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Fever of unknown origin (FUO): CMV infectious mononucleosis or lymphoma? Eur J Clin Microbiol Infect Dis 2018; 37:1373-1376. [PMID: 29679253 DOI: 10.1007/s10096-018-3262-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 04/11/2018] [Indexed: 10/17/2022]
Abstract
Fever of unknown origin (FUO) refers to fevers of > 101 °F that persist for > 3 weeks and remain undiagnosed after a focused inpatient or outpatient workup. FUO may be due to infectious, malignant/neoplastic, rheumatic/inflammatory, or miscellaneous disorders. The FUO category determines the focus of the diagnostic workup. In the case presented of an FUO in a young woman, there were clinical findings of both CMV infectious mononucleosis or a lymphoma, e.g., highly elevated ESR, elevated ferritin levels, and elevated ACE level, β-2 microglobulins. The indium scan showed intense splenic uptake. Lymph node biopsy, PET scan, and flow cytometry were negative for lymphoma. CMV infectious mononucleosis was the diagnosis, and she made a slow recovery.
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Cunha BA, Sivarajah T, Jimada I. Sarcoidosis with fever and a splenic infarct due to CMV or lymphoma? Heart Lung 2017; 46:394-396. [PMID: 28705467 DOI: 10.1016/j.hrtlng.2017.05.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 05/04/2017] [Accepted: 05/22/2017] [Indexed: 10/19/2022]
Abstract
We present a case of an adult female with a past history of pulmonary sarcoidosis who presented with fever, night sweats, profound fatigue, and LUQ abdominal pain. Sarcoidosis is an afebrile disorder (excluding Lofgren's syndrome, Heerfordt's syndrome or neurosarcoidosis). Therefore, the presence of fever with sarcoidosis should suggest infection, usually viral, or lymphoma. Sarcoidosis-lymphoma syndrome describes the evolution of a lymphoma in long standing sarcoidosis. Fever aside, possible lymphoma is suggested by otherwise unexplained fever, pleural unilateral effusion, highly elevated ESR or ferritin levels. In this case, a viral etiology was suggested because of atypical lymphocytosis and mildly elevated transaminases. In this patient, CMV IgM titers and elevated CMV PCR viral load confirmed the diagnosis of CMV infectious mononucleosis with lung and liver involvement. In this case CMV infectious mononucleosis was accompanied by procoagulant activity which resulted a DVT, pulmonary emboli and splenic infarct. We believe this to be the first reported case of CMV infectious mononucleosis splenic infarct in a patient with a history of sarcoidosis.
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Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA.
| | - Thulashie Sivarajah
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA
| | - Ismail Jimada
- Infectious Disease Division, Winthrop-University Hospital, Mineola, NY, USA; State University of New York, School of Medicine, Stony Brook, NY, USA
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Cinel G, Pekcan S, Ozçelik U, Alp A, Yalçın E, Doğru Ersöz D, Kiper N. Cytomegalovirus infection in immunocompetent wheezy infants: the diagnostic value of CMV PCR in bronchoalveolar lavage fluid. J Clin Pharm Ther 2014; 39:399-403. [PMID: 25040449 DOI: 10.1111/jcpt.12169] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Accepted: 04/03/2014] [Indexed: 11/28/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVE Cytomegalovirus (CMV) pneumonitis in immunocompetent hosts is uncommon but is being recognized more frequently, particularly when presenting as severe viral pneumonia. The objective of this study was to examine lower respiratory tract CMV infection in immunocompetent wheezy infants, based on polymerase chain reaction (PCR) in bronchoalveolar lavage (BAL) fluid, to compare CMV PCR results in BAL and in blood samples and to evaluate the benefits of antiviral ganciclovir therapy in these patients. METHODS Retrospective review of the records of patients referred to our tertiary care hospital between January 2000 and July 2010 who had unexplained persistent wheezing and underwent fibreoptic flexible bronchoscopy (FFB). RESULTS AND DISCUSSION Fibreoptic flexible bronchoscopy was applied to 102 infants with persistent wheezing and diffuse interstitial infiltration on radiological investigations; so CMV PCR in BAL fluid was performed. CMV PCR in BAL fluid was positive in 51 patients. Retrospectively, we had access to the files of 25 of these patients. The mean CMV PCR in BAL fluid was 334 840 copies/mL. Only eight patients had CMV PCR positivity in their blood samples (mean: 2026·3 copies/mL). There was not a relationship between BAL and blood CMV PCR values based on Spearman's correlation analysis (r = -0·008). Fourteen patients had severe respiratory symptoms and received ganciclovir therapy. Twelve of them fully recovered. WHAT IS NEW AND CONCLUSION Bronchoalveolar lavage fluid CMV PCR was superior to blood CMV PCR in diagnosing lower respiratory tract infections caused by CMV in immunocompetent infants. Ganciclovir therapy may be effective in selected immunocompetent wheezy infants with CMV PCR positivity in BAL fluid.
