Cytomegaly

Mareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.

More about the experts All content is checked by medical journalists.

Cytomegaly (also cytomegaly, CMV infection) is an infectious disease that is caused by viruses. Especially people who already suffer from an underlying disease are at risk. The virus is often transmitted from mother to child during pregnancy. Cytomegaly can affect almost any organ and recur for a lifetime. Here you can read everything you need to know about cytomegaly.

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. B25P35

Cytomegaly: description

Cytomegaly is an infectious disease caused by the cytomegaly virus (CMV). It belongs to the herpesvirus family and is also called human herpesvirus-5 (HHV-5). Once the infection has healed, these viruses remain in the body for a lifetime. This time is known as latency. For example, if the immune system is severely weakened by another serious illness, the viruses can be reactivated from their latency. Then they trigger the clinical picture of cytomegaly again.

The cytomegaly viruses are spread all over the world. There is a connection between the contamination and the prosperity of the population. In third world countries, over 90 percent of the population have antibodies against cytomegalovirus. In the industrialized countries of the western world, the infection rate in children up to the age of six is ​​between five and 30 percent and increases from puberty with an increase in sexual contacts to up to 70 percent in adulthood.

The cytomegaly viruses are transmitted via saliva, tear fluid, blood products, organ transplants, seminal fluid, cervical secretions, breast milk and the placenta (placenta). With 0.3 to 1.2 percent of newborns affected, cytomegaly is the most common congenital viral infection. About 35 percent of infants born to cytomegaly-positive mothers are infected by breastfeeding.

Cytomegaly: symptoms

In cytomegaly, the symptoms can vary greatly from person to person. Above all, the defense strength of the body's own immune system is decisive. In most cases, infected people with healthy immune systems show no signs of disease at all. A congenital (congenital) cytomegaly infection can sometimes lead to severe disabilities. A distinction is therefore made depending on the time of infection and the age of the person affected:

Congenital (congenital) cytomegaly symptoms

If unborn children become infected with cytomegaly in the womb, 90 percent of them are symptom-free at birth. In the course of their lives, ten to 15 percent will be diagnosed with long-term damage such as hearing impairment. Five percent of infected newborns have unspecific symptoms:

• low birth weight
• Jaundice (jaundice)

Another five percent of infected children have serious consequences:

• Premature birth
• enlarged liver and spleen (hepatosplenomegaly)
• Clotting disorders
• Water head (hydrocephalus)
• Inflammation of the retina (retinitis)

Later on, the children often have mental and physical disabilities such as learning disabilities or hearing problems.

Cytomegaly symptoms in healthy children

In healthy children, CMV infection is usually asymptomatic. This means that there are usually no symptoms at all.

Cytomegaly symptoms in healthy adults

In otherwise healthy adults, the cytomegaly infection is symptom-free in over 90 percent of cases or the patients complain of uncharacteristic, flu-like symptoms such as:

• Fatigue for weeks
• swollen lymph nodes (lymphadenopathy)
• mild inflammation of the liver (hepatitis)

Cytomegaly symptoms in immunocompromised

If patients have a weakened immune system due to a disease (such as cancer, AIDS, SCID = severe combined immunodeficiency) or immunosuppressive therapy after an organ transplant, a cytomegaly infection is often severe. The patients develop the following symptoms, among others:

• fever
• Muscle and joint pain
• severe inflammation of the lungs (pneumonia)
• Inflammation of the liver (hepatitis)
• Inflammation of the brain (encephalitis)
• Inflammation of the retina (retinitis)
• Inflammation of the colon (colitis)
• Inflammation of the kidneys (especially after transplants)

Cytomegaly: causes and risk factors

Cytomegaly is triggered by the cytomegalovirus (CMV). It is a pathogen that consists exclusively of a shell containing a capsule and genetic material. If the virus enters the body via smear infections, sexual contacts or blood products, it penetrates individual cells and multiplies in them. These cells are damaged and develop into giant cells. This gave rise to the name of the disease: the Greek word “cytos” means “cell” and “megas” means “large”.

The cytomegalovirus can affect almost all organs, preferably the salivary glands. It has not yet been conclusively determined where in the body the viruses remain for life. Some of them probably survive in hematopoietic stem cells.

The viruses can be excreted by infected people via all body fluids (including urine, saliva, seminal fluid). Often this only happens during the first few weeks of the primary infection, i.e. when the patient is infected with cytomegaly for the first time. However, it can happen that children who are infected during pregnancy or shortly after birth, excrete the virus until they are three years old.

Risk factors for cytomegaly

Pregnancy is a special risk situation: If a woman becomes infected with the cytomegalovirus for the first time during pregnancy, the unborn child will also be infected in 40 percent of cases. It is true that 90 percent of affected children are symptom-free at birth. However, ten to 15 percent of these children develop late-stage damage such as hearing impairment in the course of their lives. The remaining ten percent of children born with cytomegaly show half unspecific, mild symptoms and half severe symptoms at birth.

The risk group for cytomegaly also includes patients with immune deficiencies, such as those in AIDS, cancer, congenital immune deficiencies or organ transplants. Such a weak immune system can not only favor an initial infection, but also the reactivation of the virus from its latency period after an infection that has already occurred earlier. The same applies to pregnant women. In about ten percent of women who have previously been infected with CMV, cytomegaly breaks out again during pregnancy.

