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Human cytomegalovirus
Last reviewed: 06.07.2025
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Cytomegalovirus (CMV) is a generalized neonatal infection caused by intrauterine infection with cytomegalovirus (CMV) or infection immediately after birth. The infection is widespread and ubiquitous, with antibodies to the CMV found in 80% of people over 35 years of age. CMV can be isolated from the cervix of almost 10% of healthy women. The disease is characterized by the development of large intranuclear inclusion bodies in the salivary glands, lungs, liver, pancreas, kidneys, endocrine glands, and sometimes in the brain. Mostly children under 2 years of age die. Older children and adolescents are more likely to have asymptomatic infection. Adults receiving immunosuppressants for treatment often develop severe CMV infection.
CMV is very similar to herpes simplex and VZ viruses, but differs from them in the following ways. CMV has a longer intracellular reproduction cycle (1-2 weeks) and therefore has less cytopathic activity, has an extremely narrow host range (only humans) and is less sensitive to modified nucleosides, since it is weakly capable of inducing virus-specific thymidine kinase.
[ Pathogenesis and symptoms of cytomegalovirus infection
The most severe form of the disease develops with intrauterine infection. Children can also become infected by contact or alimentary route, since patients are able to excrete the virus in urine for quite a long time. CMV multiplies in epithelial cells of various internal organs, where it can persist for a long time. Changes in the cell in which CMV multiplies are characteristic: the size of cytomegalic cells is 25-40 µm, their nuclei contain 1-2 inclusions consisting of viral particles and nuclear chromatin, surrounded by a light rim.
In congenital cytomegalovirus disease, a specific syndrome is observed, characterized by signs of fetal immaturity, jaundice, enlarged liver and spleen, thrombocytopenic purpura, pneumonia and various CNS lesions (microcephaly, chorioretinitis, optic nerve atrophy, oligophrenia, etc.).
In children with acquired cytomegalovirus, hepatitis, interstitial pneumonia or hemolytic anemia develop. The virus is found in the salivary glands and kidneys, from where it can be excreted for a long time. Immunopathological reactions are of great importance in the disease: immune lysis of cells by the antibody + complement system and cytotoxic lymphocytes, the appearance of immune complexes in the blood and tissues. The number of T-suppressors increases sharply, and the ratio of T-helpers to T-suppressors drops to 0.23.
Immunity is humoral in nature: complement-binding and virus-neutralizing antibodies appear in the serum.
Laboratory diagnostics of cytomegalovirus infection
The virus can be isolated from various pathological (including autopsy) material by infecting human fibroblast cell cultures and diploid human lung cell cultures. Typical cytomegalic cells appear after 1-2 weeks. They can also be detected using electron microscopy of urine cellular sediment, where the virus is present in large quantities. Antibodies in paired sera are determined in the neutralization reaction in cell culture, as well as using the RSC, RPGA, RIF, IFM and RIM.