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Affiliation(s)
- G Cinel
- Pediatric Pulmonology Department, Faculty of Medicine, Hacettepe University, İhsan Doğramacı Children's Hospital, Ankara, Turkey
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4
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Vandamme YM, Ducancelle A, Biere L, Viot N, Rouleau F, Delbos V, Abgueguen P. Myopericarditis complicated by pulmonary embolism in an immunocompetent patient with acute cytomegalovirus infection: a case report. BMC Res Notes 2014; 7:193. [PMID: 24678987 PMCID: PMC3999874 DOI: 10.1186/1756-0500-7-193] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2013] [Accepted: 03/04/2014] [Indexed: 12/25/2022] Open
Abstract
Background Primary acute cytomegalovirus infection in immunocompetent patients is common worldwide. Infection is most often asymptomatic or occurs sub-clinically with a self-limited mononucleosis-like syndrome. More rarely, the infection may lead to severe organ complications with pneumonia, myocarditis, pericarditis, colitis and hemolytic anemia. Recent cases of cytomegalovirus-associated thrombosis have also been reported sporadically in the medical literature. Case presentation We report here a case of simultaneous myopericarditis and pulmonary embolism in a 30-year-old man with no medical history. The patient was not immunocompromised. We discuss the possible role of acute cytomegalovirus infection in the induction of vascular damage and review relevant cases in the literature. Conclusion Thrombosis in patients with acute cytomegalovirus infection may be more frequent than is generally thought. Physicians need to be aware of the possible association between acute cytomegalovirus and thrombosis in immunocompetent patients, especially in the presence of severe systemic infection, as our case illustrates.
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Affiliation(s)
- Yves Marie Vandamme
- Department of Infectious Diseases and Internal Medicine, Centre Hospitalier Universitaire d'Angers, 4 rue Larrey, 49933 Angers, Cedex 9, France.
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5
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Cytomegalovirus pneumonia in immunocompetent host: case report and literature review. J Clin Virol 2012; 55:356-9. [PMID: 22975082 DOI: 10.1016/j.jcv.2012.08.010] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Revised: 08/10/2012] [Accepted: 08/12/2012] [Indexed: 11/21/2022]
Abstract
CMV infection is highly prevalent in general population and its clinical picture generally ranges from asymptomatic disease to mononucleosis-like syndrome. While severe life-threatening CMV disease is well documented in certain immunocompromised risk groups, severe infection with symptomatic pneumonia in immunocompetent hosts has been rarely documented. In this paper we describe a case of primary CMV infection, complicated by severe CMV pneumonia in an immunocompetent host, successfully treated with oral valganciclovir. Moreover, we reviewed CMV pneumonia cases in immunocompetent adults reported in the literature.
