I was diagnosed with CMV five years ago. I had hepatitis and was very, very sick for a year or more. I was bedridden for at least eight months and spent a good deal of the next six months in bed for days off and on. I still have recurring weeks of illness where I am just too exhausted to do anything and have sweats (my face turns bright red) and chills. I was surprised to see your response to another person with CMV, saying that you return to "normal" after one month. I understood that this would be with me for my lifetime.

S.B.

In my earlier column on CMV, mono, and liver pain, I was speaking in generalities about the course of CMV (cytomegalovirus, a common though generally not serious infection). Most people with an intact disease-fighting immune system have few or no symptoms. In previously healthy patients who develop symptoms, the infection generally resembles mononucleosis, which is caused by the Epstein-Barr virus. Patients with this form of CMV can have a sore throat, though usually not as severe as in mono, along with weakness, fever, liver inflammation and a variety of other less common symptoms. Most people, but certainly not all, are well within a month or so. In one study, no one had fever for more than 35 days. There are case reports of CMV patients with fever for more than four months. In another series of cases, a few patients had fever for six weeks. I recently evaluated a young woman with CMV who had fever and lab abnormalities for more than two months. In general, however, illness lasts less than a month.

As I said, there are a few people who have a severe, prolonged illness. Why were you ill for so long? With any disease, some people get better more quickly than others, since no two people are quite the same. Another possibility is that you have an underlying condition that suppresses your disease-fighting immune system. Those who may be prone to severe, prolonged illness with CMV include people who are infected with HIV (the virus that causes AIDS), organ or bone-marrow transplant recipients, people on immune-suppressing medications, people who have a malignancy and those with a congenital condition that weakens the immune system. People with such conditions can also develop symptoms not commonly seen in previously healthy patients, such as lung infection, brain infection and infection of the retina of the eye.

One other possibility is that you had a second illness or infection. Many patients have been infected with both CMV and the Epstein-Barr virus. I recently saw such a case, and in one report, nine of 70 patients with CMV also had evidence of Epstein-Barr infection.