Cytomegalovirus disease
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CYTOMEGALOVIRUS DISEASE PowerPoint PPT Presentation


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CYTOMEGALOVIRUS DISEASE. In normal hosts: (a) If acquired by contact -- 1 o attack is asymptomatic or mononucleosis with subclinical hepatitis. (b) If by transfusion -- “post-transfusion syndrome”: fever and mononucleosis, FUO, granulomatous hepatitis.

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CYTOMEGALOVIRUS DISEASE

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CYTOMEGALOVIRUS DISEASE

In normal hosts:

  • (a) If acquired by contact -- 1o attack is asymptomatic or mononucleosis with subclinical hepatitis.

  • (b) If by transfusion -- “post-transfusion syndrome”: fever and mononucleosis, FUO, granulomatous hepatitis.

    In hosts with impaired T-cell immunity and in fetuses:

  • Fetus -- cytomegalic inclusion disease (TORCH) syndrome: petechial rash, hepatosplenomegaly, thrombocytopenia, anemia, CNS damage, low birth weight. Most congenital CMV infections are subtle (mental retardation, partial deafness, eye disease or asymptomatic). CMV is a common infectious cause of congenital abnormality.


CMV Routes of Infection

1.Saliva

2.Sexual contact

3.Transfusion

4.Organ transplant (usually renal)


CMVDiagnosis

Difficult on clinical data alone…viral culture (2-4 weeks), serology by indirect immunofluorescence, cytology on concentrated urine


CMV Treatment

The antiviral drugs, cidofovir and ganciclovir, are the drugs of choice for CMV retinitis and pneumonitis- ganciclovir is more toxic than cidofovir.

Experimental live attenuated vaccines are being developed but unknown efficacy or safety.


EPSTEIN-BARR VIRUS

  • EBV is a herpesvirus first seen by electron microscopy of neoplastic cells from a Burkitt’s lymphoma (BL) in 1964.

  • Antibody to EBV is found in sera of almost all patients with BL or nasopharyngeal carcinoma.

  • Antibody to EBV was found in 80% of low-income adults in Philadelphia and 100% of adults in developing countries; most didn’t have BL.

  • EBV usually results in infectious mononucleosis (IM) in North America and BL in Africa and other parts of the world.


EBV Disease Characteristics

  • EBV can be cultured in normal human B lymphocytes (virus attaches to complement C3b receptor) which then begin to behave like neoplastic lymphoma cells. These cells undergo blastogenesis and begin secreting vast amounts of polyclonal (heterophile) immunoglobulins.

  • Infection is followed by the prompt appearance of cytotoxic T cells which proceed to turn off activated B cells (the “atypical lymphocytes” are the T cells).

  • Heterophil Ab ( IgM antibodies which agglutinate sheep and horse RBCs) appears in 80% of patients with IM. These antibodies appear approximately four weeks after onset of symptoms, but are not EBV specific antibodies.


Epatein-Barr Virus (EBV) Infection


Diagnostic Procedures For Herpesviruses

1. Cell Culture: Cell rounding > fusion > giant cell formation (HSV)

2. Immunofluorescence: Intense nuclear staining for all herpesviruses

3. ELISA and Western Blot: Specificity based on glycoprotein

4.PCR

5. TORCH: Serologic assay


TORCH - Syndrome

ToxoplasmaTo

Rubella R

Cytomegalovirus C

Herpes Simplex H


Chickenpox lesions

Zoster lesions


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