The main criterion for including a virus in this enlarging group of viruses is viral morphology. A 34 year old man with an exacerbation of his colitis was diagnosed as having both. The brief version is a compilation of the tables and boxed recommendations. Final report from a longitudinal study, the journal of infectious. Occurrence of cytomegalovirus hepatitis in liver transplant patients. Papular acrodermatitis with cytomegalovirus hepatitis.
Many people are infected with this virus, though they have no symptoms. Women who develop an active cmv infection during pregnancy can pass the virus to their babies, who might then. It has been known for some time that hepatocellular function is often impaired in. A cytomegalovirus based therapeutic vaccine for chronic. The unique morphology of herpesviruses was unknown until wildy et al. In order to determine the factors responsible for the differentiation of cytomegalovirus cmv hepatitis and epsteinbarr virus ebv hepatitis in previously healthy adults, the clinical features and laboratory data of both types of hepatitis were retrospectively analyzed. We present the case of an immunocompromised patient with skin lesions, pancreatitis, colitis and hepatitis. The majority of viruses which attack the liver tend to be associated with specific disease entities. Cytomegalovirus cmv is transmitted by close contact through sex and through saliva, urine, and other body fluids. In susceptible people, such as those with suppressed immunity or unborn babies, cmv can be a dangerous infection.
Laboratory diagnostics of murine blood for detection of. Cytomegalovirus cmv is a common virus that is usually harmless. Maintenance therapy is usually not necessary, but should be considered after relapses bii managing welldocumented cmv pneumonitis. Cytomegalovirus pronounced sitomegalovirus, or cmv, is a virus that belongs to the herpesviridae family, hence its older name, human herpes virus 5 hhv 5. A retrospective study was carried out in 56 patients to establish the association of cytomegalovirus cmv with active or inactive hepatitis b virus hbv infection as a possible risk factor in the development of severe liver disease. Neonatal hepatitis is an inflammatory disease of the liver found in early infancy presenting with intrahepatic cholestasis. Cmv hepatitis showed a tendency to increase in our departement. Workup revealed varicella zoster virus, which likely put the patient at risk for multiorgan involvement, as well as clinical suspicion of other implicated viruses, specifically herpes simplex virus and cytomegalovirus. Cytomegalovirus cmv is a member of the herpes family. Cmv is similar to the herpes virus that causes cold sores and chickenpox. Despite its clinical and public health importance, questions remain regarding the best diagnostic methods for identifying maternal and neonatal infection, and regarding optimal prevention and therapeutic strategies for infected mothers and neonates. Human cytomegalovirus hcmv infects most individuals within the first few years of childhood, with approximately 70% of adults having immunoglobulin ig g antibodies specific for cytomegalovirus antigens. Autopsy specimens from 50 transplant patients were evaluated.
Systemic cytomegalovirus infection complicating ulcerative. Worldwide, most people with hepatitis b were infected with the virus as an infant. In this case report, we describe a 35yearold immunocompetent female with an acute cytomegalovirus infection presenting as acute hepatitis with ongoing upper right abdominal pain after cholecystectomy. Severe focal disease, including retinitis, can develop in hivinfected patients and in organ transplant recipients and other immunocompromised patients. Congenital cytomegalovirus is the most frequent, yet underrecognised, infectious cause of newborn malformation in developed countries. Summary human cytomegalovirus hcmv is the leading cause of congenital viral infection and mental retardation. It is a lytic virus that causes a cytopathic effect in vitro and in vivo. Most people dont know they have cmv because it rarely causes problems in healthy people if youre pregnant or if your immune system is weakened, cmv is cause for concern.
Human cytomegalovirus cmv is a ubiquitous herpesviridae virus with a wide spectrum of pathology in humans. Histological diagnosis of cytomegalovirus hepatitis in. There are data suggesting that the latter mechanism is more likely. Once infected, your body retains the virus for life. Liver pathology in cytomegalovirus infection associated. Cytomegalovirus infection american academy of pediatrics. Cytomegalovirus cmv is a doublestranded dna virus and a member of the herpesviridae family. In a 10year dynamic cohort study, 976 health care providers were followed a mean of 1. Hepatitis b virus, hepatitis c virus, and cytomegalovirus among health care personnel at risk for blood exposure.
