title: Primary cytomegalovirus infection in otherwise healthy adults with Fever of unknown origin: a 3-year prospective survey.
abstract: BACKGROUND
  Primary cytomegalovirus disease is probably still underestimated or missed in common clinical practice, and further prevalence studies should be performed, in particular in the setting of fever of under-determined origin (FUO) in adults.
  
  
  METHODS
  In a 3-year prospective survey of 123 consecutive adult patients referred for FUO often associated with a broad spectrum of constitutional signs and symptoms, 18 patients (14.6%) were found to have a primary cytomegalovirus infection, after a clinical, instrumental and laboratory workup.
  
  
  RESULTS
  In the majority of cases, this syndrome was consistently associated with altered white blood cell count, abnormal T-lymphocyte subsets and ultrasonography-confirmed hepatosplenomegaly. On the other hand, altered white blood cell differential and serum hepatic enzymes, and constitutional signs and symptoms were absent in 11.1-27.8% of cases, and an initial laboratory cross-reaction with anti-Epstein-Barr IgM antibodies was detected in 44.4% of episodes. Non-specific signs and symptoms were the only features in 27.8% of patients with adult cytomegalovirus disease, thus, confirming that this disorder may be still clinically underestimated, until virologic assays are performed. A prolonged and varied spectrum of subjective disturbances (similar to those encountered in infectious mononucleosis), which often limited daily activities, involved nearly 30% of subjects, and lasted for 3-15 months after recovery of acute cytomegalovirus disease.
  
  
  CONCLUSIONS
  In the clinical, laboratory, and instrumental workup for FUO, rapid recognition of a primary cytomegalovirus disease is useful to exclude alternative diagnoses, avoid non-necessary exposure to antibiotics, and reassure patients of their self-limiting, benign disorder.
authors.affiliation: Department of Clinical and Experimental Medicine, Division of Infectious Diseases, University of Bologna "Alma Mater Studiorum", S. Orsola Hospital, Via Massarenti 11, 40138 Bologna, Italy. manfredi@med.unibo.it
authors.forename: R
authors.initials: R
authors.lastname: Manfredi
authors.forename: L
authors.initials: L
authors.lastname: Calza
authors.forename: F
authors.initials: F
authors.lastname: Chiodo
mesh_terms: D000293:Adolescent; D000328:Adult; D000914:Antibodies, Viral / Q000097:blood; D003587:Cytomegalovirus / Q000145:classification / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D004279:DNA, Viral / Q000097:blood; D005260:Female; D005335:Fever of Unknown Origin / Q000453:epidemiology / Q000503:physiopathology / Q000821:virology; D006801:Humans; D007075:Immunoglobulin M / Q000097:blood; D008297:Male; D010750:Phosphoproteins / Q000097:blood; D016133:Polymerase Chain Reaction / Q000379:methods; D015995:Prevalence; D011446:Prospective Studies; D014763:Viral Matrix Proteins / Q000097:blood
chemical_list: D000914:Antibodies, Viral; D004279:DNA, Viral; D007075:Immunoglobulin M; D010750:Phosphoproteins; D014763:Viral Matrix Proteins; C065418:cytomegalovirus matrix protein 65kDa