Cytomegalovirus infection

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Cytomegalovirus infection

CMV is a ubiquitous herpesvirus that rarely causes symptoms in normal hosts but may result in encephalitis with or without ventriculitis and myeloradiculitis in severely immunocompromised patients (CD4 <100 cells/μL). 

What are the symptoms of Cytomegalovirus infection

Meningitis presents typically as headache, fever, and altered mental status and is commonly diagnosed by CSF PCR. CSF may show either a lymphocytic pleocytosis (ventriculitis) or a polymorphonuclear pleocytosis (myeloradiculitis) with protein elevation. Treatment typically consists of a 3-week course of ganciclovir and/or foscarnet. 

Radiculitis presents as flaccid paralysis of the lower extremity with bowel and bladder symptoms due to characteristic involvement of the lumbosacral roots from caudal extension of meningitis.

What are the diagnostic findings of Cytomegalovirus infection

MRI shows spinal cord and nerve root edema as well as adherence of roots to the thecal sac.

How is Cytomegalovirus infection treated?

Treatment similarly involves ganciclovir and/or foscarnet. MRI in encephalitis may demonstrate a number of patterns, including subependymal ventricular enhancement.

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