Comparison between cytomegalovirus hepatitis and epstein. Introduction to consider that viruses, more specifically cytomegalovirus cmv, can trigger autoimmune hepatitis. Hence, careful diagnosis of primary infection is required in the. Cmv affects nearly all humans, with a 60%100% seroprevalence worldwide, and in the immunocompetent it typically manifests as a. Clinical significance of cytomegalovirus cmv antigenemia. Unlike some forms of hepatitis, hepatitis b is also not. Other members of this family include herpes simplex viruses which cause cold sores and genital herpes, varicellazoster virus which causes chickenpox and shingles, and epsteinbarr virus which causes infectious mononucleosis. Mark jacobson and colleagues1 suggest two possible mechanisms by which treatment failure might occur.
It can cause blindness and other serious problems if youre hivpositive. Acute cytomegalovirus hepatitis in an immunocompetent host. This paper reports acute cytomegalovirus hepatitis. The syndrome of papular acrodermatitis of childhood with hepatitis gianotticrosti syndrome is classically considered to be associated with hepatitis b surface antigen hbsag infection. Cytomegalovirus cmv from the greek cyto, cell, and megalo, large is a genus of viruses in the order herpesvirales, in the family herpesviridae, in the subfamily betaherpesvirinae. The eight species in this genus include the type species, human betaherpesvirus 5 hcmv, human cytomegalovirus, hhv5, which is the species that infects humans. Overview of diagnostic tests for cytomegalovirus infection. Cytomegalovirus hepatitis in 49 pediatric patients with normal immunity article pdf available in turkish journal of medical sciences 466. Cmv during the workup of patients presenting with an infectious mononucleosis syndrome, acute hepatitis, or as an opportunistic infection in persons with human immunode. Cytomegalovirus cmv, human herpesvirus type 5 can cause infections that have a wide range of severity.
Immunocompetent patients generally develop a benign, selflimited mononucleosislike syndrome whereas gastrointestinal tissueinvasive. Cytomegalovirus hepatitis in late pregnancy sciencedirect. Pdf occurrence of cytomegalovirus hepatitis in liver. Laboratory diagnostics of murine blood for detection of mouse cytomegalovirus mcmvinduced hepatitis. Pdf cytomegalovirus hepatitis in 49 pediatric patients. It can be passed from mother to child during pregnancy and by breastfeeding. The histopathology of cmv was first described in 1904, but the virus itself was not isolated until 1957 by craig et al. Cytomegalovirus retinitis after initiation of highly. Abstract although an efficient prophylactic vaccine is available for hepatitis b virus hbv chronic hepatitis b chb affects up to million people worldwide and despite advances. A cytomegalovirus based therapeutic vaccine for chronic hepatitis b. To describe the histological pattern most frequently associated with cmv hepatitis in order to select the biopsy group in which. Landmarks in virology introduction of concept of filterable agents for plant pathogens mayer, ivanofsky, beijerinck in late 1880s first filterable agent from animals described foot and mouth disease virus loeffler and. They found that herpes simplex virus did not have the spherical shape thought, up to 1960, to be common to many viruses.
Cmv is a dna virus and a member of the herpesvirus group. If you are not infected, using condoms during sex may help prevent infection. A syndrome of infectious mononucleosis that lacks severe pharyngitis is common. We report an infant with the syndrome, but with serological evidence of infection by cytomegalovirus. Cytomegalovirus is an important etiologic agent of neonatal hepatitis. Cytomegalovirus disease brief the information in the brief version is excerpted directly from the fulltext guidelines. Neonatal hepatitis and extrahepatic biliary atresia. View enhanced pdf access article on wiley online library html view download pdf for offline viewing. Host immunity is a major determinant of the clinical manifestation of cmv and can vary widely in the gastroenterology and hepatology practice setting. Severe focal disease, including retinitis, can develop in hivinfected patients and in organ transplant recipients. Freeman department of medicine, divisions of infectious diseases and gastroenterology, university of british columbia, health sciences centre hospital, vancouver. Saarikoskia departments of obstetrics and gynecology and hpediatrics, kuopio university hospital finland received may 22nd, 1991 accepted june 15th, 1991 abstract a case of pregnancy. Human cytomegalovirus an overview sciencedirect topics. Gbs presence in acute hepatitis e virus hev and cytomegalovirus cmv infection is also sporadically reported.