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6
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Cunha BA. Cytomegalovirus pneumonia: community-acquired pneumonia in immunocompetent hosts. Infect Dis Clin North Am 2010; 24:147-58. [PMID: 20171550 PMCID: PMC7126943 DOI: 10.1016/j.idc.2009.10.008] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Burke A Cunha
- Infectious Disease Division, Winthrop-University Hospital, 259 First Street, Mineola, Long Island, NY 11501, USA
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7
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Baskar JF, Smith PP, Nilaver G, Jupp RA, Hoffmann S, Peffer NJ, Tenney DJ, Colberg-Poley AM, Ghazal P, Nelson JA. The enhancer domain of the human cytomegalovirus major immediate-early promoter determines cell type-specific expression in transgenic mice. J Virol 1996; 70:3207-14. [PMID: 8627801 PMCID: PMC190184 DOI: 10.1128/jvi.70.5.3207-3214.1996] [Citation(s) in RCA: 137] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
The human cytomegalovirus (HCMV) major immediate-early promoter (MIEP) is one of the first promoters to activate upon infection. To examine HCMV MIEP tissue-specific expression, transgenic mice were established containing the lacZ gene regulated by the MIEP (nucleotides -670 to +54). In the transgenic mice, lacZ expression was demonstrated in 19 of 29 tissues tested by histochemical and immunochemical analyses. These tissues included brain, eye, spinal cord, esophagus, stomach, pancreas, kidney, bladder, testis, ovary, spleen, salivary gland, thymus, bone marrow, skin, cartilage, and cardiac, striated and smooth muscles. Although expression was observed in multiple organs, promoter activity was restricted to specific cell types. The cell types which demonstrated HCMV MIEP expression included retinal cells of the eye, ductile cells of the salivary gland, exocrine cells of the pancreas, mucosal cells of the stomach and intestine, neuronal cells of the brain, muscle fibers, thecal cells of the corpus luteum, and Leydig and sperm cells of the testis. These observations indicate that the HCMV MIEP is not a pan-specific promoter and that the majority of expressing tissues correlate with tissues naturally infected by the virus in the human host.
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Affiliation(s)
- J F Baskar
- Department of Molecular Microbiology and Immunology, School of Medicine, Oregon Health Sciences University, Portland 97201, USA
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Plachter B, Sinzger C, Jahn G. Cell types involved in replication and distribution of human cytomegalovirus. Adv Virus Res 1996; 46:195-261. [PMID: 8824701 DOI: 10.1016/s0065-3527(08)60073-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
As the number of patients suffering from severe HCMV infections has steadily increased, there is a growing need to understand the molecular mechanisms by which the virus causes disease. The factors that control infection at one time and the events leading to virus multiplication at another time are only beginning to be understood. The interaction of HCMV with different host cells is one key for elucidating these processes. Through modern techniques, much has been learned about the biology of HCMV infections in culture systems. In addition to endothelial cells, epithelial cells, and smooth muscle cells, fibroblasts are one cell population preferentially infected in solid tissues in vivo. From these sites of multiplication, the virus may be carried by peripheral monocytes and circulating endothelial cells to reach distant sites of the body. This would explain the multiorgan involvement in acute HCMV infection and the modes of viral transmission. From what has been learned mainly from human fibroblast culture systems, future studies will focus on how HCMV regulates the expression of its putative 200 genes in different host cells at different stages of cell differentiation and activation to result in viral latency and pathogenesis.
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Affiliation(s)
- B Plachter
- Institut für Klinische und Molekulare Virologie, Universität Erlangen-Nürnberg, Germany
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Adachi N, Kiwaki K, Tsuchiya H, Migita M, Yoshimoto T, Matsuda I. Fatal cytomegalovirus myocarditis in a seronegative ALL patient. ACTA PAEDIATRICA JAPONICA : OVERSEAS EDITION 1995; 37:211-6. [PMID: 7793259 DOI: 10.1111/j.1442-200x.1995.tb03301.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Fatal cytomegalovirus (CMV) myocarditis occurred in a 2 year old boy with acute lymphoblastic leukemia (ALL) in remission. The patient showed mild hepatic dysfunction and a rapid progress of pancytopenia after complete remission had been achieved. At the fifth week of complete remission, he presented signs of heart failure such as tachycardia, S4 gallop on auscultation and decreased ejection fraction on echocardiography. However, no significant electrocardiographic changes were recognized. In addition to the cardiac dysfunction, the patient presented a marked tachypnea and dyspnea associated with hypoxemia. These were dramatically improved by methylprednisolone pulse therapy (30 mg/kg per day, for 3 days) and CMV high titer immunoglobulin (400 mg/kg per day, for 3 days). On the sixth day after signs of respiratory failure were improved, the patient suddenly presented a paroxysmal atrial tachycardia followed by a fatal ventricular fibrillation. Although we could detect neither a specific IgM antibody, a significant increase of IgG antibody, nor CMV genome by DNA hybridization techniques during the course of the illness, microscopic examination of necropsy specimens of the heart showed a marked disruption and disintegration of muscle bands associated with cytomegalic inclusion bodies. Polymerase chain reaction (PCR) yielded a 305 bp amplification product in the heart and lung tissues, supporting the view that myocarditis was caused by CMV.
