CMV (Cytomegalovirus)

Cytomegalovirus (CMV) is a DNA virus from the herpesvirus family (Herpesviridae). After initial infection, it remains in the body for life and can be reactivated during periods of immune suppression. CMV is transmitted through direct contact with infected body fluids, which results in high prevalence rates in the population. Infection occurs through blood, body fluids, and transplanted organs.

In a healthy person, a CMV infection often remains asymptomatic or manifests with flu-like symptoms. Typical are mononucleosis-like symptoms such as fever, lymph node swelling, and sore throat. The virus becomes particularly dangerous for immunocompromised individuals and newborns.

The symptoms differ for otherwise healthy people, immunosuppressed individuals, and pregnant women.

Cytomegalovirus can cause a range of symptoms that are often associated with a classic viral infection. Especially in the initial phase, the complaints are diverse and can significantly impact the daily lives of those affected.

In immunocompromised individuals, an infection with cytomegalovirus can cause more severe and potentially life-threatening symptoms. The weakened immune system is less able to effectively fight the viral load, which can lead to serious complications.

The diagnosis of cytomegalovirus infection is made through various clinical, laboratory diagnostic, and histological procedures. Particularly important is the detection of CMV-specific antibodies in the blood as well as the direct detection of the virus in body fluids. Diagnostics play a crucial role since CMV infections often progress asymptomatically and are only detected through targeted examinations.

The initial assessment is based on medical history and clinical symptoms (see above). A thorough examination is particularly important in newborns and immunocompromised patients.

To confirm a CMV infection, serological tests and molecular detection methods are employed. Serology involves detecting CMV-specific IgM and IgG antibodies in the blood:

While IgM antibodies suggest a recent infection, IgG antibodies indicate a previous or chronic infection. IgG values can be interpreted using reference tables to better determine the time of infection.
Direct viral detection is achieved through PCR testing, which identifies CMV DNA from blood, urine, or other body fluids. Urine culture is particularly common in newborns to cultivate the virus.
Additionally, a complete blood count can provide indications of an active infection, especially when the monocyte count is elevated.
In special cases, such as in immunocompromised patients, a tissue biopsy may be necessary to detect the virus in infected organs.

When tissue damage from CMV is suspected, a histological examination can be performed. Especially in immunosuppressed individuals or congenital infections, microscopic examination looks for inclusion bodies typical of CMV. These are a characteristic sign of CMV infection in affected cells.

During a CMV infection, the proportion of monocytes in the blood can be elevated. Monocytes are a type of white blood cell and play an important role in the immune defense. When an active CMV infection occurs, the immune system responds by producing more monocytes to fight the virus. An elevated monocyte count may be particularly noticeable during the acute phase.

However, an isolated elevation of monocytes is not specific for CMV, as it can also occur with other viral infections or chronic inflammations. Therefore, for a reliable diagnosis, additional tests are performed, such as the serological examination described above (CMV-IgM, CMV-IgG) or PCR detection of viral DNA.

The treatment of a CMV infection depends on the severity of the infection and the immune status of the affected person. While healthy people with a functioning immune system generally do not require special therapy, the infection can have serious consequences for newborns or immunocompromised individuals. In such cases, both conventional medical and complementary medicine approaches are used.

In severe cases or in immunocompromised patients, antiviral therapy with virostatics is used to inhibit viral replication. Commonly used active substances include:

Additionally, symptomatic treatment is provided to alleviate existing complaints. This includes antipyretic medications (such as paracetamol or ibuprofen) for fever, as well as pain-relieving medications to counteract headaches and sore throats. If the CMV infection causes inflammation, anti-inflammatory medications are used to reduce it. Furthermore, fluid replacement is very important to counter potential fluid loss.

In immunocompromised patients, possible complications such as pneumonia or rhinitis must be treated specifically. In certain cases, therapy with immunoglobulins may also be beneficial to support the weakened immune system.

In addition to conventional medical treatments, there are alternative therapies that can strengthen the immune system and support recovery.

