated later in life if the immune system becomes compromised.
Congenital vs. Acquired CMV
CMV is classified as either congenital or acquired. Congenital CMV refers to a fetus being exposed to the infection while in utero through the placenta, and it can lead to lifelong impairments. This occurs when the mother acquires the infection and passes the virus to the fetus in utero. Congenital CMV can result in developmental disabilities and congenital abnormalities that have lasting impacts. These disabilities can include cerebral palsy, visual impairments, intellectual problems, hearing loss, compromised growth, and/or motor delays.
Acquired CMV refers to an individual acquiring the virus after birth. This occurs through the transmission of infected bodily fluids, most often urine or saliva. Those who receive an infected blood or organ transplant can also acquire CMV. CMV can be acquired anytime during an individuals lifetime and may not be obvious when it is contracted.
What Do CMV Symptoms Look Like?
CMV can present differently amongst different populations, ranging from asymptomatic to life-threatening. Many healthy individuals with CMV often present asymptomatically and may not even be aware they have been infected. This is one of the reasons that many people are unaware of CMV and the potential harm it can have.
Some people present with mild symptoms, including fever, joint pain, weakness, enlarged lymph nodes, poor appetite, weight loss, headache, sore throat, malaise, and myalgia. Infants with congenital CMV can present with hearing loss, low birth weight or poor weight gain, and more. CMV is a leading cause of intellectual, learning, and motor developmental delays.
More serious consequences of congenital CMV can include stillborn, miscarriage, or the death of a newborn.
Risk Factors for CMV
There are specific factors that can increase the risk of acquiring the virus. These factors include, but are not limited to:
- Being in an immunocompromised state and unable to fight the virus.
- Being under the age of 5- children are more likely to pass the infection to each other due to a lack of understanding regarding infection prevention.
- Working with children or infants- this can pertain to daycare workers, pediatric medical professionals, or those who live with small children.
- Living in crowded conditions causing increased transmission rates.
- Poor hygiene habits or being uneducated about disease transmission.
Is There Anything I Can Do To Prevent CMV?
Healthy sanitation habits and careful interaction with potentially infected people can prevent the spread of CMV. As mentioned above, CMV is transmitted through infected bodily fluids. Proper hand hygiene, distancing oneself from those with potential symptoms, and awareness of CMV can all help prevent the spread of this virus. However, barriers exist to preventing the spread of disease, especially when infected individuals are asymptomatic and unaware they are infected.
Testing and Diagnosis
When testing for CMV, individuals are classified as either seropositive or seronegative. Seropositive means an individual has had CMV previously, and seronegative means they have never been infected, either in utero or after birth. A primary infection occurs when someone who was once seronegative is infected. A recurrent infection is when a previously seropositive individual is either reinfected or the latent virus is reactivated.
Testing is done when there is a suspected CMV infection, such as a newborn baby who may present with potential signs and symptoms of a congenital CMV infection. Blood, saliva, or urine testing can be used to diagnose a CMV infection. For infants suspected of having congenital CMV, a saliva and urine sample completed within the first weeks of life is the best form of testing. In blood testing, healthcare providers can test for CMV immunoglobulin G (IgG) or immunoglobulin M (IgM) makers. A seropositive IgG result would indicate a history of having had CMV because, as mentioned previously, CMV will remain dormant in the host even after the initial illness has cleared. A seropositive IgM result would be indicative of an acute or recent infection with CMV.
If healthcare providers are concerned about CMV in a pregnant mother, the standard diagnosis for congenital CMV while in utero is the detection of CMV in the amniotic fluid. However, it is important to consider that a positive CMV result can also result from viral shedding, not an active disease.
Management of CMV
For many individuals with a mild case of CMV, medications and medical intervention are not required. The virus will most often subside and become latent. However, for those who are immunocompromised, medications and treatment are necessary to prevent morbidity. Prophylactic therapy is also usually recommended for these patients. For those with severe infection, oral or intravenous (IV) antivirals are used to treat the infection.
Clinical trials are currently underway evaluating the effectiveness and safety of a CMV vaccine. Pharmaceutical companies are looking to be able to vaccinate pregnant women in hopes of preventing congenital CMV in newborn babies.
Conclusion
CMV is a common viral infection that can have a range of complications, from asymptomatic presentation to sensorineural hearing loss to organ dysfunction or potentially death in some patients. Many individuals will encounter and become infected with CMV at some point in their lifetime. Many will be asymptomatic, and the virus will lay dormant after the initial infection subsides. It is essential to be aware that while to some, CMV is a mild infection, it can have destructive effects on fetuses and those who are immunocompromised. Testing can be completed to determine serostatus, and antivirals can be prescribed for those in vulnerable populations with an increase in the likelihood of life-threatening complications.
About Author:
Rachel Pugmire is a registered nurse and freelance writer. She received her Bachelor of Science in Nursing in 2018, with a minor in gerontology. Her areas of expertise include emergency medicine, pediatrics, and pharmaceutical clinical trials. Medical writing has given her a platform to do what she is passionate about, which is educating patients, their families, and other healthcare professionals.
Rachel is an independent contributor to CEUfast's Nursing Blog Program. Please note that the views, thoughts, and opinions expressed in this blog post are solely of the independent contributor and do not necessarily represent those of CEUfast. This blog post is not medical advice. Always consult with your personal healthcare provider for any health-related questions or concerns.
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