What it is and prevalence

It is a virus that infects the vast majority of people during childhood. Among Brazilian adults, the prevalence of antibodies indicating prior contact with cytomegalovirus is 70 to 80%. In other countries, this number is lower, especially in more developed nations.

Transmission

Natural transmission occurs through saliva and other secretions, but cytomegalovirus can also be transmitted through blood transfusions or organ transplants, in addition to congenital transmission. Sexual transmission is also possible.

Symptoms

In people with no immune problems, the disease caused by cytomegalovirus usually resembles infectious mononucleosis: fever, swollen lymph nodes, and occasionally signs of liver damage. The disease tends to “resolve spontaneously,” but it may take longer than a “common viral infection.”

In transplant patients, the infection can be very serious, causing pneumonia, hepatitis, and solid organ rejection. It is even more severe in bone marrow transplant recipients, as it can worsen pneumonia, digestive tract lesions, etc.

In patients with AIDS, cytomegalovirus infection causes retinitis, which can lead to vision loss. It can also cause serious illness in fetuses and newborns, such as brain calcification and chorioretinitis.

Diagnosis

In patients with good immunity, diagnosis is made through serology, IgG and IgM, with IgM being present in the acute phases of the disease. In immunocompromised patients, such as those with AIDS or solid organ transplant recipients, diagnosis is made through antigenemia observed by immunofluorescence or molecular methods that measure viral load. In these patients, serological diagnosis is unreliable.

Treatment

Treatment is done with antiviral drugs such as ganciclovir, valganciclovir, and foscarnet. These drugs have side effects and must be used with caution.

Prevention

Only through hygienic care and handwashing: there is no vaccine. During transplants, it is appropriate to periodically assess viral load or antigenemia and begin preemptive treatment, as there is a window — one or two weeks — between the appearance of viral load or antigenemia and the onset of disease, allowing treatment before symptoms begin.

By Einstein Editorial Board