Treatments,symptoms of cytomegalovirus and how to prevent

What is Cytomegalovirus virus?

Cytomegalovirus (CMV) is a common virus that belongs to the herpes family of viruses. 

It's spread through bodily fluids, such as saliva and urine, and can be passed on through close contact with young children, such as when changing nappies.

CMV can also be passed on through kissing, having sex, or receiving an infected organ during an organ transplant

Causes of cytomegalovirus (CMV) 

Infection with cytomegalovirus (CMV) is mainly caused by close physical contact.

CMV is a common virus that is related to the viruses that cause chickenpox  and glandular fever. 

How CMV is spread

CMV is primarily spread through bodily fluids, including:

saliva
semen
blood
urine
vaginal fluids
breast milk

You can become infected by touching surfaces that are contaminated with saliva or urine, and then touching the inside of your nose or mouth. CMV can also be spread during kissing or sexual intercourse.

Most CMV infections occur in early childhood. The infection can spread rapidly in places where young children spend time in close contact with each other, such as day care centres and nurseries.

By the time a child is old enough to attend, their immune system should be strong enough to deal with an infection.  However, they can take CMV home to their mother, who may be pregnant.

If you experience symptoms of a CMV infection, they should pass quickly. If you're healthy, the virus will lie dormant (inactive) in your body's cells for the rest of your life.

Active CMV

CMV can be a problem for people who have a severely weakened immune system, leading to the virus infecting the body's organs.

Your immune system may become weakened if you:

have HIV that's not currently being treated 

have been taking oral steroid tablets for more than three months, or other types of high-dose steroids or immunosuppressants

Are taking medication needed for a transplant 

Active CMV frequently occurs after a person has had an organ transplant or a bone marrow transplant.

CMV and breastfeeding

CMV can be passed from a mother to her child through breast milk. However, the benefits of breastfeeding your baby far outweigh any risk from CMV.

The one exception is if a child is born prematurely. The immune system of premature babies is often not strong enough to deal with a CMV infection. Your treatment team will advise you on the best way to feed your premature baby.

Congenital CMV

Congenital CMV is where a mother passes a CMV infection on to her unborn baby.

Some cases occur when a pregnant woman is infected by CMV for the first time during, or shortly before, pregnancy (a primary infection). In around 3 out of 10 cases, the baby will also be infected.

In some cases, a previously inactive CMV infection can recur during pregnancy. The mother could also be reinfected with another strain of the CMV virus, which can be passed to her unborn baby.

In the majority of cases, the virus doesn't harm the baby. However, in severe cases, it can interfere with the baby’s normal development, resulting in the associated disabilities and symptoms of cmv

Symptoms of cytomegalovirus (CMV) 

Most cases of CMV don't cause any symptoms and you may not even realise you're infected. 

If you do experience symptoms, they'll be similar to flu symptoms or symptoms of glandular fever. They can include:

•A high temperature of 38C (100.4F) or above
•Extreme tiredness
•Sore throat
•Swollen glands
•Muscle and joint pain
•Loss of appetite
•Hepatitis (inflammation of the liver) 

These symptoms will usually last for a couple of weeks.

If CMV recurs in someone who's otherwise healthy, including during pregnancy, it will cause few, if any, symptoms.

Weakened immune system

Active CMV infection in someone with a weakened immune system can cause a wide range of symptoms, including:

•A high temperature
•Diarrhoea
•Shortness of breath
•Visual problems – such as blind spots, blurring and floaters
•Pneumonia (lung infection)
•Retinitis – inflammation of the retina (the light-sensitive layer of tissue at the back of the eye)
•Hepatitis 

These symptoms occur because the virus can quickly spread throughout the body, damaging one or more organs, particularly the digestive system, lungs and eyes.

Contact your GP or treatment team immediately if you have one or more of the above symptoms and your immune system is weakened by HIV or organ transplantation.

Congenital CMV

Around 13% of babies born with congenital CMV will have symptoms at birth. A similar number of babies who don't have symptoms at birth will develop problems at a later stage.

Symptoms at birth

Symptoms of congenital CMV at birth can include:

•Jaundice (yellowing of the skin and whites of the eyes)

•Pneumonia

•A rash consisting of small, purplish spots

•An enlarged liver and spleen

•Low birth weight

•Seizures (fits)

•Small head 

Some of these symptoms can be treated, but some babies will develop long-term conditions as a result of the infection.

