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Cytomegalovirus (CMV) is a common virus for people of all ages; however, a healthy person's immune system usually keeps the virus from causing illness.

The COVID-19 pandemic is changing rapidly and continues to affect communities across the United States differently. If you have questions about keeping your families safe and healthy during the coronavirus pandemic, please visit the CDC's coronavirus website and the People with Disabilities web page.

In the United States, nearly one in three children is already infected with CMV by age five. Over half of adults have been infected with CMV by age 40. Once CMV is in a person's body, it stays there for life and can reactivate. A person can also be re-infected with a different strain (variety) of the virus. Most people with CMV infection have no symptoms and aren't aware that they have been infected.

In some cases, infection in healthy people can cause mild illness that may include:

Occasionally, CMV can cause mononucleosis or hepatitis (liver problem).

People with weakened immune systems who get CMV can have more serious symptoms affecting the eyes, lungs, liver, esophagus, stomach, and intestines.

Babies born with CMV can have brain, liver, spleen, lung, and growth problems. The most common long-term health problem in babies born with congenital CMV infection is hearing loss, which may be detected soon after birth or may develop later in childhood.

People with CMV may pass the virus in body fluids, such as saliva, urine, blood, tears, semen, and breast milk. CMV is spread from an infected person in the following ways:

From direct contact with saliva or urine, especially from babies and young children

Through sexual contact

From breast milk to nursing infants

Through transplanted organs and blood transfusions

Blood tests can be used to diagnose CMV infection in adults who have symptoms. However, blood is not the best fluid to test newborns with suspected CMV infection. Tests of saliva or urine are preferred for newborns.

Healthy people who are infected with CMV usually do not require medical treatment. Medications are available to treat CMV infection in people who have weakened immune systems and babies with signs of congenital CMV. For babies with signs of congenital CMV infection at birth, antiviral medications, primarily valganciclovir, may improve hearing and developmental outcomes. Valganciclovir can have serious side effects and has only been studied in babies with signs of congenital CMV infection. There is limited information on the effectiveness of valganciclovir to treat infants with hearing loss alone.

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About Cytomegalovirus and Congenital CMV Infection | CDC

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See the signs and symptoms of, transmission of, and diagnosis and treatment for cytomegalovirus (CMV), a common virus for people of all ages.

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Cytomegalovirus or CMV, is a common virus that impacts all ages. Nearly 1 in 3 children have already been infected in the US, and approximately more than 50% of adults have also been infected with CMV by early 40s. The virus is latent and can remain in a person's body their whole life. Chances of reactivation (periods) of infectivity gets higher if the person's immune system is comprised, aside from a high functioning immune system the virus stays dormant and is less likely to cause any harsh symptoms.

"Cyto" is Latin for "cell, container"
"Megal" is Latin for "large, big"
"Virus" is Latin for "poison"

Cyto- + Megal + o + Virus = " Large cell containing poison"

This Padlet will feature the most common human related CMV type :  Human Betaherpesvirus 5 (HCMV) and Congenital Cytomegalovirus

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Sometimes CMV can cause retinitis and inflammation of the retinal fundus.

This video shows an Ophthalmologist performing a Fundoscopy on the retina to see how damaged it is from CMV.

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There is no cure for CMV and most people don't need  any treatment until the symptoms get worse.

Immunoglobulin G (IgG), alone or with an antiviral, can be sufficient enough to cause the prophylaxis of CVM :
- reduces risk of CMV-related death
- provides long-term prognosis
- produces little treatment related side effects

Cytovene and Valcyte are both antiviral drugs that are taken orally. Valcyte can be converted into Cytovene when amino acid changes in the UL97 protein, which has been reported to cause drug resistance. These antivirals can slow the reproduction of the virus but it can't stop it completely.

Since 2009 there have been 3 attempts to procure a CMV vaccine especially for Congenital CMV. As of 2016 the City of Hope National Medical Center in Duarte, California is rapidly developing 2 promising CMV vaccines : CMV-MVA Triplex vaccine and the CMVpp65-A0201 Peptide vaccine.

The CDC recommends regular hand washing and good hygiene at home and in public.

