Acute cytomegalovirus (CMV) infection

• Alternative Names

  CMV mononucleosis; Cytomegalovirus (CMV)

• Causes, incidence, and risk factors

  Mononucleosis can be caused by several different viruses and a few types of bacteria. Unlike the more common form of mononucleosis, caused by the Epstein-Barr virus (EBV), acute CMV infection is caused by cytomegalovirus.

  In most people with a normal immune system, CMV infection does not cause any symptoms. But some people with this infection develop a "mononucleosis syndrome."

  The infection is spread by:

  • Blood transfusions
  • Respiratory droplets
  • Saliva
  • Sexual contact
  • Urine

  Some young children release the virus in their urine for a long period of time, even when they do not have symptoms. CMV infection may occur at any age. It most commonly develops between ages 10 - 35.

  Most people are exposed to CMV early in life and do not realize it because they have no symptoms. People with a compromised immune system can have a more severe form of the disease.

• Symptoms
  • Enlarged lymph nodes, especially in the neck
  • Fever
  • Frequent tiredness or fatigue
  • Loss of appetite
  • Malaise
  • Muscle aches or stiffness
  • Rash
  • Sore throat

  Less common symptoms include:

  • Chest pain
  • Cough
  • Headache
  • Hives
  • Irregular heart rate
  • Jaundice
  • Neck stiffness
  • Rapid heart rate
  • Sensitivity to light
  • Shortness of breath
  • Swollen spleen
• Signs and tests

  Your health care provider will perform a physical exam and feel your belly area. The liver and spleen may be tender when they are gently pressed (palpated). There may be a skin rash.

  Special lab tests may be done to check for substances in your blood that are produced by CMV. This includes a CMV ELISA antibody test and CMV serum PCR test.

  Other tests include:

  • Blood tests for platelets and white blood cells
  • Chemistry panel
  • Monospot test
• Treatment

  Most patients recover in 4 - 6 weeks without medication. Rest is needed, sometimes for a month or longer to regain full activity levels. Painkillers and warm salt water gargles can help relieve symptoms.

  Antiviral medications are usually not used in people with normal immune function.

• Expectations (prognosis)

  Fever usually goes away in 10 days, and swollen lymph glands and spleen return to normal in 4 weeks. Fatigue may linger for 2 to 3 months.

• Complications

  Throat infection is the most common complication. Rare complications include:

  • Colitis
  • Guillain-Barré syndrome
  • Neurologic complications
  • Pericarditis or myocarditis
  • Pneumonia
  • Rupture of spleen
• Calling your health care provider

  Call for an appointment with your health care provider if you have symptoms of acute CMV infection.

  Go to the emergency room or call the local emergency number (such as 911) if you have sharp, sudden pain in your left upper abdomen. This could indicate a ruptured spleen, which requires emergency surgery.

• Prevention

  CMV infection can be contagious if the infected person comes in close or intimate contact with another person. You should avoid kissing and sexual contact with an infected person.

  The virus may also spread among young children in day care settings.

• References

  Crumpacker CS, Wadhwa S. Cytomegalovirus. In: Mandell GL, Bennett JE, Dolin R, eds. Principles and Practice of Infectious Diseases. 6th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2005: chap 134.

Review Date: 9/17/2008

Reviewed By: David C. Dugdale, III, MD, Professor of Medicine, Division of General Medicine, Department of Medicine. University of Washington School of Medicine; and Jatin M. Vyas, PhD, MD, Instructor in Medicine, Harvard Medical School, Assistant in Medicine, Division of Infectious Disease, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.