Cytomegaly, also called inclusion body disease, is transmitted by the human cytomegalovirus, or HZMV. This virus, a member of the herpesvirus family, remains in the human body for life following infection.
What is cytomegaly?
Infection with cytomegaly usually goes unnoticed by the affected person, as the symptoms of the disease are varied in nature and can also be triggered by a wide variety of other diseases. It is even assumed that 50 to 60 percent of healthy Europeans are carriers of this disease. In developing countries, this figure is even significantly higher. Infection with cytomegaly is only problematic in people with a weakened immune system or newborns. The virus can already be transmitted from mother to child in the womb. Although the majority of infected newborns are born healthy, serious illnesses can also occur. Due to the high number of unreported cases of cytomegaly, the exact incubation period is not known. It is estimated to last between one to three months.
Causes
Cytomegaly is caused by the cytomegaloviruses and is one of the herpes viruses. Carriers of the virus can transmit it to a wide variety of animal species and humans. This includes: sexual intercourse, urine, saliva, blood and its components. But cytomegaly can also be transmitted through blood transfusions and organ transplants. Since patients who need a transfusion or transplant are usually seriously ill, an infection with cytomegaly can have serious consequences for them. It is also possible that an existing infection with cytomegaly only leads to more noticeable symptoms after an organ transplant. In such cases, rejection of the transplanted organ often occurs.
Symptoms, complaints, and signs
As a rule, cytomegaly progresses without symptoms. However, about ten percent of those affected suffer from mildly swollen lymph nodes and fatigue that lasts for weeks. However, an infection during pregnancy can have serious effects on the fetus. Thus, in some cases, malformations occur in the newborn. Nevertheless, most infected babies are born healthy. In people with severely weakened immune systems (AIDS, cancer, organ transplantation), severe courses of disease are often observed, which can lead to life-threatening complications. These people often suffer from severe pneumonia, hepatitis or retinitis of the eyes. There is also fever, muscle pain and blood clotting disorders. In addition, the number of white blood cells in the blood is reduced. In some cases, a life-threatening brain inflammation (encephalitis) also develops. Retinitis spreads to both eyes without treatment. Visual disturbances occur, manifested by blurred vision and reduced visual acuity. Although eye pain does not occur. But if retinitis is not treated, complete blindness is imminent. Examinations often reveal bleeding at the back of the eye. Symptoms can also occur in the gastrointestinal tract. In addition to abdominal pain and diarrhea, heartburn, difficulty swallowing, and loss of appetite occur. Pneumonia caused by cytomegaloviruses manifests itself as a dry cough. At the same time, fluid accumulates in the lung tissue. Pneumonia is often fatal.
Diagnosis and course
The course of cytomegalovirus infection can vary widely. For the most part, healthy adults have no symptoms. Few get swollen lymph nodes when they have cytomegaly. It is also possible for the affected person to feel exhausted and tired for weeks. However, in immunocompromised individuals, such as those who have had an organ transplant or AIDS, cytomegaly can cause severe symptoms and discomfort. These may include hepatitis, fever, blood clotting disorders, pneumonia, or some types of eye inflammation. Furthermore, the affected person has significantly fewer leukocytes (white blood cells) in the blood. In particularly bad cases, cytomegaly can also spread to the brain in such individuals and cause encephalitis, or inflammation of the brain.The eye inflammation caused by cytomegaly often leads to decreased visual acuity and blurred vision, caused by inflammation of the retina. Furthermore, it is possible that cytomegaly causes inflammation of the gastric mucosa or esophagus. In such a case, cytomegaly infection is manifested by abdominal pain, difficulty swallowing, or a burning sensation behind the breastbone. In newborns, cytomegaly can lead to malformations, anemia, vision problems, disabilities, deafness[ or pneumonia. Similarly, cytomegaly can cause premature birth. Diagnosis of cytomegaly is not straightforward because of the wide range of symptoms, as many other viral or bacterial diseases can cause similar symptoms. One possible way to diagnose cytomegalovirus infection is by exclusion, which rules out all other diseases. However, blood or tissue tests can help confirm the suspicion of cytomegalovirus infection. In some cases, it is even possible to detect the cytomegaloviruses in urine, tissue, or blood.