Cytomegaly: examinations and diagnosis

In order to be able to make the diagnosis of cytomegaly, your doctor will ask you in detail about your medical history (anamnesis). For example, he asks you the following questions:

• How long have you been feeling sick?
• Are you pregnant?
• Do you suffer from an underlying disease such as cancer or AIDS?
• Are you breathing well?
• Do you feel pressure in your upper abdomen?

During the subsequent physical examination, the doctor will listen to your lungs and palpate the lymph nodes in your neck and stomach. In addition, the fundus of your eye is mirrored (fundoscopy / ophthalmoscopy) in order to detect possible retinal inflammation.

Sample investigation

In addition, a sample of a body fluid is taken, which is examined for the cytomegaly viruses in the laboratory. Blood, urine, bronchial fluid, amniotic fluid or umbilical cord blood are suitable for this. It is checked whether it contains genetic material or surface proteins of the cytomegalovirus or antibodies against them.

Here it is important to find out whether it is a first-time infection with the cytomegalovirus (primary infection) or whether an earlier and then dormant (latent) infection has been reactivated. For this purpose, two samples are examined, which are obtained every two weeks. If the first sample does not contain any specific antibodies against CMV (seronegative) and the second sample contains antibodies of both IgG and IgM classes (seropositive), a primary infection has been proven. The change from seronegative to seropositive sample material is called seroconversion.

Hearing tests in children

Children who were infected with cytomegaly during pregnancy should have hearing tests at regular intervals, as the hearing impairment can sometimes only be diagnosed late.

Cytomegaly: treatment

How cytomegaly is treated depends largely on the strength of the immune system and the severity of the symptoms. Normally, no medication is given to healthy adults with a well-functioning immune system and, accordingly, mostly only uncharacteristic signs of illness such as tiredness.

Patients with a weakened immune system are given antivirals and hyperimmunoglobulins.

Antivirals

Antivirals are drugs that prevent viruses from multiplying and spreading. They are often associated with severe side effects and are therefore only given in severe cases of illness. Like all other herpes viruses, CMV cannot be completely removed. Some of the viruses remain in the body for life despite antiviral therapy.

Cytomegaly is treated with the antiviral ganciclovir. It can cause severe side effects because it is toxic to the kidneys and bone marrow. Other antivirals can be used depending on how well ganciclovir works. These include valganciclovir, which is preferred for treating retinal inflammation, cidofovir, foscarnet and fomivirsen. Pregnant women and nursing mothers should not be treated with these drugs. Newborns with cytomegaly should only be treated in special facilities that have experience with the disease.

Hyperimmunoglobulins

A hyperimmunoglobulin consists of antibodies that are effective against a specific pathogen. In the case of cytomegaly, CMV hyperimmunoglobulin sera are used. These are used both in immunocompromised patients and in pregnant women who are suspected of having contracted CMV for the first time.

Cytomegaly: disease course and prognosis

The time between infection and the onset of cytomegaly (incubation period) is around four to eight weeks. Cytomegaly viruses remain in the body for life after the illness has been overcome. Therefore, especially when the immune system is weakened, the disease can break out again and again.

Patients with an intact immune system have a good prognosis and cytomegaly usually heals without consequences. In all other patients, the outcome of the disease depends on the type and severity of the symptoms. Cytomegaly in newborns can heal without consequences or it can lead to blindness, hearing damage and intellectual disabilities. In immunocompromised patients, the generalized infection (i.e. an infection of many different organ systems) can be fatal. Pneumonia associated with cytomegaly infection is particularly dangerous: around half of all cases it ends with death.

Cytomegaly: Prevention

Cytomegaly is common worldwide. When it comes to prevention, it is therefore particularly important to protect risk groups. These include pregnant women who have not been infected before and people with weakened immune systems (such as those with underlying diseases or after organ transplants).

Organ transplant:

Organ transplantation carries a high risk of transmission of cytomegalovirus. In order not to reject the received organ, the immune system of the organ recipient is weakened (immunosuppressed) with the help of medication. This can make infections such as cytomegaly more difficult because the body's own defense system cannot fight them. To prevent such an infection, organ donors who are seronegative are selected as far as possible. During a blood transfer, the blood can be filtered so that cells that may contain cytomegaly virus are not transferred.

In addition, the organ recipients can receive hyperimmunoglobulin sera against CMV before the transplant. This means that there are antibodies against cytomegaly in your blood, which can render invading viruses harmless.

Pregnant women:

Women can have their CMV status tested at the beginning of a pregnancy or in advance. To do this, the blood is checked for specific antibodies against cytomegaly. According to the maternity guidelines, this examination is not provided and therefore corresponds to an individual health service (IGeL) that is not paid for by all health insurance companies. If seroconversion is detected in the course of pregnancy, action can be taken accordingly.

Pregnant women who have not had cytomegaly before should exercise strict hand hygiene when they come into contact with small children. Children excrete the cytomegalovirus in their urine or saliva, often without showing any signs of the disease. The risk of infection can be minimized by washing your hands with soap or disinfecting your hands with alcohol. In addition, seronegative pregnant mothers of infected young children should heed the following tips:

• Do not kiss your children on the mouth.
• Do not use the same cutlery or dishes as your children.
• Do not use the same towels or washcloths.
• Disinfect your hands after blowing your child's nose or touching toys that the children previously had in their mouth.

These measures reduce the risk of contracting cytomegaly for pregnant women.

Employment ban:

Pregnant women who, for example, look after children up to the age of 3 as educators and who, according to a blood test, do not have sufficient immunity against cytomegaly, are prohibited from employment for the entire duration of the pregnancy. This serves to protect the unborn child.

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