CMV (or CytoMegaloVirus) is a common viral infection after an organ transplant operation. It belongs to the same family as the herpes virus and spreads via direct contact of body fluids such as saliva, blood, urine, semen and breast milk. In most people who are healthy, there are no symptoms. A majority of adults have antibodies to the virus, which means that they have had a past infection with CMV. Even when symptoms do occur, healthy people will recover without any need for anti-viral treatments.
A common trait of this virus is its ability to lie dormant or inactive in the body for life. This is called “latent” infection. In people whose immune system is weakened, this virus can get reactivated and can then cause serious disease that can affect various organ systems such as:
- the retina (the inner lining of the eye that is responsible for our vision), causing blurred vision and blindness
- the lungs, causing pneumonia
- the large intestine or colon, causing colitis
- the nerves, causing weakness and numbness of the legs and feet
- the esophagus and stomach, causing esophagitis or gastritis, causing pain on swallowing food or liquids or stomach pains
- the liver, causing hepatitis
- the brain, causing meningoencephalitis
- the pancreas, causing pancreatitis
- the heart, causing myocarditis
Other ways a person can get infected is by receiving an organ from a donor who has CMV or getting a new infection after the transplant procedure.
In a patient whose immune system is weak after an organ transplant, it is common to see flu-like symptoms due to CMV. Symptoms include fever, malaise, body aches, low blood counts and liver dysfunction. These symptoms usually appear from the 3rd to the 16th week after the transplant.
The incidence is higher in patients who have received lung or heart-lung transplants and in patients undergoing pancreas or kidney-pancreas transplants.
Other risk factors include those who have received strong medications to either prevent or treat rejection after the transplant, advanced age of either the donor or the recipient and when there is a greater degree of genetic mismatch between the donor and the recipient
Diagnosis is usually by doing specific blood tests and in certain cases, performing a biopsy to look for the presence of CMV.
It is best to prevent CMV from spreading by giving anti-viral medications to certain high risk patients right after the transplant procedure. It is usually given for three months.
Treatment in someone who has CMV is by giving intravenous ganciclovir or oral valganciclovir. The treatment is continued till the virus is eradicated.