Biology Reference
In-Depth Information
Manifestations of Human Cytomegalovirus
Infection: Proposed Mechanisms of Acute
and Chronic Disease
W. Britt
Contents
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418
Natural History of Acute CMV Infections in the Normal Host . . . . . . . . . . . . . . . . . . . . . . . 421
Natural History of Acute CMV Infection in the Immunocompromised Host . . . . . . . . . . . . 426
Congenital Infection. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427
Allograft Recipients . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432
Patients with AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 439
Diseases Associated with Chronic Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 442
Chronic Vascular Disease in the Normal Host. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 443
Chronic Disease in the Transplanted Allograft . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 446
References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 449
Abstract
Infections with human cytomegalovirus (HCMV) are a major cause of
morbidity and mortality in humans with acquired or developmental deficits in innate
and adaptive immunity. In the normal immunocompetent host, symptoms rarely accom-
pany acute infections, although prolonged virus shedding is frequent. Virus persist-
ence is established in all infected individuals and appears to be maintained by both a
chronic productive infections as well as latency with restricted viral gene expression.
The contributions of the each of these mechanisms to the persistence of this virus in
the individual is unknown but frequent virus shedding into the saliva and genitourinary
tract likely accounts for the near universal incidence of infection in most populations
in the world. The pathogenesis of disease associated with acute HCMV infection is
most readily attributable to lytic virus replication and end organ damage either sec-
ondary to virus replication and cell death or from host immunological responses that
target virus-infected cells. Antiviral agents limit the severity of disease associated
with acute HCMV infections, suggesting a requirement for virus replication in clinical
W. Britt
Departments of Pediatrics, Microbiology, and Neurobiology, University of Alabama School
of Medicine, Childrens Hospital, Harbor Bldg. 104, 1600 7th Ave. SouthBirmingham,
AL 35233 , USA
wbritt@peds.uab.edu
