Cytomegalovirus infection and the liver

Česká verzia

Authors: K. Chmelová ; S. Fraňková ; J. Šperl
Authors place of work: Klinika hepatogastroenterologie, Transplantcentrum, IKEM, Praha
Published in the journal: Gastroent Hepatol 2017; 71(6): 517-523
Category: Hepatology: Review article
doi: https://doi.org/10.14735/amgh2017517

Summary

Cytomegalovirus (CMV) is a DNA virus that belongs to the Herpesviridae family and the Betaherpesvirinae subfamily. Similar to other herpes viruses, CMV remains latent in myeloid cells for the entire lifespan of the host. The seroprevalence of CMV varies widely and negatively correlates with socioeconomic status, ranging from 40% of adults in Western European countries to almost 90% of adults in developing countries. CMV infection occurs via bodily fluids, especially saliva, and the virus can also be transmitted sexually and through transplanted organs. CMV replicates in many cells including hepatocytes, persists latently in bone marrow myeloid cells and can be reactivated upon immunosuppression. Primary CMV infection usually has an asymptomatic course, but can lead to life-threatening disease in immunocompromised individuals. However, a more common problem is reactivation of the latent virus. The clinical manifestation of CMV disease varies widely from asymptomatic viraemia (CMV infection sensu stricto) to CMV viral syndrome and CMV disease with organ involvement. CMV infection is a severe illness in solid-organ transplant patients and HIV-positive individuals. Anti-CMV prophylaxis and treatment of CMV infection are crucial in immunocompromised individuals. On the other hand, in healthy individuals, CMV hepatitis represents only 1% of all causes of liver function tests elevation. The 1-year incidence of CMV hepatitis is estimated to be 4/100,000 individuals. This disease mostly occurs in middle age and has a mild course that does not require antiviral therapy; a fulminant course is extremely rare. CMV never causes chronic hepatitis. Assessment of anti-CMV antibodies and CMV DNA are not part of the first-line differential diagnosis in patients with abnormal liver function tests. CMV hepatitis must be ruled out in middle-aged individuals presenting with viral syndrome and abnormal liver function tests.

Key words:
cytomegalovirus – hepatitis – seroprevalence – incidence – treatment – risk – immunosuppression

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
18. 9. 2017

Accepted:
26. 9. 2017

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