Cytomegalic inclusion disease (CID) is a systemic infectious disease caused by cytomegalovirus (CMV), characterized by the presence of giant cells with intranuclear and cytoplasmic inclusions in infected organ tissues. The virus can be transmitted to the fetus through the placenta or birth canal, making it one of the most common viral infections. It can also spread via the digestive tract, respiratory tract, or blood transfusion. This disease primarily affects newborns and infants but can also occur at other ages, with congenital cases often presenting more severe symptoms.

bubble_chart Clinical Manifestations

If the infection is confined to the salivary glands, systemic symptoms are mostly absent, but the virus can still be shed. In cases of systemic infection, multi-system symptoms may appear.

1. Most systemic symptoms involve fever, ranging from mild fever to around 40°C, with a few cases showing normal or subnormal body temperature.
2. Respiratory symptoms include cough, shortness of breath, cyanosis, etc.
3. Digestive symptoms include vomiting, diarrhea, hepatosplenomegaly, jaundice, etc.
4. Neurological symptoms include drowsiness, unconsciousness, convulsions, retinitis, chorioretinitis, optic atrophy, sensorineural deafness, meningoencephalitis, microcephaly, etc.
5. Hematological manifestations may resemble those of infectious mononucleosis, with transient maculopapular rash, hepatosplenomegaly, peripheral lymphocytosis with atypical lymphocytes, but only mild or no lymphadenopathy and a negative heterophile agglutination test.
6. It may coexist with other severe conditions, such as bacterial or viral pneumonia.

bubble_chart Auxiliary Examination

1. Blood picture: Anemia and thrombocytopenia may be observed.
2. Virus isolation by tissue culture: Can confirm the diagnosis. The virus can be isolated from urine, throat swabs, saliva, blood leukocytes, and infected tissue specimens.
3. Serological tests: A positive specific IgM antibody or a fourfold or greater increase in IgG antibody titer in paired sera can diagnose recent infection. Umbilical bleeding with CMV IgM antibody positivity suggests congenital infection.
4. PCR-based DNA detection: CMV DNA can be detected in the patient's urine, secretions, and tissue fluids, with high sensitivity and strong specificity.

bubble_chart Treatment Measures

1. Symptomatic Treatment
   1. For primarily respiratory symptoms: bed rest, appropriate temperature and humidity, fresh air, and oxygen therapy.
   2. For primarily gastrointestinal symptoms (vomiting, diarrhea): replenish fluids and calories, correct electrolyte imbalances.
2. Etiological Treatment Some have tried ganciclovir (a derivative of acyclovir, 50–100 times more potent than acyclovir), achieving a 70–80% efficacy rate. For acute infections, the dose is: 5–15 mg/(kg·d), divided into 2–3 intravenous injections, with a treatment course of 10–14 days.
3. Other Options Adrenocortical hormones may be tried, with reports of effectiveness in some cases.

bubble_chart Prevention

1. Children found to be infected should be isolated, and their secretions and excretions should be disinfected.
2. Vaccination: Experimental active immunization with CMV-attenuated live vaccines and passive immunization with CMV immune globulin have both proven effective, but are still in the trial stage and require further research.
3. To prevent CMV infection after blood transfusion, strictly adhere to transfusion indications and screen blood donors for CMV infection.