HUMAN CYTOMEGALOVIRUS PATHOGENESIS - AN O VERVIEW

Human cytomegalovirus (HCMV) can establish lifelong persistence after primary infection with reactivation occuring as a result of immunosupp ression. There is which evidence that molecular interactions between t he immune system and the HCMV are responsible for immune escape. HCMV in many cells especially in mononuclear blood cells during latency are frequently the source of transmission and spreading and results in a variety of disorders. In this review some data about acute infection i n immunocompetent host (mononucleosis, hepatitis), about intrauterine HCMV infection, about infection and endogenous reinfection in bone mar row and solid organ transplant recipients (pneumonitis) and about HCMV disease in AIDS patients (encephalitis, neuropathy, retinitis, coliti s) are investigated Moreover, HCMV associated vasculitis is described in patients with myocarditis, rheumatoid arthritis or polyradiculopath y. HCMV could play an important role in atherosclerosis. Several types of human human malignancy have been linked to HCMV and it has been sh own that HCMV ie genes upregulate expression of cellular oncogenes. Th e diagnosis of HCMV infection is carried out by viremia in cell cultur e using immediate early antigen staining, by antigenaemia which appear s to be an early quantitative and predictive tool, by HCMV DNA detecti on using hybridization and PCR and by IgM and IgG antibody evaluation. Two antiviral drugs are used for treatment: ganciclovir and phosphono formic acid; few resistant clinical isolates have been reported Specif ic gammaglobulin activity is discussed. HCMV vaccine is not available.