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Affiliation(s)
- N Adachi
- Department of Pediatrics, Kumamoto University School of Medicine, Japan
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Studahl M, Ricksten A, Sandberg T, Elowson S, Herner S, Säll C, Bergström T. Cytomegalovirus infection of the CNS in non-compromised patients. Acta Neurol Scand 1994; 89:451-7. [PMID: 7976234 DOI: 10.1111/j.1600-0404.1994.tb02665.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Six non-compromised patients with cytomegalovirus (CMV) associated meningoencephalitis are described. CMV was isolated from the cerebrospinal fluid (CSF) in 2/4 cases, while the diagnosis was based on an 8-fold rise in CMV-specific serum IgG antibodies and intrathecal antibody production against CMV in one case. By the polymerase chain reaction (PCR) CMV DNA was detected in the CSF in 5/5 cases and in serum in 3/4 cases. In one patient who had an Influenza A infection, both CMV and Epstein-Barr virus DNA were detected by PCR in the CSF. In 4 patients possible triggering events could be identified. Symptoms and signs indicating a multifocal brain involvement were present in 4 patients. The outcome was generally favourable except for sequelae in form of slight dysphasia in one case.
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Affiliation(s)
- M Studahl
- Department of Infectious Diseases, University of Gothenburg, Sweden
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Yoser SL, Forster DJ, Rao NA. Systemic viral infections and their retinal and choroidal manifestations. Surv Ophthalmol 1993; 37:313-52. [PMID: 8387231 DOI: 10.1016/0039-6257(93)90064-e] [Citation(s) in RCA: 79] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Viruses are one of the most common causes of infections involving the posterior segment of the eye. Such infections can occur either on a congenital or an acquired basis, and may affect primarily the retina or the choroid. Congenital cytomegalovirus (CMV) and rubella infections may result in retinitis. CMV retinitis is also the most common cause of acquired viral retinitis, primarily because of the acquired immunodeficiency syndrome (AIDS). Other types of viral retinitis, such as those caused by herpes simplex or herpes zoster, can occur in immunocompromised or immunocompetent individuals. Retinitis or choroiditis caused by viruses such as measles, influenza, Epstein-Barr virus, and Rift Valley fever virus, typically occurs subsequent to an acute viral systemic illness. The systemic and ocular manifestations, as well as the histopathology, laboratory tests, differential diagnoses, and treatment regimens for each of the individual viruses are discussed in detail.
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Affiliation(s)
- S L Yoser
- Doheny Eye Institute, University of Southern California School of Medicine, Los Angeles
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13
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Abstract
A 29-year-old man had a febrile illness accompanied by chest pain and tachycardia. The ECG suggested either myocarditis or acute ischemia. Heart muscle enzymes were normal, the peripheral blood count showed absolute and relative lymphocytosis, and an echocardiogram disclosed a small pericardial effusion. After defervescence, splenomegaly was noted and the SGPT level was elevated to four times normal. There was a greater than fourfold rise in titer of IgM antibodies to cytomegalovirus. This is only the second report in detail of perimyocarditis caused by cytomegalovirus mononucleosis. An interesting aspect of the case was an afebrile prodrome that lasted for more than one week, during which prostration, palpitations, and breathlessness on exertion were present and the sole physical finding was tachycardia.
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Affiliation(s)
- A Biton
- Department of Family Medicine, Ben-Gurion University of the Negev, Beersheba, Israel
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Begovac J, Soldo I, Presecki V. Cytomegalovirus mononucleosis in children compared with the infection in adults and with Epstein-Barr virus mononucleosis. J Infect 1988; 17:121-5. [PMID: 2846703 DOI: 10.1016/s0163-4453(88)91571-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We report clinical and laboratory findings in 11 previously healthy children with cytomegalovirus (CMV) mononucleosis and compare them with those of 18 adults with CMV mononucleosis and with those of 22 age-matched children with Epstein-Barr virus (EBV) mononucleosis. Exudative pharyngitis was more common in children whereas prolonged fever was more common in adults. Prominent lymphadenopathy and exudative pharyngitis, however, were less frequent in children with CMV mononucleosis than in those with EBV mononucleosis. Nevertheless, children with CMV mononucleosis are more likely to resemble those with EBV mononucleosis than adults with CMV mononucleosis.
