Sarepta shares that a teenager with Duchenne muscular dystrophy has passed away following treatment with ELEVIDYS. Sarepta stated that this sad event occurred due to acute liver failure (ALF) and that this was caused by cytomegalovirus (CMV) infection. What is Cytomegalovirus Infection (CMV)?
Learn more: Sarepta, Reports 16 Years Old Boy Death After Elevidys Gene Therapy Treatment
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What is Cytomegalovirus Infection (CMV)?
Cytomegalovirus (CMV) is a common virus that belongs to the herpesvirus family. It is widespread around the globe and infects people of all ages. In most cases, CMV infection is asymptomatic, and individuals may carry the virus without ever experiencing noticeable symptoms. However, the virus can cause serious health issues in certain populations, such as newborns, immunocompromised individuals, and pregnant women. Understanding the virus, its transmission, symptoms, complications, and treatments is essential for managing CMV infections effectively.
What is Cytomegalovirus (CMV)?
Cytomegalovirus (CMV) is a virus that typically remains dormant in the body after the initial infection. It is a member of the herpesvirus family, which includes other well-known viruses such as herpes simplex virus (HSV) and varicella-zoster virus (VZV), which causes chickenpox. CMV shares many similarities with other herpesviruses in that it can persist in the body for a person’s lifetime and can reactivate later, often when the immune system is weakened.
CMV infects a wide range of body tissues, including the salivary glands, eyes, lungs, liver, kidneys, and gastrointestinal tract. Once someone is infected with CMV, it stays in their body for life, typically in a dormant or latent state. The virus can reactivate under certain conditions, especially when the immune system is compromised, leading to new or recurrent symptoms.
How is CMV Transmitted?
Cytomegalovirus spreads primarily through bodily fluids. It can be transmitted through the following ways:
- Direct Contact with Infected Bodily Fluids:
- Saliva, urine, blood, breast milk, semen, and vaginal fluids are common carriers of CMV.
- For instance, CMV can be passed through kissing (especially in children and caregivers who have not been previously infected), sexual contact, organ transplantation, or blood transfusions.
- Mother-to-Child (Congenital CMV):
- CMV can be transmitted from a pregnant woman to her fetus through the placenta, during childbirth, or through breastfeeding. This is known as congenital CMV and can have severe effects on the newborn, including developmental delays, hearing loss, or vision problems.
- Organ Transplants and Blood Transfusions:
- CMV can be spread through organ transplants, as the virus can be transmitted in the donor’s organs. Similarly, the virus can be spread through blood transfusions.
- Close Personal Contact:
- CMV can be transmitted in daycare settings, especially among young children who shed the virus in their urine or saliva.
Who is at Risk of CMV Infection?
Most healthy individuals are not severely affected by CMV infection, and many do not even know they are infected. However, CMV can cause significant health issues in the following groups of people:
- Infants (Congenital CMV Infection):
- CMV can be passed from mother to baby during pregnancy (congenital CMV). In some cases, the virus causes no symptoms at birth, but it can lead to developmental issues or hearing and vision problems as the child grows.
- Congenital CMV is the leading cause of non-genetic hearing loss in infants.
- Immunocompromised Individuals:
- People with weakened immune systems, such as those undergoing chemotherapy, HIV/AIDS patients, organ transplant recipients, or individuals on immunosuppressive drugs, are more vulnerable to severe CMV infections.
- In these individuals, CMV can cause organ damage, pneumonia, retinitis (inflammation of the eye), and other complications.
- Pregnant Women:
- If a pregnant woman contracts CMV for the first time during pregnancy (primary CMV infection), there is a risk of transmitting the virus to the fetus. Although CMV infections during pregnancy are common, not all result in congenital infection. The risk of transmission is higher if the mother contracts the virus in the first trimester.
- Newborns:
- Infants born with CMV may experience serious health problems, such as developmental delay, cerebral palsy, seizures, vision problems, hearing loss, and growth restriction.
