Cytomegalovirus (CMV) testing is not a routine screening test for everyone but is employed selectively to aid in diagnosing active, reactivated, or prior CMV infections in specific situations.
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CMV testing is typically considered in the following situations:
CMV tests might be requested in conjunction with influenza, mononucleosis (mono), and Epstein-Barr virus (EBV) tests when a pregnant woman or an immunocompromised individual presents with flu- or mono-like symptoms, including:
The type of sample needed for CMV testing varies depending on the specific test being conducted. For CMV antibody testing, a blood sample is obtained by venipuncture. However, when detecting the virus itself in symptomatic patients, the sample can be obtained from blood, urine, sputum, amniotic fluid, cerebrospinal fluid, duodenal fluid, other body tissues, or even saliva in newborns. For certain samples like amniotic fluid, cerebrospinal fluid, or body tissue (biopsy), special procedures may be necessary to collect them.
Cytomegalovirus (CMV) is a prevalent virus that often remains asymptomatic or causes only mild illness. CMV testing identifies antibodies in the blood, which the body generates in response to the infection, or directly detects CMV. The majority of individuals become infected during childhood or as young adults, yet many remain unaware of it since CMV typically manifests with no discernible symptoms or only results in mild illness in those who are otherwise healthy. In cases of mild illness, individuals might experience non-specific signs and symptoms, including a sore throat, fever, fatigue, and swollen glands. Among otherwise healthy adults, CMV infection may occasionally induce flu-like symptoms or mononucleosis (mono)-like manifestations, such as profound fatigue, fever, chills, body aches, and headaches, which typically subside within a few weeks.
Once you are infected, CMV remains in your body for life without causing symptoms. After the initial "primary" infection resolves, CMV becomes dormant or latent, similar to other herpes family members. However, if your immune system becomes significantly weakened, the virus can reactivate and cause illness.
CMV can lead to significant health problems in the following situations:
- Eyes, leading to retinal inflammation and potential blindness.
- Digestive tract, resulting in bloody diarrhea and abdominal pain.
- Lungs, causing pneumonia characterized by a non-productive cough and shortness of breath.
- Brain, causing encephalitis.
- Spleen and liver.
- Organ or bone marrow transplant recipients, contribute to some degree of organ rejection.
Active CMV infection can further weaken the immune system, making individuals susceptible to secondary infections such as fungal infections.
Cytomegalovirus (CMV) testing is not performed on everyone but is utilized in specific cases, including:
Several testing methods may be employed depending on the purpose of the test:
Antibody Testing (Serology):
This test identifies antibodies produced in response to a CMV infection in the blood. It can diagnose both current and past infections by measuring two classes of CMV antibodies:
Healthcare providers compare the presence or absence of IgG and IgM antibodies in the same sample or the amount of antibody present (titer) in samples collected at intervals (acute and convalescent samples) to differentiate between active and latent CMV infections.
Direct Detection of CMV:
Molecular techniques like polymerase chain reaction (PCR) are used to diagnose congenital infections in newborns and can detect and/or confirm active infections in other individuals. These methods identify the genetic material (DNA) of CMV (qualitative testing) and may measure the quantity of viral DNA in a sample (quantitative, or viral load). Molecular techniques offer higher sensitivity than culture methods, and results can be obtained quickly.
People with weakened immune systems experiencing active CMV infections may be monitored with various CMV tests. Healthcare providers often assess the viral load to determine a person's response to antiviral therapy.
Viral Cultures:
Although not routinely available, viral cultures may occasionally be employed to detect CMV.
CMV testing may be requested when a pregnant woman or an individual with a weakened immune system presents with flu- or mono-like symptoms, including:
CMV tests are also used when monitoring individuals who have received a transplant or to assess the effectiveness of antiviral therapy.
In the case of newborns or infants, CMV molecular testing may be conducted when they exhibit specific symptoms such as:
When a person is being considered for an organ or bone marrow transplant, CMV antibody testing may be ordered to determine whether they have been previously exposed to CMV.
Interpreting CMV test results requires careful consideration. Healthcare practitioners evaluate the results in the context of clinical findings, including signs and symptoms. Distinguishing between latent, active, or reactivated CMV infections can sometimes be challenging due to several factors, such as:
Regarding antibody testing:
Interpreting viral detection results:
The CMV test is one of the components in a TORCH testing panel. This panel of tests is designed to screen for a group of infectious diseases that can lead to illness in pregnant women and potentially cause birth defects in their newborns. TORCH is an abbreviation representing: Toxoplasmosis, Rubella, Cytomegalovirus, and Herpes simplex virus. Additionally, it may include screening for other infections.
In situations requiring blood transfusions, specific patients, such as CMV-negative individuals with HIV/AIDS or CMV-negative candidates for heart/lung transplants, should be provided with blood components that have been confirmed as negative for CMV antibodies (referred to as CMV seronegative blood products) or blood products that have been subjected to leukocyte reduction.
If you are infected with CMV, either recently or in the past, you can potentially transmit the virus to others, even if you are not displaying any symptoms. Symptoms can manifest within 9 to 60 days after the initial infection. However, close contact with others is typically required for transmission. CMV can be transmitted through various body fluids, including saliva, breast milk, vaginal fluids, semen, urine, and blood.
At present, there is no vaccine for CMV. Practicing diligent hygiene measures can aid in preventing the transmission of the virus. However, because CMV is highly prevalent, found in various body fluids, and is typically transmitted through close contact, most individuals become infected early in life. It has been estimated that up to 70% of children in daycare settings have been exposed to CMV, and each year, approximately 8% to 20% of childcare providers contract CMV.
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