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Affiliation(s)
- J Begovac
- University Hospital of Infectious Diseases, Dr Fran Mihaljević, Zagreb, Yugoslavia
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Baldwin S, Stagno S, Whitley R. Transfusion-associated viral infections. CURRENT PROBLEMS IN PEDIATRICS 1987; 17:391-443. [PMID: 2824131 DOI: 10.1016/0045-9380(87)90024-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Viral infections are a frequent occurrence following transfusion of blood products. While generally benign, these infections are capable of causing significant morbidity and mortality. Therefore, it is prudent to follow several general approaches diligently to reduce the risks of these infections in patients undergoing transfusions of blood products. These suggested measures include the following: 1. Prescribe and administer blood and blood products only when absolutely needed. 2. Use volunteer blood donors only. 3. Avoid use of pooled blood products when possible. 4. Use only blood and blood products that have been appropriately tested for HBsAg and HIV. 5. Use ALT determinations to screen blood products and eliminate those with high level. 6. Avoid the use of clotting-factor concentrates but, if necessary, use only those which have been heat-treated. 7. Limit use of leukocyte transfusion. 8. Use only CMV seronegative blood and blood products or frozen deglycerolized red cells in patients at high risk for posttransfusion CMV infection.
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Affiliation(s)
- S Baldwin
- Department of Pediatrics and Microbiology, University of Alabama, Birmingham School of Medicine
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Pannuti CS, Vilas Boas LS, Angelo MJ, Amato Neto V, Levi GC, de Mendonca JS, de Godoy CV. Cytomegalovirus mononucleosis in children and adults: differences in clinical presentation. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1985; 17:153-6. [PMID: 2992073 DOI: 10.3109/inf.1985.17.issue-2.05] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
In 2 previously healthy groups of 14 children and 17 adults with cytomegalovirus mononucleosis, significant clinical differences were observed. Cervical lymphadenopathy, hepatomegaly and lymphocytosis (greater than 5000/microliter) were more common in children and protracted fever more common in adults. Exudative tonsillitis indistinguishable from infectious mononucleosis was sometimes seen in children but never in adults.
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Abstract
A patient with dyspnea, skin rash, hypoxemia and mononucleosis was shown to have acute cytomegalovirus infection. The chest X-ray was normal, but the lung scan showed perfusion defects. Although pulmonary embolism cannot be ruled out, it seems likely that the CMV infection was responsible for the abnormalities observed.
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Baruch D, Bouvet E, Calamy G, Vachon F. Complications neurologiques de l'infection a cytomegalovirus (CMV) chez l'adulte sain. Med Mal Infect 1982. [DOI: 10.1016/s0399-077x(82)80135-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Koeppen AH, Lansing LS, Peng SK, Smith RS. Central nervous system vasculitis in cytomegalovirus infection. J Neurol Sci 1981; 51:395-410. [PMID: 6268757 DOI: 10.1016/0022-510x(81)90117-9] [Citation(s) in RCA: 65] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
A 51-year-old man received cyclophosphamide, vincristine, procarbazine and prednisone in the treatment of a small-cell undifferentiated lymphoma. Two years later, he developed a rapidly progressive neurological syndrome characterized by a decline in alertness, deafness, blindness and paraplegia. Examination of his eyes revealed severe hemorrhagic chorioretinitis. Leg weakness was thought to be due to transverse myelopathy at a thoracic level. He had a grand mal convulsion and died from terminal bronchopneumonia. Autopsy examination of the eyes revealed sweeping destruction of the retina due to inclusion body chorioretinitis. The brain and spinal cord showed multiple small infarcts accounting for the deafness and paraplegia. The lesions were due to occlusive arteritis in gray and white matter. Veins were also involved. Tissue surrounding the foci of necrosis contained cells with intranuclear an intracytoplasmic inclusion bodies. Some of the Cowdry type A inclusion bodies were large, measuring 30 micrometer in diameter and were located in enlarged cells. Electron microscopy of retina and brain tissue disclosed virus particles compatible with cytomegalovirus. The subject of cerebral and ocular angiitis due to herpes virus infections is reviewed.