Here, a rare case of gbs in a chronic hepatitis b virus carrier co. Aimsto determine the incidence of histologically documented cytomegalovirus cmv hepatitis following orthotopic liver transplantation olt and to assess the effectiveness of immunohistochemistry and in situ hybridisation ish in detecting cmv. Cytomegalovirus cmv has been identified as an important viral pathogen in humans for more than a century. Cytomegalovirus cmv infection is a common complication of immunosuppression, and is frequently seen in transplant recipients, patients with the acquired immunodeficiency syndrome aids, and those who have received steroids. Evidence for direct hepatic viral infection using monoclonal antibodies s. Cytomegalovirus cmv infection is one of the most common opportunistic infections following organ transplantation, occurring in up to 30% of liver transplant recipients. Multiorgan involvement secondary to varicella zoster. Complications in immunocompetent patients are rare but may affect the liver and lead up to an acute organ failure. In immunocompromised hosts, however, cmv infection can result in a broad array of clinical presentations, including a nonspecific syndrome which may include fever, malaise, weakness, myalgias, arthralgias, leukopenia, andor thrombocytopenia in the setting. Cytomegalovirus is a common infection worldwide and in the immunocompromised individual it can be a major cause of morbidity and mortality. However, in some cases there may be close resemblances to infectious hepatitis which may cause confusion. The addition of the protease inhibitor ritonavir in patients with.
Prenatally acquired cytomegalovirus infection in twins was temporally associated with a discordant development of neonatal hepatitis and extrahepatic biliary atresia. Congenital and perinatal cytomegalovirus infection cmv. Thus, cytomegalovirus hepatitis should be considered in the differential diagnosis in immunocompetent paticipants presenting with nonspecific prodromal symptoms and unexplained hepatitis. Congenital cytomegalovirus infection in pregnancy and the. This case presents evidence suggesting an association between perinatal cytomegalovirus infection and selected extrahepatic biliary atresia and neonatal hepatitis. Download fulltext pdf download fulltext pdf download fulltext pdf cytomegalovirus hepatitis during pregnancy article pdf available in infectious diseases in obstetrics and gynecology 34. Signs at birth, if present, are intrauterine growth restriction, prematurity, microcephaly, jaundice, petechiae, hepatosplenomegaly, periventricular calcifications, chorioretinitis, pneumonitis, hepatitis, and sensorineural hearing loss. Cytomegalovirus infection may be acquired prenatally or perinatally and is the most common congenital viral infection. Cytomegalovirus brief the information in the brief version is excerpted directly from the fulltext guidelines. Cytomegalovirus cmv is related to the herpes virus that gives you cold sores. Case report 54 yearold female presents with new onset jaundice, which was associated with abdominal distension, lower extremity edema and 10 pound weight gain. Infection with cytomegalovirus is an unusual cause of acute infectious hepatitis in an immunocompetent adult. To evaluate the clinical significance of a cytomegalovirus cmv antigenemia assay in the prediction and diagnosis of cmv gastrointestinal cmvgi disease after hematopoietic stem cell.
Hcmv infection, while causing asymptomatic infections in most immunocompetent subjects, can be transmitted during pregnancy from the mother with primary and also recurrent infection to the fetus. Cytomegalovirus cmv generally produces an asymptomatic or minimally symptomatic acute illness in immunocompetent patients. She has no history of intravenous drug use, blood transfusions, any new sexual partners in over 8 years or a family. In patients with inflammatory bowel disease cytomegalovirus infection has been described in both immunocompetent and immunocompromised individuals. The etiologies remain unknown in about one half to two thirds of patients.
1299 207 469 897 205 623 46 1116 552 1557 1203 251 291 490 1513 267 657 230 278 524 91 880 1534 312 986 296 1168 227 1159 482 615 384 900 449 866 1333 502 1281 551