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Cytomegalovirus Infection (CMV)
- Transmitted by direct contact – During birthing process, sexual contact
- Virus may shed without any symptoms and is found in urine, saliva, blood, tears, semen and breast milk
- One of the TORCH infections (Toxoplasmosis, Rubella, CMV, Herpes)
- May remain latent in the body for long periods of time
- Human herpes type 5
- Viral infection may be very serious in the immunocompromised
- Causes mononucleosis without a sore throat (T -Cells have only one nucleus and are enlarged with this infection)
Clinical Presentation
- Most commonly there are no symptoms
- Fever
- Loss of appetite
- Enlarged lymph nodes
- Muscle aches
- Fatigue
- Diarrhea
- Ulcers in the digestive tract, possible causing bleeding
- Hepatitis
- Encephalitis – inflammation of the brain
- Behavioral changes
Neonatal signs and symptoms
- Jaundice
- Purple skin splotches or a rash or both
- Low birth weight
- Seizures
- Enlarged spleen and poorly functioning liver
- Pneumonia
Diagnosis
- Culture is possible but very difficult
- Tissue biopsy with H&E stain will show owl eye inclusion bodies — (The only other place you are likely to see owl eye’s is in Reed-Sternberg cells in Hodgkin’s lymphoma and they are referring to the entire nucleus not to inclusion bodies)
- PCR may be used on body fluids
- Antibody serology is also used
Treatment
- Typically no treatment is necessary other than supportive care
- Medication – Antivirals
- Ganciclovir
- Valganciclovir
- Foscarnet
- Cidofovir
- CMV immunoglobulin
Epstein-Barr
- Human herpesvirus 4 (HHV-4),
- Types of infection:
- Infectious mononucleosis with a sore throat (T -Cells have only one nucleus and are enlarged with this infection)
- Nasopharyngeal carcinoma
- Burkitt’s lymphoma (Epstein Barr virus found in 100% of patients)
- Mode of transmission: direct contact
Clinical Presentation
- Fever
- Sore throat
- Significant fatigue that may last for weeks
- Swollen lymph nodes
- Lack of appetite
- Rash
- Weakness and sore muscles
Physical exam findings
- Think Strep throat +
- Lymphadenopathy. Strep is anterior chain, mono is Anterior posterior and cervical
- Exudative pharyngitis
- Enlarged spleen
Diagnosis
- Heterophil antibody test (Monospot)
- False positives and negatives may occur
- Retest a few weeks later to confirm results if necessary
- EBV Antibody test
- The presence of EBV IgM indicates acute infection
Treatment
- Supportive care
- Painkillers relieve body aches
- Acetaminophen
- Ibuprofen
- Hydration
Herpes Simplex Types 1 & 2
- Transmitted through direct contact. Transmission may occur without any visual signs of disease.
- Skin infection, eye infection, Central nervous System infection
- HSV type 1 – oral herpes – cold sore
- HSV type 2 – genital herpes
- Virus becomes latent within a neuron and is never fully cleared
- Causes of reactivation
- Overexposure to sunlight
- Illness
- Stress
- Immunosuppression
Clinical Presentation
- Fluid filled blisters
- Tingling itching and burning occurs before blisters appear
- Flu like symptoms
- Fever
- Muscle aches
- Swollen glands
- Genital herpes may cause painful or difficult urination
- Severe conjunctivitis
Labs, Studies and Physical Exam Findings
- Blisters typically around mouth (vermillion border) or genitals
- Tzanck test – multinucleated giant cells
- PCR
- Slit lamp examination with fluorescein stain for suspected eye infection
- Dendritic lesion is diagnostic
Treatment
- Prevention
- Barrier protection for sex
- Antivirals oral and topical
- Acyclovir
- Valaciclovir
- Famciclovir
Influenza
- Influenza virus is an RNA virus in the Orthomyxoviridae family
- Three subtypes
- Influenza A
- Aquatic birds are the natural host
- Most virulent type
- Spanish Flu, Asian Flu, Bird Flu
- Influenza B
- Humans are the natural host
- Slower mutating than Influenza A
- Influenza C
- Infects dogs and pigs
- Influenza A
- Airborne transmission
- Children < 5 and adults > 65 are at risk for significant complications
Clinical Presentation
- Fever
- Aching muscles and joints
- Sore throat
- Chills and sweats
- Headache
- Photophobia
- Congestion
- Fatigue / weakness
Labs, Studies and Physical Exam Findings
- Clinical assessment
- Rapid influenza diagnostic tests (RIDTs)
- Throat swab or nasal secretions with PCR
- Viral culture
- Gold standard – but not helpful for treatment because it take about a week to get results.
- Used to identify different strains of the Flu
- Pulse oximetry
- Chest x-ray
Treatment
- Yearly vaccination for everyone > 6 months old
- Supportive care
- Bedrest
- Neuraminidase inhibitors (stop release of virus from cells)
- Oseltamivir (Tamiflu) can be used in children > 12
- Zanamivir – (Relenza) can be used in children > 7
