The cytomegalovirus (CMV) is a member of the herpes family of viruses which behaves in a similar manner as the other herpes viruses. After a primary infection it remains dormant to produce secondary disease during, mostly either transient or progressive immunodeficiency.
The primary infection can be as early as the neonatal period. A second flair of infection occurs among adolescents associated to increased sexual activity. The virus is transmitted through blood, semen and saliva. It is assumed that after 60 years of age nearly 100 percent of the population has been infected with this virus.
The clinical manifestations in the neonatal infection are generally hepatosplenomegaly, encephalitis, retinitis and petechial hemorrhages. CMV infection in adolescents and adults generally resembles infectious mononucleosis with the development of fever, myalgias, abnormal liver functions and atypical lymphocytes.
The clinical manifestations of CMV infection have increased since the onset of the AIDS epidemic. CMV retinitis is the most frequent ocular infection in AIDS patients which in many cases eventuates in blindness. Other systemic manifestations in HIV positive and AIDS patients produced by CMV are colitis, hepatitis, pneumonitis and encephalitis, among the most frequent.
Intraoral lesions associated to CMV in AIDS patients have been mostly chronic persistent ulcers. These ulcers in some patients have been shown to be the result of a coinfection by CMV and herpes simplex virus. CMV induced oral ulcerations also have been reported in AIDS patients with intraoral Kaposi sarcoma. Occasional cases of HIV associated periodontal disease produced by CMV also have been reported. Salivary gland enlargement and xerostomia have been recently associated to CMV infection especially in AIDS patients with a CD4 count of less than 150 cell per mm3.
CMV induced oral ulcers have responded to intensive and prolongued treatment with acyclovir, foscarnet and ganciclovir. CMV oral infections in AIDS patients suggest systemic involvement, therefore the patient should be referred for medical evaluation and treatment.
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