This HIV+ male is experiencing CMV retinitis caused by the cytomegalovirus (CMV) which is a linear, dsDNA enveloped virus.
CMV, or human herpes virus type 5, is a linear, dsDNA, enveloped virus that is transmitted via the following routes: congenital, blood transfusion, sex, saliva, urine, and transplantation. Once CMV has established its initial infection, it establishes a latent infection within mononuclear cells. CMV causes mononucleosis in immunocompentent individuals. In infants, it causes cytomegalic inclusion disease resulting in neonatal jaundice, hepatosplenomegaly, thrombocytic purpura, hearing loss, and seizures. In the immunocompromised (e.g. individuals with AIDS or transplant patients taking immunosuppressive medications), it causes retinitis and pneumonia.
Taylor discusses that CMV infection is typically asymptomatic but in 7% of infected individuals, it will cause mononucleosis similar to that caused by Epstein-Barr virus. Complications are rare except in neonates, but the virus can reactivate in the immunocompromised with the retina being the most common location for CMV-related problems.
Ahmed reviews the treatment of CMV infections. Treatments for CMV were first developed during the AIDS epidemic for treatment of end-organ disease. Four antivirals were developed to treat CMV: ganciclovir, valganciclovir, foscarnet, ad cidofovir.
Figure A demonstrates cotton-wool spots on the retina in CMV retinitis, which appear as white patches on the retina and are caused by neuronal damage. Illustration A shows the classic CMV inclusion body which is intranuclear and is surrounded by a clear halo. Illustration B is another example of a CMV inclusion body that is demonstrating the "CMV owl's eye" appearance.
These viruses do not cause cotton-wool spots (Figure A).
Answer 1: Rhinovirus is a linear (+)ssRNA, nonenveloped virus.
Answer 2: Influenza virus is a linear (-)ssRNA, segmented enveloped virus.
Answer 3: Hepatitis B is a partial circular, dsDNA enveloped virus.
Answer 5: JC virus is a circular dsDNA, nonenveloped virus.
Taylor GH. Cytomegalovirus. Am Fam Physician. 2003 Feb 1;67(3):519-24. Review.
PMID:12588074 (Link to Abstract)
Ahmed A. Antiviral treatment of cytomegalovirus infection. Infect Disord Drug Targets. 2011 Oct;11(5):475-503. Review.
PMID:21827432 (Link to Abstract)