Cytomegalovirus (CMV) is one of the most infectious complications that occur in kidney transplant recipients, as well as a significant cause of severe and occasionally life-threatening disease and death; causing approximately 30 – 75% of CMV related infections in the absence of any preventative therapy. These include other immuno-compromised patients like cancer patients, HIV infected patients, and patients receiving immunosuppressive drugs. Although a CMV infection is usually harmless, about 50-80 of 100 adults in the United States are infected with CMV by the time they are 40 years of age, and it stays in their body for the rest of their life. The virus stays inactive most of the time, but can become active again and cause illness. Reactivation of the virus is the concern of persons with weakened immune systems as mentioned above because of the vast population of people who end up infected with CMV.
Causes of Cytomegalovirus Infection
- During transplant when the CMV virus is contained within an organ obtained from a donor previously infected with CMV (Primary infection- when a CMV – naïve recipient is first exposed to the virus)
- Transfusion of blood from a CMV-positive donor
- Direct contact rom infected people to others though body fluids such as urine, saliva, or breast milk
- Transmitted from pregnant woman to her fetus during pregnancy
- Nosocomial infection
Note: CMV is sexually transmitted
Note: About 1 in 150 children are born with congenital CMV infection and may develop permanent problems such as hearing loss or developmental disabilities. However, infants and children who are infected with CMV after birth rarely have symptoms or problems.
Symptoms of Cytomegalovirus Infection
- Sore throat
- Swollen glands
Note: These are symptoms of many other illnesses and so most people do not realize they have been infected with CMV.
Note: CMV is asymptomatic (without symptoms) in healthy children and adults.
Complications of Cytomegalovirus Infection in Kidney Transplant Recipients
There has been evidence of CMV infection associated with acute and chronic graft rejection in kidney transplant recipients as well as increased risk of death resulting from cardiovascular complication causes. Other complications include, sever pneumonia, CMV Gastrointestinal I disease, CMV encephalitis, diabetes, post-transplant lymph proliferative disorder (PTLD), and even death.
Treatment of Cytomegalovirus Infection
Although there is no drug licensed to treat congenital CMV infection, and limited data on the use of antiviral medications in infants with symptomatic congenital CMV infection with central nervous system involvement, there are several drugs that have been developed and used for CMV prophylaxis after kidney transplantation, due to the substantial morbidity in solid organ transplant recipients. Some of these drugs include CMV immunoglobulin, Acyclovir, Valacyclovir, Ganciclovir, and Valganciclovir.
Note: Pediatricians and other specialists play an important role in making sure that children with congenital CMV infection are assessed and treated as needed.
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