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Herpes VirusesHerpes Viruses

CytomegalovirusCytomegalovirus

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Presentation OutlinePresentation Outline

StructureStructureClassificationClassificationMultiplicationMultiplicationClinical manifestationsClinical manifestationsEpidemiologyEpidemiologyDiagnosisDiagnosisControlControl

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Latent InfectionsLatent Infections

ALLALL herpes viruses can establish latent herpes viruses can establish latent infections. The viral genome may become infections. The viral genome may become incorporated into the host DNA or remain incorporated into the host DNA or remain extrachromosomalextrachromosomal

Latent viruses can be reactivated by stress, Latent viruses can be reactivated by stress, menstruation or uv lightmenstruation or uv light

Reactivation may be asymptomatic or lead Reactivation may be asymptomatic or lead to mild or severe disease.to mild or severe disease.

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Herpes DiagnosisHerpes Diagnosis

Isolation of virus by tissue cultureIsolation of virus by tissue culture herpevirinae cause cytopathic effectsherpevirinae cause cytopathic effectsintranuclear fluorescence of scrapings using intranuclear fluorescence of scrapings using

fluorescent antibodiesfluorescent antibodiesPCR being developedPCR being developed

CMV retiniitis is diagnosed clinicallyCMV retiniitis is diagnosed clinically

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CytomegalovirusCytomegalovirus

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CytomegalovirusCytomegalovirus

Cytopathic effect on the host cell. The cell swells and a large inclusion body forms in the Cytopathic effect on the host cell. The cell swells and a large inclusion body forms in the nucleus.nucleus.

Transmission: Transmission: not highly infectious, virus found in saliva, urine and blood. not highly infectious, virus found in saliva, urine and blood. infants and children acquire CMV from other children.infants and children acquire CMV from other children.congenital. In utero, at birth during perinatal period.congenital. In utero, at birth during perinatal period.see clinical note in the textbook.see clinical note in the textbook.Clinical forms of Cytomegalovirus infectionClinical forms of Cytomegalovirus infectionCongenital:Congenital:the following possibilities relate to the congenital type.the following possibilities relate to the congenital type.severe deformities and death.severe deformities and death.survive with serious defects - physical and mental.survive with serious defects - physical and mental.survive with out deformities.survive with out deformities.newborns: - Enlarged liver and spleen, jaundice, capillary bleeding, microcephaly, ocular newborns: - Enlarged liver and spleen, jaundice, capillary bleeding, microcephaly, ocular

inflammation.inflammation.

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Disseminated cytomegalovirusDisseminated cytomegalovirus

Symptoms:Symptoms:fever, severe diarrhea, hepatitis, arthritis, pneumonia, high mortality.fever, severe diarrhea, hepatitis, arthritis, pneumonia, high mortality.activation of inapparent infection.activation of inapparent infection.also due to:also due to:

immunosuppressive therapy.immunosuppressive therapy. cancer.cancer. AIDS.AIDS.

Virus in blood or organ:Virus in blood or organ:post transfusion.post transfusion.post organ transplant.post organ transplant.Cytomegalovirus mononucleosis:Cytomegalovirus mononucleosis:teenage, young adult similar to other mono.teenage, young adult similar to other mono.

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Epidemiology of CMVEpidemiology of CMV

whereever human populations tested - high percentage (40-100%) were positive for whereever human populations tested - high percentage (40-100%) were positive for the antibodies.the antibodies.

newborns 7.5% positive in the USA & UK.newborns 7.5% positive in the USA & UK.woman of child bearing age were 20-100% positive in many countries that were woman of child bearing age were 20-100% positive in many countries that were

studied (pregnant - virus in the urine).studied (pregnant - virus in the urine).IV drug users were 100% positive for the antibodies.IV drug users were 100% positive for the antibodies.homosexual males were 30% positive for the antibodies - high percentage shed virus.homosexual males were 30% positive for the antibodies - high percentage shed virus.Transmission:Transmission:saliva, respiratory mucus, milk, urine, semen, cervical secretions, feces and saliva, respiratory mucus, milk, urine, semen, cervical secretions, feces and

lymphocytes.lymphocytes.Diagnosis:Diagnosis:the differential diagnosis in neonates must include toxoplasmosis, rubella, herpes the differential diagnosis in neonates must include toxoplasmosis, rubella, herpes

simplex, bacterial sepsis.simplex, bacterial sepsis.in adults it must be differentiated from Epstein-Barra and hepatitis A & B.in adults it must be differentiated from Epstein-Barra and hepatitis A & B.

