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Cytomegalovirus: pathogen, paradigm, and puzzle
Michael Boeckh, Adam P. Geballe
Michael Boeckh, Adam P. Geballe
Published May 2, 2011
Citation Information: J Clin Invest. 2011;121(5):1673-1680. https://doi.org/10.1172/JCI45449.
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Science in Medicine

Cytomegalovirus: pathogen, paradigm, and puzzle

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Abstract

Human cytomegalovirus (CMV), one of the eight herpesviruses that commonly infect humans, is best known for its propensity to cause disease in immunocompromised patients, especially transplant recipients, patients with advanced AIDS, and congenitally infected newborns. Advances in molecular virology coupled with improvements in diagnostic methods and treatment options have vastly improved our understanding of and ability to manage CMV, but many uncertainties remain, including the mechanisms of persistence and pathogenesis and its hypothesized roles in a variety of human illnesses. Here we review recent advances that are reshaping our view and approach to this fascinating virus.

Authors

Michael Boeckh, Adam P. Geballe

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Figure 2

CMV disease mechanisms.

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CMV disease mechanisms.
Many humans harbor clinically quiescent or laten...
Many humans harbor clinically quiescent or latent CMV. Even when asymptomatic, the virus may cause indirect effects, possibly by altering immune system function after subclinical reactivation episodes or by expression of viral genes (e.g., LAcmvIl-10) during latency. Immune system dysfunction resulting from a variety of iatrogenic or natural causes or from a new transmission event can lead to active CMV replication. Depending on the clinical setting, active replication may contribute to indirect effects, but also leads to direct tissue damage, resulting in an inflammatory response and dysfunction of various organ systems. In addition to CMV antigenemia, a common indicator of active infection, examples of end CMV organ disease commonly occurring in AIDS patients and in transplant recipients are shown. Image credits: antigenemia, pp65+ cell in a leukocyte cytospin preparation (M. Boeckh); retinitis, ophthalmoscopic view of retinal hemorrhage and inflammation (E. Chuang); ependymitis, periventricular inflammation detected by MRI (left; reproduced from ref. 119 with permission from McGraw Hill) and postmortem brain specimen (right; C. Marra); hepatitis, microabscesses associated with CMV hepatitis (A. Limaye); esophagitis, endoscopic view of shallow esophageal ulcers (G. McDonald); colitis, deep ulcer in a colonic biopsy (G. McDonald); pneumonia, chest CT scan of CMV pneumonia (M. Boeckh).

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