Symptoms of Cytomegalovirus Infection
In healthy individuals, CMV infection is typically mild or asymptomatic. When symptoms do appear, they can resemble those of other viral infections and may include:
- Fever
- Fatigue
- Swollen lymph nodes
- Sore throat
- Muscle aches
- Hepatitis (inflammation of the liver)
For most people, these symptoms resolve on their own and do not lead to long-term health problems. However, in immunocompromised individuals, CMV infection can result in more severe and life-threatening complications.
In cases of congenital CMV (when the baby is infected before birth), symptoms can be severe and include:
- Jaundice (yellowing of the skin and eyes)
- Small size at birth (growth restriction)
- Microcephaly (small head)
- Hearing loss
- Seizures
- Developmental delays
In immunocompromised individuals, CMV can lead to severe complications, such as:
- CMV retinitis: This condition can cause blindness if untreated, especially in people with HIV/AIDS.
- CMV pneumonia: A life-threatening lung infection that can occur in organ transplant recipients or HIV patients.
- CMV colitis or esophagitis: Inflammation of the intestines or esophagus, leading to symptoms like abdominal pain and difficulty swallowing.
Diagnosis of CMV Infection
CMV infection can be diagnosed through several methods, including:
- Blood Tests:
- The most common test to detect CMV is a blood test that measures the presence of antibodies (IgM or IgG) or CMV DNA through PCR (polymerase chain reaction). IgM antibodies indicate a recent infection, while IgG antibodies suggest past infection.
- Viral Cultures:
- CMV can also be cultured from blood, urine, or other bodily fluids. However, this method takes time and is less commonly used in clinical practice.
- Imaging Tests:
- In cases of CMV retinitis or other organ complications, imaging tests (like an eye examination or CT scans) may be used to identify damage caused by the virus.
- Amniocentesis:
- For pregnant women, amniocentesis (sampling of the amniotic fluid) can be done to test for CMV if there is concern that the virus has been transmitted to the fetus.
Treatment for Cytomegalovirus Infection
There is no cure for CMV infection, and in many cases, treatment is not necessary, especially in otherwise healthy individuals. However, antiviral medications can be used to manage severe infections, particularly in immunocompromised patients or those with congenital CMV.
- Antiviral Medications:
- Drugs such as ganciclovir, valganciclovir, foscarnet, and cidofovir are often used to treat CMV infections, especially in immunocompromised individuals.
- These drugs work by inhibiting the replication of the virus, but they may have side effects, including kidney toxicity.
- Supportive Care:
- In some cases, supportive care (such as hydration and fever management) is sufficient for mild infections.
- Prevention:
- For Pregnant Women: Pregnant women can take precautions, such as frequent handwashing, avoiding contact with young children’s saliva or urine, and minimizing exposure to people who are sick, to reduce the risk of contracting CMV.
- CMV Vaccine: Research into a CMV vaccine is ongoing, and a vaccine would be a potential tool for preventing CMV infections, particularly in pregnant women.
- Monitoring in Immunocompromised Patients:
- Immunocompromised patients, including organ transplant recipients, may be given antivirals as a preventive measure to avoid CMV reactivation.
Prevention of CMV
There are currently no vaccines available to prevent CMV infection, but certain precautions can reduce the risk of transmission, especially in high-risk groups:
- Good Hygiene: Regular hand washing, especially after contact with bodily fluids like saliva and urine, can reduce the risk of contracting CMV.
- Safe Sexual Practices: Using condoms can reduce the likelihood of sexual transmission.
- Screening: In organ transplant and HIV patients, regular screening for CMV can help catch infections early and start antiviral treatment before complications arise.
Conclusion
Cytomegalovirus (CMV) is a widespread virus that typically causes mild or no symptoms in healthy individuals but can lead to severe complications in certain groups, such as immunocompromised people and newborns. While there is no cure for CMV, antiviral treatments are available to manage the infection in high-risk patients. Prevention through good hygiene, safe sexual practices, and screening in vulnerable populations is crucial. As research into vaccines and treatments progresses, it is hoped that better strategies for managing CMV infection will become available, reducing the risk of complications and improving outcomes for affected individuals.
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