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What is Cytomegalovirus
Cytomegalovirus is closely related to the viruses that cause chickenpox and mononucleosis. CMV infections are very common, and most of us will likely contract it during our lifetime. Most people infected with this virus have no symptoms at all or experience the illness in a mild form. For healthy individuals, it generally poses no threat. However, CMV can cause serious problems in certain particularly vulnerable categories. For example, in newborns who were infected during pregnancy (congenital infection, which can cause deafness and neurological sequelae), and in patients with reduced immune system defense (immunosuppression). This virus is very important for transplant recipients, in whom it can cause severe symptoms and contribute to the rejection of the transplanted organ, as well as for premature infants, whose immune system is not yet mature.
Prevalence
CMV infection has a very high global prevalence: approximately 90% of the population in developing countries and 60% in developed countries are carriers. It is the most common congenital infection in European countries. According to various studies, one in 200 children is born infected with this virus, which can have corresponding consequences, including neurological ones.
Causes
Cytomegalovirus is transmitted through saliva, breast milk, vaginal secretions, urine, semen, feces, blood, and other body fluids. Additionally, the infection can be acquired through tissue or organ transplantation. The virus is also transmitted from the mother to the fetus (vertical transmission) through the placenta. It is not a highly contagious virus, and its spread requires very close or intimate contact. Transmission usually occurs by touching the eyes, the inside of the nose, or the mouth after contact with the biological fluids of an infected person.
Symptoms
The symptoms and consequences of CMV infection vary depending on the category of people.
Healthy individuals (immunocompetent). In healthy children and adults, the infection is usually asymptomatic or presents with mild symptoms. It may cause a catarrhal state, pharyngitis, or, at most, a mononucleosis syndrome similar to that caused by the Epstein-Barr virus.
Congenital infection. Pregnant women are exposed to many viruses, bacteria, and other pathogens, but only a few pose a threat to the unborn child. CMV is one of them and is particularly dangerous in the first trimester of pregnancy. It can lead to various neurological problems. In the most severe cases, it results in long-term mental or psychomotor retardation. The virus can also cause deafness and, less frequently, affect vision. In any case, pediatricians clarify that not all infected pregnant women transmit the virus to the fetus, and not all children with congenital infection develop symptoms; only a small percentage of them have a severe course. It is estimated that the risk of CMV transmission to the fetus during pregnancy is 40%, and approximately 85% of children with congenital infection are asymptomatic. Although 10% of them may develop hearing problems after some time. The remaining 15% of infants show symptoms, the severity of which will depend primarily on the time during pregnancy when the infection occurred. The first trimester is the most critical for the development of neurological and auditory complications. If the infection occurs in the later weeks of pregnancy, the damage to the newborn is usually not as significant.
Postnatal infection. Newborns can be infected in the first six months of life, with breast milk being the primary route of virus transmission. In these cases, the symptoms are usually not pronounced, except in cases of premature infants whose immune system is not yet fully developed and who have not received maternal antibodies, which usually happens in the final weeks of pregnancy.
Immunocompromised individuals. CMV infection can cause pneumonia, hepatitis, encephalitis, inflammation of the retina (retinitis), febrile syndromes, and gastrointestinal tract pathology in people with a weakened immune system, such as transplant recipients or HIV patients on antiretroviral therapy.
Diagnosis
Cytomegalovirus is easily detectable through a blood test. Serological tests measure two types of antibodies, Immunoglobulins IgG and IgM, which are also analyzed when searching for other viruses (such as SARS-CoV-2 coronavirus) and allow determination of whether it is a previous or recent infection. The method for detecting viral DNA, known as the Polymerase Chain Reaction (PCR), is also used. The presence of cytomegalovirus in amniotic fluid, determined by performing amniocentesis in a pregnant woman, confirms the presence of the infection in the fetus. In newborns, urine or saliva samples are usually taken for diagnosis.
Treatment
CMV infection does not require specific treatment in healthy individuals with a normal immune system. Should symptoms appear, routine measures for controlling fever and general malaise will be applied. Congenital infection is treated with an antiviral drug, but only if symptoms are present. Infected but asymptomatic children are monitored for the early detection of potential hearing problems and their appropriate treatment. Children born with neurological, auditory, ocular, or other problems caused by CMV must be treated and remain under long-term observation by a multidisciplinary team. Prevention and early treatment strategies, including the use of antiviral medications, are employed in post-transplant patients to reduce the impact of CMV infection.
Prevention
Proper hygiene is the best way to prevent CMV infection and its transmission. It is a virus that is easily destroyed by washing hands and using disinfecting hydro-alcoholic solutions. Specialists advise observing special hygiene measures when planning a pregnancy and during its first weeks, when transmission of the infection to the fetus poses a greater danger. It should be noted that one of the peaks of CMV infection occurs in early childhood. A typical case of infection, according to neonatologists, is that of a pregnant woman who has a one- or two-year-old child who contracted the infection at the maternity ward and experienced it asymptomatically. The toddler continues to shed the virus in their urine, and the mother becomes infected while changing their diapers or feeding them.
Here are some tips for pregnant women with young children or those who are in contact with children (teachers, caregivers, nannies):
• Frequent hand washing, especially after changing diapers.
• Do not kiss children on the lips.
• Do not share cutlery.
• Do not suck on a pacifier to clean it if it has fallen on the floor.
A study published in 2020 in the journal The Lancet shows that the administration of an antiviral drug to pregnant women infected with CMV significantly reduces the rate of congenital infection. Some pediatricians believe this could become a strategy for preventing vertical transmission of the virus.
