Internal Medicine

0521779407-C04 CUNY1086/Karliner 0 521 77940 7 June 14, 2007 20:37

Cystitis and Pyelonephritis Cytomegalovirus 461

complications and prognosis

■Prostatic abscess (requires drainage – can be source of fever of

unknown origin), perinephric abscess, bacteremia, urinary obstruc-

tion, emphysematous pyelonephritis

Cytomegalovirus.....................................

CAROL A. GLASER, MD

history & physical

■DNA virus/member of herpesvirus group (herpesvirus 5)

■Human only reservoir

■Transmission via:

➣direct personal contact with bodily secretions, saliva, tears, urine,

stool, semen

➣Vertical: mother to infant before, during and after birth (including

breast milk)

➣Blood transfusion

■Incubation period; 3–12 weeks following blood transfusion, 1–4

months after tissue transplantation, incubation period unknown in

household transmission

■No seasonal predilection

■Persists in latent form after primary infection

■Most common cause of congenital infection

■Most common cause of postransplant infection (source can be reac-

tivation, donor organ, or blood products)

■Infection higher in lower socioeconomic groups

■Large variation, seroprevalence varies 30–90%

Signs & Symptoms

■Most asymptomatic in normal hosts or

■Mononucleosis-like syndrome

➣Prolonged fever; malaise, myalgia, pharyngitis, hepatos-

plenomegly, mild hepatitis. Can also cause organ-specific

disease: colitis, encephalitis, Guillain-Barre, myocarditis. ́

In immunocompromised hosts:

More severe organ-specific disease. Pneumonitis can mimic rejection

in lung transplant. Chorioretinitis primarily seen in AIDS.