Acute cytomegalovirus (CMV) infection

Definition

Acute cytomegalovirus (CMV) infection is a condition caused by a member of the herpesvirus family. In most people with a normal immune system, CMV infection does not cause any symptoms. But, some people with this infection develop a "mononucleosis syndrome."

See also: Mononucleosis

Alternative Names

Causes

Mononucleosis can be caused by several different viruses and a few types of bacteria. Unlike the more common form of mononucleosis, caused by the Epstein-Barr virus (EBV), acute CMV infection is caused by cytomegalovirus (CMV).

The symptoms of mononucleosis syndrome with CMV include fever and fatigue. Swollen lymph glands in the neck, sore throat, and swollen spleen are less common with CMV. Up to a third of patients may have a rash.

The infection is spread by saliva, urine, respiratory droplets, sexual contact, and blood transfusions. Some young children release the virus in their urine for a long period of time, even when they do not have symptoms. CMV infection may occur at any age. It most commonly develops between the ages of 10 and 35.

Most people are exposed to CMV early in life and do not realize it because they have no symptoms.

Symptoms

• Fever
• Sore throat
• Enlarged lymph nodes, especially in the neck
• Malaise (vague ill feeling)
• Frequent tiredness or fatigue
• Loss of appetite
• Muscular aches or stiffness

• Jaundice (yellow cast to skin)
• Headache
• Neck stiffness
• Sensitivity to light
• Cough
• Shortness of breath
• Chest pain
• Rapid heart rate
• Irregular heart rate
• Hives

Exams and Tests

Your health care provider will perform a physical exam and feel your belly area. The liver and spleen may be tender when they are gently pressed (palpated). There may be a skin rash.

Special lab tests will be done to check for substances in your blood that are produced by CMV. This includes a CMV ELISA antibody test and CMV serum PCR test.

A monospot test should be negative in CMV mononucleosis.

Blood tests show a low number of platelets and a high number of certain white blood cells.

A chemistry panel may show abnormal liver enzymes.

Treatment

Most patients recover within 4 to 6 weeks without medication. Rest is needed, sometimes for a month or longer to regain full activity levels. Relief of symptoms is provided with pain killers and warm salt water gargles for sore throat.

Anti-viral medications are usually not used in those with normal immune function.

Outlook (Prognosis)

Fever usually goes away in 10 days, and swollen lymph glands and spleen return to normal in 4 weeks. Fatigue may linger for 2 to 3 months.

Possible Complications

Secondary throat infection is the most common complication. Rare complications include:

• Colitis
• Pneumonia
• Pericarditis or myocarditis
• Guillain-Barré syndrome
• Rupture of spleen
• Neurologic complications

When to Contact a Medical Professional

Call for an appointment with your health care provider if symptoms of acute CMV infection develop.

Go to the emergency room or call the local emergency number (such as 911) if sharp, sudden pain in left upper abdomen occurs. This could indicate a ruptured spleen, which requires emergency surgery.

Prevention

CMV infection can be contagious if the infected person comes in close or intimate contact with another person. You should avoid kissing and sexual contact with an infected person.

The virus may also spread among young children in day care settings.