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Cytomegalovirus (CMV) Infections

by Dr. Jamie Kunkle

Cytomegalovirus (CMV) is generally VERY similar to Epstein Barr Virus (EBV) and Human Herpes Herpesvirus 6 (HHV-6), but it tends to be more treatment-resistant than common prescription antivirals like acyclovir.

CMV is extremely common, infecting between 60% to 70% of adults in industrialized countries and close to 100% in emerging countries (though it is slightly less recognized than EBV in lab testing).

Although it is often asymptomatic in healthy adults, CMV can be fatal in infants and life-threatening in immunocompromised individuals.

Similar to EBV, once acquired, this virus can replicate at any time during one’s life and represents a lifelong burden of antigenic T-cell surveillance and immune dysfunction.

Congenital CMV is a leading infectious cause of deafness, learning disabilities, and intellectual disability.

Human CMV infections commonly affect the salivary glands. It is also associated with some Cancers; namely mucoepidermoid carcinoma and some prostate cancers.

Common symptoms of CMV that contrast EBV and HHV-6:

  • May present as a more severe encephalopathy/encephalitis.
  • More dangerous in utero, infants, and early childhood.
  • May be more likely to affect the eyes and visual processing.
  • May see more liver and gut involvement at times.
  • Generally, treatment-resistant (if using pharmaceuticals may require valganciclovir, a fairly potent antiviral).
  • Tends to co-infect other chronic neurologic-associated infections like Bartonella.

Human Herpes Virus 6 (HHV-6):

There are technically TWO strains that exist for HHV-6 (HHV-6A and HHV-6B), but they are difficult to differentiate effectively through testing. The majority of infections are caused by HHV-6B. This virus induces a lifelong latent infection in humans, similar to other herpesviruses.

HHV-6 can infect multiple types of tissue but preferentially infects CD4 T-lymphocytes. Other tissues susceptible to infection are monocytes/macrophages, salivary glands, brain, and kidneys.

Associated conditions include:

  • Multiple sclerosis
  • Malignancy
  • Infectious mononucleosis
  • Drug hypersensitivity syndromes
  • Skin eruptions

Primary infection of HHV-6 may present as exanthema subitum (AKA Roseola, AKA Sixth Disease), a self-limiting disease of infancy.

Viral reactivations can induce severe encephalitis in all ages.

HSV-1 and HSV-2

Largely considered the “sexually transmitted” or STI herpesviruses.
Common cause of cold sores (HSV-1) and genital herpes lesions (HSV-2).
May cause encephalitis and other neurologic symptoms.

Varicella/Herpes Zoster:

  • Causes chickenpox in early infancy and shingles in adulthood.
  • Chickenpox is fairly rare with the addition of the varicella vaccine to childhood scheduling.
  • Despite adult vaccination for shingles, cases are still fairly common, especially in the COVID-19 era.
  • Acute chickenpox results in a skin rash that forms small, itchy blisters that scab over, typically starting on the chest, back, and face and then spreading.
  • Acute infection may present with fever, fatigue, pharyngitis, and headaches, which usually last five to seven days.
  • Complications include pneumonia, brain inflammation, and bacterial skin infections.
  • Shingles most often affects adults and is typically more severe than childhood chicken pox.
  • Lesions often follow a single dermatome (nerve root) on one side of the body.
  • Lesions/rashes can be itchy, painful and sometimes cause chronic neuralgia (nerve pain).
  • Infection of nerves can be dangerous and permanent, including nerves around the eyes or other vital structures.
  • Symptoms begin ten to 21 days after exposure, but the average incubation period is about two weeks.

HHV-7:

  • Often neglected amongst herpesviruses clinically.
  • Considered for a long time only to infect immune-compromised individuals, but this notion is brought into question with the rise of encephalitis cases, especially in the COVID-19 era.
  • HHV-7 may cause a severe encephalitis infection with epileptic seizures as its clinical manifestation.
  • Tends to infect lymphocytes and has a high tropism for the central nervous system.