Book of Medical Disorders in Pregnancy - Tintash

after exposure favors but does not prove
the interpretation that the HAl antibodies
represent an infection that occurred
sometime earlier. Unlike HAl antibodies
the CF levels tend to drop off and
disappear after a few days.
Fig13.2: Shows hydrocephalic head of
the baby
Cytomegalovirus infection: This virus
is a member of the herpes group, but is
antigenically distinct from Herpes virus
Homini (HVH), varicella zoster and EB
virus. Like other herpes viruses, it may
persist in a latent form following a
primary infection, and produce large
chromatin positive (viral particles)
intranuclear inclusion bodies. The
affected cells markedly increase in size.
CMY is a DNA virus which takes 5 to
21 days to produce cytopathic changes in
tissue culture.
Route of infection:
Children become frequently infected
early in life, presumably by contact.
Although exact mechanisms are
unknown, the virus is shed for long
periods (often several years) in saliva
and urine and spread probably involves
these sources. In adults CMY has also
been recovered from cervical secretions,
semen and mother's milk. Acquisition of
infection is related to age and to
socioeconomic factors.
167
Clinical features: Although acquired
infections are usually not accompanied
by clinical signs, a heterophil antibody
negative, infectious mononucleosis like
syndrome has been described in young
adults and in recipients of transfusion of
fresh blood (postperfusion syndrome).
Like other herpes viruses, CMY has a
strong tendency to become latent.
Reactivation of such infections in
immunosuppressed patients, particularly
trans-plant recipients, constitutes a major
pro-blem. The rare individual with a
primary infection who develops CMY
mononucleosis presents with an acute
onset of fever and non specific
symptoms. The peripheral WBC count
reveals a relative and absolute
lymphocytosis, with many atypical
lymphocytes. Liver function tests are
frequently abnormal. The fever is apt to
persist for several weeks, and in
convalescence there is little
lymphadenitis. Pharyngitis is unusual
and the heterophil antibody test is
negative.
Diagnosis: Specific laboratory diagnosis
can be made by recovering the virus
from saliva, cervical swab or liver
biopsy specimen, but urine is the best
source and may contain as many as
million virus particles per ml. The virus
grows slowly and cultures may not
become positive for a month or more.
The presence of owl eyed cells
containing intranuclear inclusions in
fresh urine or cervical smear helps in
establishing a presumptive diagnosis, but
this is a much less sensitive method than
viral culture. Serologic tests include CFT,
which is the most widely used test, but
the recently introduced fluorescent
antibody test appears to be very
promising and has the potential of