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Granström M, Linde A, Wahren B. Antibody response to cytomegalovirus: a comparison between adult patients with neurological disease and uncomplicated infection. J Med Virol 1981; 7:127-34. [PMID: 6267187 DOI: 10.1002/jmv.1890070206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Cytomegalovirus (CMV) infection in adults can cause neurological diseases such as the Guillain--Barré syndrome (GBS) and myelitis. The mechanism leading to the development of neurological damage is, however, still unknown. We have investigated the possibility that an abnormal humoral immune response, either weak or hyperactive, could be the cause. The antibody response of four patients with a primary CMV followed by neurological symptoms was compared to that of four age-matched controls with an uncomplicated infection. IgG and IgM antibodies to CMV early antigens (EA), late antigens (LA), and IgG antibodies to CMV immediate early antigens (IEA) were measured in consecutive serum samples. Comparison of titers indicated a longer time lapse between the onset of CMV infection and the development of symptoms in the group with neurological disease. We found no conclusive evidence of an abnormal humoral immune response to CMV in the patients with neurological disease compared to the patients with an uncomplicated infection.
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Abstract
A male patient, aged 31 years, with a cytomegalovirus (CMV) myocarditis is described, who showed a high IgM antibody titer for cytomegalovirus infection of 1:1,024 and a rise of the titer for complement-fixing antibody from 1:< 16 to 1:256. CMV could be isolated from the urine. Investigations for other etiological factors were negative, and we assumed a connection between the cytomegalovirus infection and the myocardial involvement.
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Abstract
An extensive literature survey was performed and hospital records were reviewed in order to identify cases of fever of undetermined origin in patients aged 65 or older. Analysis of the 111 cases discovered demonstrates a characteristic but not unique spectrum of underlying disorders. Potentially curable entities such as abdominal abscess, bacterial endocarditis, tuberculosis and giant-cell arteritis account for more than half of the serious illnesses presenting with prolonged pyrexia in elderly subjects. A diagnostic approach to the management of the persistently febrile geriatric patient is discussed.
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Bäck E, Höglund C, Malmlund HO. Cytomegalovirus infection associated with severe encephalitis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1977; 9:141-3. [PMID: 197592 DOI: 10.3109/inf.1977.9.issue-2.17] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
A previously healthy 37-year-old woman had a 5-week febrile disease starting 10 days after delivery, which was complicated by disseminated intravascular coagulation and treated with fresh blood transfusions. She developed severe encephalitis with coma. She also had signs of perimyocarditis and enlargement of liver and lymph nodes. The encephalitis was completely reversible. There was a 16-fold rise in complement-fixing antibodies against cytomegalovirus.
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Abstract
A case of cytomegalovirus mononucleosis with myocarditis as the major presenting clinical manifestation is described. The rarity of symptomatic myocarditis in this condition is discussed.
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Spencer ES. Clinical aspects of cytomegalovirus infection in kidney-graft recipients. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1974; 6:315-23. [PMID: 4375300 DOI: 10.3109/inf.1974.6.issue-4.04] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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30
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Klemola E, Stenström R, von Essen R. Pneumonia as a clinical manifestation of cytomegalovirus infection in previously healthy adults. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1972; 4:7-10. [PMID: 4336589 DOI: 10.3109/inf.1972.4.issue-1.02] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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31
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Waris E, Räsänen O, Kreus KE, Kreus R. Fatal cytomegalovirus disease in a previously healthy adult. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1972; 4:61-7. [PMID: 4336588 DOI: 10.3109/inf.1972.4.issue-1.13] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Tiula E, Leinikki P. Fatal cytomegalovirus infection in a previously healthy boy with myocarditis and consumption coagulopathy as presenting signs. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1972; 4:57-60. [PMID: 4336587 DOI: 10.3109/inf.1972.4.issue-1.12] [Citation(s) in RCA: 40] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Nordbring F, Johansson SG. IgM in cytomegalovirus mononucleosis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES 1971; 3:87-90. [PMID: 4329259 DOI: 10.3109/inf.1971.3.issue-1.17] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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