Long-term problems

A small proportion of babies with congenital CMV (including those with no symptoms at birth) will develop one or more physical or mental problems at a later stage. These can include:

•Hearing loss (see below)

•Visual  impairment or blindness

•learning difficulties

•Dyspraxia (lack of physical co-ordination)

•Epilepsy

CMV infection is responsible for around 25% of cases of hearing loss during childhood.

Hearing loss caused by congenital CMV may develop during the first few years of life. This usually gets worse over time. It can also be permanent and range from mild to total.

The hearing problems can affect either one or both ears. Children with hearing loss in both ears are also likely to experience difficulties with speech and communication as they get older.

For lifelong protection against CMV disease, the patient must develop a specific anti-CMV immune response.

Treatment
•Painkiller's such as paracetamol or  ibuprofen then antivirals

•Ganciclovir treatment.

•Valganciclovir.

•Ganciclovir prophylaxis.

•Foscarnet.

•Acyclovir prophylaxis.

•Cidofovir prophylaxis.

•Maribavir.

•Leflunomide.

Preventing cytomegalovirus (CMV) 

It's not always possible to prevent a cytomegalovirus (CMV) infection, but there are steps you can take to reduce the risk.

Most people don't worry about  preventing CMV, because it doesn't often cause symptoms. However, you should be careful if you're at increased risk of developing more serious problems or if you're planning a pregnancy.

Newborn babies, pregnant women, people receiving an organ transplant and people with a weakened immune system have an increased risk of developing serious problems.

A person donating an organ will be screened for CMV before or at the time of the organ transplant.

Good hygiene

Maintaining high levels of hygiene is a simple measure that may help prevent a CMV infection spreading. For example, always wash your hands with soap and warm water:

•Before preparing, serving or eating food

•After going to the toilet

•After changing a baby’s nappy

•After coming into contact with bodily fluids, such as semen or urine

You should clean any surfaces that have come into contact with bodily fluids, and wear disposable gloves while doing this.

Pregnant women

CMV infections are common in young children. If you're pregnant, you can reduce your risk of becoming infected by taking some simple measures, such as:

regularly washing your hands with soap and hot water, particularly if you've been changing nappies, or you work in a nursery or day care centre

not kissing young children on the face; it's better to kiss them on the head or give them a hug

not sharing food or eating utensils with young children, or drinking from the same glass as them

These precautions are particularly important if your job brings you into close contact with young children. If it does, you can have a blood test to find out whether you've previously been infected with CMV.

CMV is particularly dangerous to the baby if the pregnant mother hasn't had a previous CMV infection. However, all pregnant women should follow the hygiene precautions above to reduce their risk of infection, even if they've had CMV before, because they could be infected with a different strain of the virus.

Organ transplants

CMV used to be one of the main causes of illness and death during the first six months after having an organ transplant. However, antiviral medicines have proved very effective in preventing CMV infections in people who've received transplants.

Therefore, it's likely that you'll be given antiviral medicines to help prevent a CMV infection developing into a problem if you're having an organ transplant.

Weakened immune system 

Your immune system may be weakened if you have HIV, or you're taking medication to prevent a transplanted organ being rejected. The immune system is the body's natural defence against illness and infection. If it's weakened, you'll be more vulnerable to infections, including CMV.

As well as maintaining a high level of hygiene, you can help prevent infections developing by:

having daily showers or baths, and washing your clothes, towels and bed linen regularly 

avoiding contact with people who have serious infections, such as chickenpox  or flu

taking extra care not to cut or graze your skin (if you do, clean the area thoroughly with warm water, dry it and cover it with a sterile dressing)

eating a healthy, balanced diet that includes plenty of fresh fruit and vegetables

resting when you need to asking your friends and relatives to make sure their flu vaccines, MMR vaccines and chickenpox vaccines are up-to-date before they visit you 

Contact your GP if you have a weakened immune system and you think you may have an infection – for example, if you have a high temperature of 38C (100.4F) or above.

Vaccination

Research is currently underway to find vaccines for CMV. 

One possible vaccine is aimed at young women. The theory is that vaccinating women before they become pregnant could reduce the risk of congenital CMV.

Another possible vaccine is aimed at toddlers. By reducing their chance of getting active CMV, their mothers may be protected from CMV during pregnancy.

A third possible vaccine is aimed at people having organ transplants. The aim is to prevent the donated organ causing a new CMV infection or reactivating an existing CMV infection in the person receiving the transplant.

However, because of the stringent safety checks that all new medicines and vaccinations have to go through, it's likely to be several years before routine vaccinations against CMV are available.

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