A CLINICO.PATHOLOGICAL STUDY OF ANAL FISTULAE

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Revlprt olLiterutwrc
Pathosenesis
Primant Infeetion and Latencv
Most CMV infections are acquired either in the pErinatal period and
infancy or in adulthood through sexual contacts (HO, 1990. )
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Although congenital infections due to primary CMV infection in
pregnaricy af,e a cause of substantial morbidity and death (Demmler, I99I),
Most primary CMV infections in immunologically healthy adults are
asymptomatic or are associf,ted with a mild mononucleosis like syndrome.
Serious gastrointestinal disease due to primary infection is rare (see below
in "Healthy persons"). All primary infections resolve and enter a state of
latency in which live virus is sequestered in a non replicative state. Persons
with latent infection have no symptoms but do have antibody to CMV.
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The predominantissue site of viral latency is not known (Rabin
1990) but circulating lymphocytes, monocytes, and polymorphnuclear
leukocytes all probably contrilin latent vinrs (Merigan 1990).
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Organs. at risk for subsequent CMV disease, including the
gashointestinal ttact, may contain latent virus that may cause local disease
with reactivation (Tyms et atr., 1989)
Inf'ect ion C ompared with Disease
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Because most patients previously exposed to CMV have latent vinrs in
various organs without evidence of organ damage, infection with CMV is
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