Last reviewed:September 2019
Last updated:January  2019

Summary

Definition

History and exam

Key diagnostic factors

  • presence of risk factors
  • malaise
  • fever
  • diarrhoea
  • nausea and vomiting
  • visual floaters and blindness
  • abnormalities on fundoscopy
  • newborn: microcephaly
  • newborn: poor tone and motor function and abnormal head lag
  • newborn: hearing loss

Other diagnostic factors

  • newborn: hepatosplenomegaly
  • newborn: petechiae or purpura
  • pain and weakness

Risk factors

  • CMV D+/R- status (donor CMV seropositive, recipient seronegative) in solid organ transplant recipients
  • CMV R+ (recipient seropositive) in transplant recipients
  • type of immunosuppressive drugs
  • AIDS
  • inflammatory bowel disease
  • acute illness in intensive care setting
  • newborn in CMV infection during pregnancy

Diagnostic investigations

1st investigations to order

  • FBC
  • serum creatinine
  • serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
  • serum alkaline phosphatase
  • serology
  • pp65 antigenaemia
  • nucleic acid detection
  • CD4 count
  • chest x-ray
Full details

Investigations to consider

  • chest CT scan
  • histopathology of biopsy
  • upper gastrointestinal endoscopy and colonoscopy
  • serial fetal ultrasound examinations (congenital CMV infection)
  • amniocentesis or fetal blood sampling (congenital CMV infection)
  • brain ultrasound/brain MRI: newborns
Full details

Treatment algorithm

Contributors

Infectious Disease Service and Transplantation Center

University Hospital (CHUV)

University of Lausanne

Lausanne

Switzerland

Disclosures

MM declares that he has no competing interests.

Infectious Disease Service and Transplantation Center

University Hospital (CHUV)

University of Lausanne

Lausanne

Switzerland

Disclosures

OM has received research grants from Lophius

Dr Matteo Mombelli and Dr Oriol Manuel would like to thank Dr Sandra Asner from the University Hospital of Lausanne, Switzerland for her careful review of congenital CMV in this topic. They would also like to gratefully acknowledge Dr Raymund R. Razonable and Dr Atul Humar, the previous contributors to this topic.

Peer reviewersVIEW ALL

Assistant Professor

Department of Family Medicine

University of Maryland School of Medicine

MD

Disclosures

GHT declares that he has no competing interests.

Clinical Director

HIV and Sexual Health

Chelsea and Westminster Hospital

London

UK

Disclosures

SB has been funded by GlaxoSmithKline and Gilead for speaking at scientific meetings.

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