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There are 11 subtypes of CMV, not all of them affect humans like they would for animals. Different strains and compatibility of the immune system determines the range and severity of symptoms.

CMV Polyradiculomyelopathy presents in person's that has acquired Neurologic CMV with HIV-AIDS : lower extremity weakness, abnormal sensation of the limbs, radicular nerve pain, urinary tract retention, and insufficient motor reflexes.

Human CMV 5 with normal immune system : Fever, sore throat, fatigue, swollen glands, mononucleosis, hepatitis, and inflammation of the pharynx.

Human CMV 5 immunocompromised : Fever, sore throat ; severe infections in salivary glands, thyroid, bronchi, and the lining of the lungs. These symptoms are more recognized in patients with HIV infections, organ recipients (vice-versa), and new born infants.

Congenital Newborn CMV : Low birth weight, microcephaly, seizures, petechial rashes, sensorineural hearing loss, moderate enlargement of the liver which can cause post- birth jaundice. Newborn CMV is the most common viral infection in babies.

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The transmissibility of CMV is still unknown but the clear infection comes from body fluids, typically saliva. This includes urine, blood, sweat, and even TEARS wow !!!

Infection requires close immediate contact to another person. It cannot be passed through spores or air through coughing or sneezing (only if fluids from the mucosal lining leaks)

CMV has be tested to not have a huge viral load or highly contagious, but it has been reported to spread in houses and daycare centers.

The infection can be passed from an infected mother to newborns through the birth canal or breastfeeding. As well as receiving translated organs and blood transfusions.

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Nearly 78% of all CMV cases go undiagnosed because high immune functioning patients are usually asymptotic or don't know they have the virus. People infected will have the virus for the rest of their life, the body does make life long antibodies to stop reactivation of the virus.

The virus can be taken from urine, throat, tissue, and bronchial samples in order to test them. The most used teasing is PCR testing, this tests the viral load of the person.

CMV pp65 Antigenemia test can also be used to detect the virus. Indirect immunofluorescence identifies the pp65 protein of CMV in white blood cells. One sample is taken and then another one is taken 2 week later to compare the viral load.

It isn't effective to test blood in newborns for CMV because their white blood cells have yet to recognize the immune system, so clinicians use saliva or urine instead.

Fun Fact : They can't test tears because the lacrimal glands of babies won't produce tears until about 3 months !!!

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CMV replicates mostly inside of endothelia cells. Typically the lining of the salivary glands and lungs but it can attract internally anywhere in the body.

It takes about 5-10 days, from transmission to infection, for the virus to fully code for structural proteins within the host cell.

CMV makes its own DNA polymerase, but uses the host's RNA polymerase for the transcription of its genes. CMV is a double-stranded DNA virus and formation of the double strand takes place in the host cell nucleus.

Fun Fact : Strain AD169 of Human CMV can have almost 75% of its genes delete and still possess the ability to cause infection. This implies that strains can avoid the immune system for a moment until latency !!!!

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This is Dr. Stanley Ridell of the Fred Hutchison Cancer Research Center in Seattle. He and team of colleagues first isolated T-cells for therapy for patients who acquired CMV after stem cell transplantation in the 1990s.

Since then his work has expanded into the modification and reinfusion of T cells so that people can have a fightable response to CVM.

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Researchers and scientist need to determine how much of a burden CMV is in populations so they can figure out preventive measures and treatment options.

Prevalent Percentage by Continent :
- Africa 100 %
- Asia 100%
- Europe 80%
- North America 80%

Prevalent Percentage by Presence of CMV IgG Antibodies :
- General Population 83%
- Women of Childbearing Age 86%
- Recipients of Organs or Blood : 86%

Out of those 3 groups, the World Health Organization recognized a high prevalence in Eastern Mediterranean and Middle Eastern regions at 90%. Lowest prevalence was reported in Europe at 66%

Exclusively in the US communities of color are more impacted by CMV. Disparities that play a role in CMV infections include high mortality among adults, high mortality among infants, and lower socioeconomic disparities.

https://pubmed.ncbi.nlm.nih.gov/30706584/

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Affiliations

¹ Department of Virology, Royal Free NHS Foundation Trust, London, UK.

² Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.

³ Instituut of Tropical Medicine (ITM), Antwerp, Belgium.

⁴ Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium.

⁵ Institute for Global Health, University College London, London, UK.

⁶ Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium.

Affiliations

¹ Department of Virology, Royal Free NHS Foundation Trust, London, UK.

² Department of Virology, Parasitology and Immunology, Faculty of Veterinary Medicine, Ghent University, Ghent, Belgium.

³ Instituut of Tropical Medicine (ITM), Antwerp, Belgium.

⁴ Institute of Health and Society (IRSS), Université Catholique de Louvain, Brussels, Belgium.

⁵ Institute for Global Health, University College London, London, UK.

⁶ Department of Public Health and Surveillance, Scientific Institute of Public Health (WIV-ISP), Brussels, Belgium.

Abstract

Cytomegalovirus (CMV) infection does not usually produce symptoms when it causes primary infection, reinfection, or reactivation because these three types of infection are all controlled by the normal immune system. However, CMV becomes an important pathogen in individuals whose immune system is immature or compromised, such as the unborn child. Several vaccines against CMV are currently in clinical trials that aim to induce immunity in seronegative individuals and/or to boost the immunity of those with prior natural infection (seropositives). To facilitate estimation of the burden of disease and the need for vaccines that induce de novo immune responses or that boost pre-existing immunity to CMV, we conducted a systematic survey of the published literature to describe the global seroprevalence of CMV IgG antibodies. We estimated a global CMV seroprevalence of 83% (95%UI: 78-88) in the general population, 86% (95%UI: 83-89) in women of childbearing age, and 86% (95%UI: 82-89) in donors of blood or organs. For each of these three groups, the highest seroprevalence was seen in the World Health Organisation (WHO) Eastern Mediterranean region 90% (95%UI: 85-94) and the lowest in WHO European region 66% (95%UI: 56-74). These estimates of the worldwide CMV distribution will help develop national and regional burden of disease models and inform future vaccine development efforts.

Keywords: cytomegalovirus; prevalence; worldwide.

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national center for biotechnology information

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Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta-analysis - PubMed

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Cytomegalovirus (CMV) infection does not usually produce symptoms when it causes primary infection, reinfection, or reactivation because these three types of infection are all controlled by the normal immune system. However, CMV becomes an important pathogen in individuals whose immune system is imm ...

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Emerging Success In Confirming CMV Arrests Host Cells before S Phase : Human cytomegalovirus RNA2.7 inhibits RNA polymerase II (Pol II) Serine-2 phosphorylation by reducing the interaction between Pol II and phosphorylated cyclin-dependent kinase 9 (pCDK9)

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Emerging Success In Confirming CMV Arrests Host Cells before S Phase : Human cytomegalovirus RNA2.7 inhibits RNA polymerase II (Pol II) Serine-2 phosphorylation by reducing the interaction between Pol II and phosphorylated cyclin-dependent kinase 9 (pCDK9)

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RNA 2.7 is a long non-coding RNA (lncRNAs) that doesn't have coding activity for proteins, research suggests that despite this viruses can still regulate gene expression. Viruses can produce  lncRNAs which plays a role in biological and genetic processes. This study helps researchers to better identify what mechanisms cause cell death and promotion of viral DNA replication

The article highlights 3 main points :
-  HCMV RNA 2.7 inhibits the phosphorylation of Pol II Serine-2
- RNA 2.7 reduces activity between Pol II and pCDK9
- RNA 2.7 regulates cell cycles by blocking the cell from entering into S phase

The figure above details how RNA2.7 in HCMV infections can hijack the host cells entire replication process :

- RNA 2.7 binds to Pol II
- RNA 2.7 binding of Pol II blocks interaction between pCDK9 and Pol II (acts as a buffer), thus causing inhibition of Pol II Serine-2
- Prevention of Pol II Serine-2 phosphorylation decreases amount of MCMs, Cdt1, and Cdc6 (all of which are pre-replication complex factors that help set the cell from G0/G1 to S phase)
- This induces arrest and death for the host cell which prevents the body from taking aggressive immune responsive measures to a lytic infections like HCMV-RNA 2.7