Synonyms: Giant Cell Inclusion Disease, Cytomegalovirus Infection, Salivary Gland Disease, Cytomegalic Inclusion Body Disease
What are Neurological Consequences of Cytomegalovirus Infection?
The cytomegalovirus (CMV) is a virus found universally throughout the world that infects between 50 to 80 percent of all adults in the United States by the age of 40. CMV is in the same family of viruses that includes herpes simplex types 1 and 2, and the viruses that cause infectious mononucleosis (EBV), chickenpox, and shingles. A hallmark of CMV is the reappearance of symptoms throughout life, as the virus cycles through periods of dormancy and active infection. Most people who acquire the virus as children or adults display no signs or have mild symptoms and no long-term health consequences. Those who do have symptoms experience mononucleosis-like indications, such as a prolonged fever, fatigue, mild hepatitis, and tender lymph nodes. Severe forms of infection include CMV retinitis and encephalitis. Infected individuals periodically shed the virus in their body fluids, such as saliva, urine, blood, tears, semen, or breast milk. It is most commonly transmitted when an uninfected person comes in contact with infected body fluids and then touches his or her mouth or nose, at which point the virus is absorbed into the mucous membranes.
Is there any treatment?
There is no cure for CMV infection. Good hygiene, including proper hand washing, is recommended to avoid transmission from one person to the next. Individuals who work with young children should avoid sharing drinking glasses and utensils, and carefully throw away diapers, tissues, and other items contaminated with body fluids. Antiviral drugs, such as ganciclovir and acyclovir, are used to prevent infection in immune-compromised people or to reduce their “viral load” (the amount of virus they have in their body). High titer immunoglobulin (IVIG, CytoGam) is also used in acutely infected individuals with some impaired immunity. Vaccines are in the development and trial stage with good indications from clinical studies in humans that they can help prevent primary infection or modify symptoms.
What is the prognosis?
For most people CMV infection is not a problem. However, CMV infection puts three groups of people at high risk. They are:
- unborn babies whose mothers have CMV infection, who are at risk for lung infection, excessive bleeding, anemia, liver damage, vision impairment, or neurological conditions that include seizures, hearing loss, varying degrees of mental impairment, or problems with physical coordination. CMV is the most common congenital (present at birth) viral infection in the United States. Most babies will not be harmed, but a small number will develop lifelong disabilities. Babies at the highest risk are those whose mothers have had their first CMV infection during pregnancy.
- immune-compromised individuals, such as organ-transplant patients, particularly renal allograft recipients and people with HIV-AIDS. People recovering from transplant surgeries may also develop encephalitis or inflammation of the retina of the eyes. End-stage AIDS patients with CMV infection may experience neuromuscular impairments in the form of leg weakness and bladder or bowel dysfunction.
- women who work daily with young children and are pregnant, or who are considering becoming pregnant could put their unborn child at a higher risk for birth complications if they acquire CMV infection for the first time during pregnancy. They should be educated about the risks of acquiring CMV infection and the importance of good hygiene.
What research is being done?
The National Institute of Neurological Disorders and Stroke (NINDS), and other institutes of the National Institutes of Health (NIH), conduct research related to CMV infection in laboratories at the NIH, and support additional research through grants to major medical institutions across the country. Much of this research focuses on finding a safe and effective vaccine for the virus, and better ways to treat immune-compromised individuals with CMV infection.