These include the following therapies:

In pregnant women, a primary infection with CMV typically presents asymptomatically or with mild flu-like symptoms. The situation becomes problematic when the virus is transmitted across the placenta to the child (congenital CMV infection). This can lead to severe complications, especially in the first and second trimesters.

The possible consequences of congenital CMV infection range from mild symptoms to severe disabilities. Approximately 10-15% of infected newborns show symptoms at birth. Even apparently healthy babies may later develop delayed consequences such as hearing loss or developmental disorders.

CMV is transmitted through bodily fluids such as saliva, urine, tears, breast milk, or genital secretions. Young children, who frequently carry the virus, represent a significant source of infection. Pregnant women who have close contact with young children are therefore particularly at risk. Due to this, pregnant women should pay particular attention to careful hygiene when handling small children.

Congenital CMV infection means that an unborn child becomes infected with the cytomegalovirus (CMV) during pregnancy. This occurs when the mother contracts the virus for the first time during pregnancy or when a previous infection becomes active again. While it is usually harmless for healthy adults, it can have serious consequences for unborn babies.

Not all affected newborns show symptoms immediately. Some are born healthy and develop problems later, while others display visible signs or developmental disorders from birth. The manifestation and severity of the disease can therefore vary significantly.

In the prevention of cytomegalovirus (CMV), the focus is on various preventive measures and regular health checks, especially for high-risk groups. Pregnant women and immunosuppressed individuals benefit from close monitoring to detect infection early and avoid possible complications.

Immunocompromised individuals, such as organ transplant recipients, cancer patients undergoing chemotherapy, or HIV-infected individuals, have a particularly high risk of severe courses of CMV infection. Prevention plays a crucial role in avoiding complications.

An important measure is antiviral prophylaxis, which is particularly used after transplantations to counteract CMV reactivation or disease. Antiviral medications such as ganciclovir or valganciclovir are commonly used for this purpose.

Furthermore, regular check-ups are essential. Through frequent laboratory tests, for example using PCR testing for CMV DNA in the blood, an infection can be detected and treated early.

Additionally, immunoglobulin supplementation may be considered for certain high-risk patients. This therapy aims to support the immune system and reduce the risk of severe CMV disease.

Through these measures, the infection risk can be significantly reduced and the prognosis for immunocompromised patients improved.

Pregnant women who are not immunized should avoid CMV exposure. Consistent hygiene measures should be applied, especially when in contact with children. These include handwashing and avoiding contact with bodily fluids such as saliva, urine, and mucous secretions from children. Hands should be washed thoroughly after contact.
Another measure is testing for CMV infection, especially if risk factors are present.

CMV infection can cause long-term consequences not only in newborns and immunocompromised patients but also in healthy individuals. While the acute infection often remains unnoticed or presents with mild symptoms, certain risk groups may experience significant long-term effects that can considerably impair quality of life.

In newborns suffering from congenital CMV infection, the long-term consequences can have severe impacts. Even children who are asymptomatic at birth may later develop health impairments such as hearing loss, developmental delays, or cognitive deficits. Approximately 10-15% of infected newborns show symptoms that can appear years after birth. These include symptoms such as neurological damage and vision disorders.

Congenital and Perinatal Cytomegalovirus Infection (CMV) – Pediatrics – MSD Manual Professional Edition

In immunocompromised patients, such as those with HIV or organ transplant recipients, CMV infection can lead to severe long-term damage. The lungs are particularly frequently affected, which can lead to chronic respiratory problems and CMV pneumonia. Additionally, recurrent infections can occur, resulting in permanent organ damage, e.g., to the liver or gastrointestinal tract. If untreated, CMV infection in these patients can lead to serious complications and even death.

While most healthy adults do not experience long-term consequences after a CMV infection, in very rare cases, even immunocompetent individuals may develop long-term effects such as chronic fatigue, recurrent viral activation, or vision disorders. However, these long-term consequences are generally less severe and occur primarily in people with impaired immune function.

To provide you with a better understanding, we have compiled and answered the most common questions about Cytomegalovirus (CMV).

The information listed contains relevant topics and serves to improve understanding.