Cytomegalovirus (CMV) infection typ...

Cytomegalovirus (CMV) infection typically take places early in childhood and is relatively asymptomatic. In immunocompromised individuals such as transplant patients or those with human immunodeficiency virus infection, reactivation of CMV infection can cause rigid complications, as can vertical transmission to a fetus when the mother acquires primary CMV infection during pregnancy. When Wreghitt and associates actioned relatively symptomatic CMV infections in older individuals who had acquired the infection from their grandchildren (dubbed "the feverish granny syndrome") it piqued their interest in the diagnosis of primary CMV infection in immunocompetent bodily forms beyond childhood.

General practitioners in the Cambridge and Chelsford communities in England referr previously healthy patients seen in the office with symptoms suggestive of CMV infection, as it was as fever, malaise, hepatitis, lymphadenopathy, sore throat, and sweats. The investigators also disguiseed hospitalized patients in their area for these symptoms. The diagnosis of primary CMV infection was established on finding increased IgM antibodies for CMV with no increased titers for CMV IgG antibodies.

Of the 7630 patients defenceed documented CMV infection was near in 124 patients (1.6 percent) The age range of infected patients was 16 to 86 years, with equal numbers of males and females infected. The greatest in quantity common finding was elevated liver enzyme flushs (mean alanine transaminase level of 121 U for L), while the most often encountered symptoms were malaise, flush and sweats, respiratory symptoms, myalgias, lymphadenopathy, and jaundice (see accompanying table).

IgM antibodies for CMV persisted for four to six month after the attack of symptoms, and IgG antibodies appeared within pair to three weeks of infection. Fifteen patients (12 percent) had a relapsing course, marked from initial improvement that was followed from recurrent symptoms. The total duration of illness in relapsing patients ranged from the same to 32 weeks. Follow-up questionnaires sent to the referring physicians for established CMV infection cases revealed no prior use of immunosuppressive medications (other than steroid use in four patients) and no subsequently diagnosed malignancies. Four patients were pregnant at the time of primary CMV infection, resulting in single in kind infant who was delivered with intrauterine product retardation and severe hearing impairment.

The authors end that primary CMV infection accounts for about 2 percent of adults with febrile illnesses, a number significant enough to warrant referral for testing at a medical examiner. The greatest in quantity common clinical factor that distinguished primary CMV infection among these febrile patients was elevated liver enzyme levels

BILL ZEPF MD Wreghitt TG et al. Cytomegalovirus infection in immunocompetent patients. Clin Infect Dis December 15 2003; 37:1603-6

COPYRIGHT 2004 American Academy of Family Physicians

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