Published on: December 17, 2020
Samantha Isaacs, a mother of four, had a history of healthy pregnancies. She saw trouble brewing only two days after her youngest son was born, however, when he failed a newborn hearing test in the hospital. She was first told he might have fluid in his ears following a C-section, but months later, he was diagnosed with congenital cytomegalovirus, or CMV.
“We know that probably the most common way mothers get CMV is from their own children. How do you get it from your children? It can be from exposure to things like saliva,” states Dr. Kenneth Alexander, Chief of Infectious Diseases at Nemours Children’s Hospital. It can also be picked up like the common cold, or from contact with children’s bodily fluids.
CMV is a viral infection that can affect one part of the body, such as the eyes, or spread elsewhere throughout the carrier. Sadly, it is difficult to detect by symptoms alone. If you are pregnant or plan to become pregnant, it is important to get blood tests and screen for the virus as part of neonatal care, as well as screen your newborn for the virus.
As for Samantha, her son was left with a brain malformation and hearing loss. One in every 150 babies is born with congenital CMV. While the damage caused is permanent, there are treatments available to keep it from getting worse. Ultimately, education is the key to prevention.
What is Cytomegalovirus?
CMV is a very common, but often unknown, virus which infects anywhere from 50 to 80% of American adults by the age of 40. One in three children are infected by the age of five, at which time they are the most contagious carriers of the disease. Yet, according to the National CMV Foundation, only as few as 9% of women have ever heard of it!
In most healthy individuals, the symptoms of CMV can be mild and comparable to a cold or flu-like illness, with muscle aches, sore throat, or fever. It is often mistaken for mononucleosis. Once a person is infected, CMV remains in the body for life, potentially reactivating with stress or suppression of the immune system.
CMV can be potentially serious in some people and detected early by recognizing some of its symptoms, including:
- Retinitis — This involved inflammation of the light-sensitive portion of the retina. What CMV does is infect and kill the cells in the eyes and cause massive inflammation. This can lead to ailments such as blurry vision, floaters in the eyes, light flashes, blind spots, and eventually can lead to blindness. Two thirds of people who are diagnosed with retinitis usually have CMV in at least one eye, two if left untreated.
- Esophagitis — CMV can affect the esophagus and can cause fever, swelling, nausea,
swollen lymph nodes, and difficulty swallowing.
- Colitis — When the colon gets infected by the disease, it can cause fever, diarrhea, weight loss, pain in the abdomen, and general feeling of being unwell.
- Diseases of the central nervous system — CMV can infect the brain and spinal cord causing confusion, fatigue, fever, seizures, weakness and numbness in the legs, and loss of bowel and bladder control.
- Pneumonia — If CMV infects the lungs, it can cause pneumonia.
Who is Most at Risk?
Those who have a weakened immune system are more at risk of experiencing more severe complications of the infection. The weakened immune system can be caused by long term use of drugs that suppress the immune system, cancer or receiving a bone marrow or organ transplant. Before today’s HIV treatments, many patients with HIV would develop CMV disease as their immune systems were much more vulnerable.
HIV patients most at risk should be cautious about the following:
- Have a CD4 count below 50 cell/mm3
- Have a viral load over 100,000 copies/ml
- Are not taking or do not respond to ART
- Have previously had CMV or other life-threatening infections
For women who are pregnant or wish to become pregnant, it can be highly beneficial to talk to their doctor about CMV and get tested. Women infected for the first-time during pregnancy are especially likely to transmit CMV to their fetuses. A simple blood test can reveal their exposure and risk. While CMV is not entirely preventable, there are steps which can be taken to minimize its damage should the worst occur.
Cytomegalovirus Treatment and Prevention
Generally, treatment for mild cases of cytomegalovirus / CMV is not needed. For more serious infections, treatments can include oral or IV medication or injection directly into the eye. A laser treatment can also be done that focuses on the retina.
Another important way to treat CMV if HIV is also present, is by taking highly active antiretroviral therapy that can boost the immune system and strengthen it. This will help the immune system control CMV.
There are methods of prevention that can easily be implemented into daily life, including:
- Wash your hands regularly with soap and water.
- Avoid kissing young children as there may be contact with saliva or tears.
- Do not share drinks or utensils that may be in contact with another’s saliva.
- Carefully dispose of diapers
- Practice safe sexual intercourse by wearing a condom to limit interaction with fluids
Many people are carriers of the disease without showing any symptoms, and can pass it others unknowingly, so it is best to err on the side of caution.
Cytomegalovirus United States Statistics
Among the United States population ages 12–49, the force of infection was 1.6 infections per 100 susceptible persons per year. The average infected person transmits CMV to nearly two susceptible people. The average age of CMV infection was 28.6 years.
Based on these CMV incidence estimates, approximately 27,000 new CMV infections occur among seronegative pregnant women in the United States each year. The USA has a 51-65% prevalence rate for those in the 16–50 year age range in comparison to other countries, including:
- Canada (66%-80%)
- Russia (81%-90%)
- Australia (66%-80%)
While this bodes well for expectant American mothers and the immunocompromised, this lowered rate of infection can be attributed to good societal hygiene and a consistent standard of high-quality neonatal care.
It is important to maintain good habits and be aware of the risks, both posed to you and to others. Keeping the public educated about CMV not only improves overall health, but it can save lives and prevent suffering.
Cytomegalovirus in Tampa | Infectious Disease Associates of Tampa Bay
Infectious Disease Associates of Tampa Bay (IDATB) is dedicated to providing world class health care to our patients in the Tampa, FL metro area. If you are feeling unwell or have noticed any of the above symptoms, then please feel free to contact us at 813-251-8444.