Complications
Inclusion body disease can lead to a number of different symptoms and complications. Affected individuals themselves feel very tired and fatigued with this disease and therefore no longer actively participate in daily life. The lymph nodes are also usually swollen and those affected suffer from fever or various inflammations. Inflammation in the lungs or in the eye may also occur. Reduced visual acuity can also occur as a result of inclusion body disease and can have a very negative effect on the daily life and quality of life of the affected person. Without treatment, most patients also suffer from an inflammation of the gastric mucosa and thus also from severe abdominal pain. Furthermore, the disease can also lead to swallowing difficulties and thus to difficulties in taking food and liquids. In the worst case, the disease causes severe disabilities or deafness. Premature birth can also cause the child to die. Treatment of inclusion body disease is usually done without complications with the help of medications. It limits most of the symptoms. If the disease is detected early, there is a positive course of the disease in most cases.
When should one go to the doctor?
A diffuse feeling of illness or an impairment of general well-being should always be checked by a physician if the complaints increase over a longer period of time. The risk group includes in particular people with a weakened immune system, with previous illnesses or pregnant women. Therefore, these persons in particular should seek the cooperation of a physician if a general feeling of illness or internal weakness becomes apparent. In case of fatigue, swollen lymph nodes as well as changes in the skin appearance, action is required. If swallowing difficulties, loss of appetite, diarrhea or abdominal pain occur, medical examinations should be initiated. Only in this way can a clarification of the cause take place and a diagnosis be made. In case of fever, irregularities of the heart rhythm, pain of the muscles or flu-like symptoms, cooperation with a physician is advisable. If there is a sudden deterioration of health with a present illness, the changes should be discussed with the attending physician as soon as possible. Inflammation or limitations in general functional activity should also be examined more closely and treated by a physician without delay. Without medical care, irreversible damage may occur. To prevent complications, it is therefore advisable to seek the assistance of a physician as soon as the first health impairments become apparent. In addition, pregnant women should always attend all check-ups offered.
Treatment and therapy
In individuals with an intact immune system who contract cytomegaly, no special therapy is usually available. The disease heals on its own, but the virus remains in the body. The cytomegalovirus infection can therefore break out again at any time as soon as the immune system is weakened again. However, patients who have an immune deficiency require special therapy. For this therapy, antivirals such as foscarnet, valganciclovir or ganciclovir are used.If cytomegaly is diagnosed in pregnant women, they are administered antibodies against the cytomegalovirus. In milder courses of cytomegaly, treatment of the symptoms that occur may be sufficient. However, an added bacterial infection should be treated promptly with antibiotics to prevent the cytomegalovirus disease from worsening.
Prevention
A preventive vaccine against cytomegaly does not yet exist but is under development. In organ transplantation, infection with cytomegaly can be prevented by administration of certain antivirals. Pregnant women can try to prevent cytomegalovirus infection by taking special precautions. This can include hygiene measures such as frequent hand washing as well as avoiding contagious situations or groups of people. Pregnant educators should refrain from swaddling other children during pregnancy.
Here’s what you can do yourself
To protect yourself from infection with cytomegalovirus in everyday life, it is a good idea to follow normal hygiene guidelines. Careful hand washing with soap and warm water is important and effective because the cytomegalovirus can be inactivated by detergents and soap. If the immune system is weakened, there is an increased risk of CMV. It is recommended to strengthen one’s immune system through a healthy lifestyle by paying attention to a healthy diet, adequate vitamin intake and enough exercise in everyday life. There is currently no vaccine against the virus, so vaccination prophylaxis is not possible. If cytomegalovirus is present, it can be treated in some cases with antivirals. These drugs prevent the viruses from multiplying. In most cases, treatment is not necessary in healthy people, and treating the symptoms is sufficient. Antivirals and other special drugs are used especially in immunocompromised people or during pregnancy. However, prevention of these risk groups and prophylaxis in women of childbearing potential who have not yet had contact with cytomegalovirus is much more important. If possible, close contact with young children should be avoided in everyday life, as well as the sharing of objects such as crockery, cutlery, towels or bed linen. Again, special attention should be paid to carefully performed hand hygiene and hygiene in general.