Research part 1 :Cytomegalovirus (CMV Virus)

Recently one of my kill time project is doing research on Cytomegalovirus (CMV virus), AABB require all the patient need to go for HIV, HTLV 1&2, Hepatitis B&C, VDRL, Syphilis & CMV screening. Among all the viruses, CMV is least that we know about it. When come to STD, people are familiar with HIV, Herpes & Syphilis, however a lot of people overlooked at CMV until the patient need to do transplantation or seriously ill.

Compare to Syphilis, the virus look less attractive. Personally I think Syphilis virus look more artistic.

In USA, 50%-85% adult are infected by this virus. To me this statistic is like "whole nation is doom". Because there is no antibody to prevent this virus. So my next question will be, how about in Malaysia? Do people ever wonder why some transplantation fails apart from just a reason “body rejection?” Why some pregnant lady died before or after giving birth? Why some kids had mental problem or serious illness? Well there must be lot of cause, any one of the contribution to the cause is this less attractive deathly CMV virus.
This virus can transmit to child before birth or/and most people are infected by it without knowing it.

Cytomegalovirus (from the Greek cyto-, "cell", and -megalo-, "large") is a viral genus of the Herpesviruses group: in humans it is commonly known as HCMV or Human Herpesvirus 5 (HHV-5).[1] CMV belongs to the Betaherpesvirinae subfamily of Herpesviridae, which also includes Roseolovirus.

Symptoms:

Most children and adults who are infected with CMV do not develop symptoms. Those who develop symptoms may experience an illness resembling infectious mononucleosis and have fever, swollen glands and feel tired.

People with a compromised immune system (such as AIDS patients or those receiving chemotherapy) may experience more serious illness involving fever, pneumonia and other symptoms.

Mode of transmission:
-From person to person
-Secretion or excretion (Urine, saliva, breast milk, cervical secretion, semen)
- From a donated organ
-Transfused blood
-Reactivation of a past infection

CMV infection can be associated with:
-Lower success rate in stem cell transplantation
-Organ rejection
-Cause illness such as pneumonia, hepatitis or death

Consequences of CMV infection can be devastating by causing disease or death in:
-Pregnant women
-Transplant patient
-Person with HIV
-Person with low immune system
-Person with cancer
-Baby -Generalized infection may occur in the infant, and can cause complications such as low birth weight, microcephaly, seizures, petechial rash similar to the "blueberry muffin" rash of congenital rubella syndrome, and moderate hepatosplenomegaly (with jaundice). Though severe cases can be fatal, with supportive treatment most infants with CMV disease will survive. However, from 80% to 90% will have complications within the first few years of life that may include hearing loss, vision impairment, and varying degrees of mental retardation.
Another 5% to 10% of infants who are infected but without symptoms at birth will subsequently have varying degrees of hearing and mental or coordination problems.

Baby with CMV retinitis

Baby with CMV Virus

Two types of IgM & IgG antibodies testing before send for RNA test (Total CMV DNA Assay) helps control the infection risk of these groups:
-Antibodies to CMV are evidence of a current or past infection
-It does not mean the person has lifetime immunity
-After infection usually they can stay hidden inside a person (latent)
-Can cause infection if the person’s immune system later weakens and antibody protection decreases due to the therapeutic drugs or disease

IgM
-IgM antibodies are the first to be produced by the body in response to a recent CMV infection.
- Present in most individuals within a week or two after the initial exposure.
- After several months, the level of CMV IgM antibody usually falls below detectible levels

IgG
-IgG antibodies are produced by the body several weeks after the initial CMV infection
-Levels of IgG rise during the active infection then stabilize as the CMV infection resolves and the virus becomes inactive
- A raised IgG indicates previous infection and does not mean the blood is infective.
Interpretation

Total CMV DNA Assay
-Using quantitative PCR to determine the total CMV DNA. We can perform this test if the IgM CMV is inconclusive.
-Less than 600 particles the person might be safe.
-More than 600 particles the person is CONFIRM to have the virus
YOU ARE GOING TO BE...................................................................…H.I.S.T.O.R.Y…….

What is the treatment for CMV infection?
In most cases, there is no treatment. An effective vaccine has not yet been developed.


Transmission of the virus is often preventable because it is most often transmitted through infected bodily fluids that come in contact with hands and then are absorbed through the nose or mouth of a susceptible person. Therefore, care should be taken when handling children and items like diapers. Simple hand washing with soap and water is effective in removing the virus from the hands.





Source References:


Mr Ooi Ghee Chien,


http://www.clinlabnavigator.com/Tests/CytomegalovirusAntibody.html


http://en.wikipedia.org/wiki/Cytomegalovirus

http://www.health.state.ny.us/diseases/communicable/cytomegalovirus/fact_sheet.htm