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Cytomegalovirus - con’tCytomegalovirus - con’t

Laboratory diagnosis:Laboratory diagnosis:virus can be grown from all organs.virus can be grown from all organs.many serological tests.many serological tests.Treatment:Treatment:gancyclovir, foscarnet, hyperimmune CMV immunoglobulin, have some effect.gancyclovir, foscarnet, hyperimmune CMV immunoglobulin, have some effect.interferon does not prevent infection or promote recovery.interferon does not prevent infection or promote recovery.Prevention:Prevention:no animal can be found that can be infected with CMV.no animal can be found that can be infected with CMV.Two deterents:Two deterents:vaccine stimulated antibodies may not be protective. Patients already vaccine stimulated antibodies may not be protective. Patients already

seropositve can be reinfected.seropositve can be reinfected.a vaccine could be oncogenic.a vaccine could be oncogenic.

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EBV and burkitt’s lymphoma were shown to be the same virus when a lab technician acquired mononucleosis while working with the Burkitt’s lymphoma

virus.

EBV and burkitt’s lymphoma were shown to be the same virus when a lab technician acquired mononucleosis while working with the Burkitt’s lymphoma

virus.

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CytomegalovirusCytomegalovirus

Urine isolateUrine isolate

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Intranuclear inclusionsIntranuclear inclusions

The cell swells The cell swells and a large and a large inclusion body inclusion body forms in the forms in the nucleus.nucleus.

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CytomegalovirusCytomegalovirus

Nuclear & cytoplasmic inclusionsNuclear & cytoplasmic inclusions

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Transmission: CMV Transmission: CMV

not highly infectious, virus found in saliva, not highly infectious, virus found in saliva, urine and blood. urine and blood.

infants and children acquire CMV from infants and children acquire CMV from other children.other children.

congenital. In utero, at birth during congenital. In utero, at birth during perinatal period.perinatal period.

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Congenital: CMVCongenital: CMV

the following possibilities relate to the congenital the following possibilities relate to the congenital type.type.

severe deformities and death.severe deformities and death.survive with serious defects - physical and mental.survive with serious defects - physical and mental.survive with out deformities.survive with out deformities.newborns: - Enlarged liver and spleen, jaundice, newborns: - Enlarged liver and spleen, jaundice,

capillary bleeding, microcephaly, ocular capillary bleeding, microcephaly, ocular inflammation.inflammation.

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Disseminated cytomegalovirusDisseminated

cytomegalovirus

fever, severe diarrhea, hepatitis, arthritis, fever, severe diarrhea, hepatitis, arthritis, pneumonia, high mortality.pneumonia, high mortality.

activation of inapparent infection.activation of inapparent infection.also due to:also due to:

immunosuppressive therapy.immunosuppressive therapy. cancer.cancer. AIDSAIDS..

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Virus in blood or organ:Virus in blood or organ:

post transfusion.post transfusion.post organ transplant.post organ transplant.

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Cytomegalovirus mononucleosis:Cytomegalovirus mononucleosis:

teenage, young adult similar to other mono.teenage, young adult similar to other mono.

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Epidemiology of CMVEpidemiology of CMV high percentage (40-100%) were positive for the high percentage (40-100%) were positive for the

antibodies.antibodies.newborns 7.5% positive in the USA & UK.newborns 7.5% positive in the USA & UK.woman of child bearing age were 20-100% positive woman of child bearing age were 20-100% positive

in many countries that were studied (pregnant - in many countries that were studied (pregnant - virus in the urine).virus in the urine).

IV drug users were 100% positive for the IV drug users were 100% positive for the antibodies.antibodies.

homosexual males were 30% positive for the homosexual males were 30% positive for the antibodies - high percentage shed virus.antibodies - high percentage shed virus.

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Transmission:Transmission:

saliva, respiratory mucus, milk, urine, saliva, respiratory mucus, milk, urine, semen, cervical secretions, feces and semen, cervical secretions, feces and lymphocytes.lymphocytes.

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Differential Diagnosis:Differential Diagnosis:

the differential diagnosis in neonates must the differential diagnosis in neonates must include toxoplasmosis, rubella, herpes include toxoplasmosis, rubella, herpes simplex, bacterial sepsis.simplex, bacterial sepsis.

in adults it must be differentiated from in adults it must be differentiated from Epstein-Barra and hepatitis A & B.Epstein-Barra and hepatitis A & B.

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Laboratory diagnosis: CMVLaboratory diagnosis: CMV

virus can be grown from all organs.virus can be grown from all organs.many serological tests.many serological tests.

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Treatment: CMVTreatment: CMV

gancyclovir, foscarnet, hyperimmune CMV gancyclovir, foscarnet, hyperimmune CMV immunoglobulin, have some effect.immunoglobulin, have some effect.

interferon does not prevent infection or interferon does not prevent infection or promote recovery.promote recovery.

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Prevention:CMVPrevention:CMV

no animal can be found that can be infected no animal can be found that can be infected with CMV.with CMV.

Two deterents:Two deterents:vaccine stimulated antibodies may not be vaccine stimulated antibodies may not be

protective. Patients already seropositve can protective. Patients already seropositve can be reinfected.be reinfected.

a vaccine could be oncogenic.a vaccine could be oncogenic.