Cytomegalovirus is closely related to the viruses that cause chickenpox and mononucleosis. CMV infections are very common, and most of us will likely contract it during our lifetime. Most people infected with this virus have no symptoms at all or experience the illness in a mild form. For healthy individuals, it generally poses no threat. However, CMV can cause serious problems in certain particularly vulnerable categories. For example, in newborns who were infected during pregnancy (congenital infection, which can cause deafness and neurological sequelae), and in patients with reduced immune system defense (immunosuppression). This virus is very important for transplant recipients, in whom it can cause severe symptoms and contribute to the rejection of the transplanted organ, as well as for premature infants, whose immune system is not yet mature.
Prevalence
CMV infection has a very high global prevalence: approximately 90% of the population in developing countries and 60% in developed countries are carriers. It is the most common congenital infection in European countries. According to various studies, one in 200 children is born infected with this virus, which can have corresponding consequences, including neurological ones.
Causes
Cytomegalovirus is transmitted through saliva, breast milk, vaginal secretions, urine, semen, feces, blood, and other body fluids. Additionally, the infection can be acquired through tissue or organ transplantation. The virus is also transmitted from the mother to the fetus (vertical transmission) through the placenta. It is not a highly contagious virus, and its spread requires very close or intimate contact. Transmission usually occurs by touching the eyes, the inside of the nose, or the mouth after contact with the biological fluids of an infected person.
Symptoms
The symptoms and consequences of CMV infection vary depending on the category of people.
Healthy individuals (immunocompetent). In healthy children and adults, the infection is usually asymptomatic or presents with mild symptoms. It may cause a catarrhal state, pharyngitis, or, at most, a mononucleosis syndrome similar to that caused by the Epstein-Barr virus.
Congenital infection. Pregnant women are exposed to many viruses, bacteria, and other pathogens, but only a few pose a threat to the unborn child. CMV is one of them and is particularly dangerous in the first trimester of pregnancy. It can lead to various neurological problems. In the most severe cases, it results in long-term mental or psychomotor retardation. The virus can also cause deafness and, less frequently, affect vision. In any case, pediatricians clarify that not all infected pregnant women transmit the virus to the fetus, and not all children with congenital infection develop symptoms; only a small percentage of them have a severe course. It is estimated that the risk of CMV transmission to the fetus during pregnancy is 40%, and approximately 85% of children with congenital infection are asymptomatic. Although 10% of them may develop hearing problems after some time. The remaining 15% of infants show symptoms, the severity of which will depend primarily on the time during pregnancy when the infection occurred. The first trimester is the most critical for the development of neurological and auditory complications. If the infection occurs in the later weeks of pregnancy, the damage to the newborn is usually not as significant.
Postnatal infection. Newborns can be infected in the first six months of life, with breast milk being the primary route of virus transmission. In these cases, the symptoms are usually not pronounced, except in cases of premature infants whose immune system is not yet fully developed and who have not received maternal antibodies, which usually happens in the final weeks of pregnancy.
Immunocompromised individuals. CMV infection can cause pneumonia, hepatitis, encephalitis, inflammation of the retina (retinitis), febrile syndromes, and gastrointestinal tract pathology in people with a weakened immune system, such as transplant recipients or HIV patients on antiretroviral therapy.
Diagnosis
Cytomegalovirus is easily detectable through a blood test. Serological tests measure two types of antibodies, Immunoglobulins IgG and IgM, which are also analyzed when searching for other viruses (such as SARS-CoV-2 coronavirus) and allow determination of whether it is a previous or recent infection. The method for detecting viral DNA, known as the Polymerase Chain Reaction (PCR), is also used. The presence of cytomegalovirus in amniotic fluid, determined by performing amniocentesis in a pregnant woman, confirms the presence of the infection in the fetus. In newborns, urine or saliva samples are usually taken for diagnosis.
Treatment
CMV infection does not require specific treatment in healthy individuals with a normal immune system. Should symptoms appear, routine measures for controlling fever and general malaise will be applied. Congenital infection is treated with an antiviral drug, but only if symptoms are present. Infected but asymptomatic children are monitored for the early detection of potential hearing problems and their appropriate treatment. Children born with neurological, auditory, ocular, or other problems caused by CMV must be treated and remain under long-term observation by a multidisciplinary team. Prevention and early treatment strategies, including the use of antiviral medications, are employed in post-transplant patients to reduce the impact of CMV infection.
Prevention
Proper hygiene is the best way to prevent CMV infection and its transmission. It is a virus that is easily destroyed by washing hands and using disinfecting hydro-alcoholic solutions. Specialists advise observing special hygiene measures when planning a pregnancy and during its first weeks, when transmission of the infection to the fetus poses a greater danger. It should be noted that one of the peaks of CMV infection occurs in early childhood. A typical case of infection, according to neonatologists, is that of a pregnant woman who has a one- or two-year-old child who contracted the infection at the maternity ward and experienced it asymptomatically. The toddler continues to shed the virus in their urine, and the mother becomes infected while changing their diapers or feeding them.
Here are some tips for pregnant women with young children or those who are in contact with children (teachers, caregivers, nannies):
• Frequent hand washing, especially after changing diapers.
• Do not kiss children on the lips.
• Do not share cutlery.
• Do not suck on a pacifier to clean it if it has fallen on the floor.
A study published in 2020 in the journal The Lancet shows that the administration of an antiviral drug to pregnant women infected with CMV significantly reduces the rate of congenital infection. Some pediatricians believe this could become a strategy for preventing vertical transmission of the virus.
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