Sketchy Micro: Cytomegalovirus

Question 1

To what family does Cytomegalovirus belong?

Answer 1

The Herpesvirus family

There’s a Hermes messenger on the back shelf.

Question 2

What kind of genetic material does Cytomegalovirus have?

Answer 2

dsDNA

Like the blue overtones of the supermarket

Question 3

All DNA viruses replicate inside ___________.

Answer 3

the nucleus

Question 4

All members of the Herpesvirus family have what behavioral commonality?

Answer 4

They remain dormant in cells. In the case of Cytomegalovirus, it stays inside mononuclear leukocytes: lymphocytes and macrophages.

(Think of the archers, T knights, and cages in the back shelf of the store next to the sleeping man.)

Question 5

____________ can reactivate Cytomegalovirus.

Answer 5

Immunosuppression (like the old woman waking the sleeping man with her cane)

Question 6

How can CMV be transmitted?

Answer 6

Through any fluid contact

Question 7

What is the ToRCHeS mnemonic?

Answer 7

Infections that can cross the placenta:

• Toxoplasmosis
• Rubella
• CMV
• HSV, HIV
• Syphilis

(In this sketch, think of the torches by the checkout.)

Question 8

What are presenting signs of neonatal CMV infection?

Answer 8

Blueberry muffin rash (due to thrombocytopenia), hepatosplenomegaly, jaundice, and sensorineural deafness

(Think of the tumbling blueberry muffins, the boy covering his ears, and the advertisement of the yellow cow with the large liver, spleen.)

Question 9

Why might you do an MRI on a newborn with CMV?

Answer 9

Because it can cause periventricular calcifications

Think of the enlarged ventricle-shaped vents on the boy’s helmet with the milk spilled on it.

Question 10

What neurologic symptom can result from CMV?

Answer 10

Seizures (like the man slipping and shaking near the boy)

Question 11

Most congenital CMV infections are ____________.

Answer 11

asymptomatic (like the sign that says 80% – 90% off!)

Question 12

The trimester associated with the worst outcomes in peripartum CMV infections is ________.

Answer 12

the second (often causing hydrops fetalis)

Question 13

What common thing screened at well-child visits can catch the effects of CMV infection?

Answer 13

Hearing

This is because CMV can cause progressive hearing loss that might only arise later.

Question 14

CMV is the #1 cause of _____________.

Answer 14

viral hearing loss and mental retardation in neonates

Question 15

What adult populations are at increased risk of CMV infections?

Answer 15

Transplant patients can get pneumonia and AIDS patients with CD4s less than 50 can get retinitis.

(Think of the butcher –transplanting meat –coughing with lung stains and the cashier next to the Charity Drive AIDS ribbons being sold for 50 cents; the cashier is scanning a pizza, because the CMV retinitis that AIDS patients get is said to look like “pizza pie necrosis.”)

Question 16

In addition to retinitis, AIDS patients infected with CMV can get ________________.

Answer 16

deep linear ulcerations of the esophagus (represented by the long scratches in the cashier’s conveyor belt) and colitis (represented by the bags that look like haustra)

Question 17

Histologic examination of cells infected with CMV might show _____________.

Answer 17

owl-eye inclusions in the nucleus (represented by the Owl-Eye cereal that the seizure guy is buying)

Question 18

What two treatments can you give to someone with CMV?

Answer 18

Ganciclovir and foscarnet

Think of the green recycling bin with “cANs only” and the FaSt CAR NET on the back of the boy’s cart.

Question 19

When should you administer foscarnet instead of ganciclovir?

Answer 19

When CMV has the UL97 mutation

UL97 is written on the boy’s cart.

Question 20

CMV can look a lot like ___________. How can you tell the two apart?

Answer 20

EBV; the monospot test will be negative

Think of the mom with the NO MO SPOTs detergent.