Cytomegalovirus infection differential diagnosis

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]

Overview

Differential Diagnosis of Cytomegalovirus infection

Cytomegalovirus Retinitis

Cytomegalovirus retinitis must be differentiated from the following infectious causes of retinitis:

Infectious Agent Clinical Manifestations
Cytomegalovirus
  • Physical evidence of a cytomegalovirus presence in one of both eyes will generally clinical present in the form of lesions, adjacent retinal vessels.
  • These lesions may impinge upon the fovea and the optic nerve. Furthermore they are usually discovered in close proximity to both.
  • Further extending lesions may be present in close proximity to the vortex veins as well as the ora serrata.[1]
Tuberculosis
Fungal

Candida albicans

Aspergillus fumigatus

  • Yellow subretinal infiltrates
  • Retinal infiltrates
  • Fungal hyphae are located throughout the eye - suggestive of pulmonary involvement[1]

Cryptococcus neoformans

Toxoplasmosis
  • Localized areas of infiltrate
  • Active lesions are adjacent to initial scarring[1]
Syphilis

Cytomegalovirus Colitis

The symptoms of colitis such as bloody diarrhea and abdominal pain are seen are seen in all forms of colitis. The table below differentiates among the common causes of colitis:[2][3] Cytomegalovirus colitis is diagnosed by demonstration of intranuclear inclusion bodies on colonic biopsy.

Diseases History and Symptoms Physical Examination Laboratory findings
Diarrhea Rectal bleeding Abdominal pain Atopy Dehydration Fever Hypotension Malnutrition Blood in stool (frank or occult) Microorganism in stool Pseudomembranes on endoscopy
Allergic Colitis + ++ + ++ ++
Chemical colitis + ++ ++ + + ++ +
Infectious colitis ++ ++ ++ +++ +++ ++ + ++ ++ +
Radiation colitis + ++ + + + ++
Ischemic colitis + + ++ + + + + ++
Drug-induced colitis + + ++ + ++ +

References

  1. 1.0 1.1 1.2 1.3 1.4 1.5 1.6 Infectious Retinitis: A Review. YACHNA AHUJA, MD · STEVEN M. COUCH, MD · RAYMUND R. RAZONABLE, MD · SOPHIE J. BAKRI, MD. http://www.retinalphysician.com/articleviewer.aspx?articleID=102293. Accessed April 13, 2016.
  2. Thielman NM, Guerrant RL (2004). "Clinical practice. Acute infectious diarrhea". N Engl J Med. 350 (1): 38–47. doi:10.1056/NEJMcp031534. PMID 14702426.
  3. Khan AM, Faruque AS, Hossain MS, Sattar S, Fuchs GJ, Salam MA (2004). "Plesiomonas shigelloides-associated diarrhoea in Bangladeshi children: a hospital-based surveillance study". J Trop Pediatr. 50 (6): 354–6. doi:10.1093/tropej/50.6.354. PMID 15537721.