Cytomegalovirus infection

Last reviewed: 2 Sep 2023
Last updated: 22 Jun 2023



History and exam

Key diagnostic factors

  • malaise
  • fever
  • diarrhea
  • 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
More key diagnostic factors

Other diagnostic factors

  • newborn: hepatosplenomegaly
  • newborn: petechiae or purpura
  • pain and weakness
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • CBC
  • serum creatinine
  • serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
  • serum alkaline phosphatase
  • serology
  • pp65 antigenemia
  • nucleic acid detection
  • CD4 count
  • chest x-ray
More 1st investigations to order

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
More investigations to consider

Treatment algorithm


acquired self-limited illness: immunocompetent

infection in transplant recipient: no known drug resistance

infection in patient with AIDS: no known drug resistance

infection: known drug resistance

congenital infection



Matteo Mombelli, MD

Infectious Disease Service and Transplantation Center

University Hospital (CHUV)

University of Lausanne




MM declares that he has no competing interests.

Oriol Manuel, MD

Infectious Disease Service and Transplantation Center

University Hospital (CHUV)

University of Lausanne




OM has been reimbursed by MSD, Takeda, and Biotest for Advisory Boards and Lectures regarding CMV in organ transplantation.


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.


RRR is an author of a number of references cited in this topic. AH has done consultancy work for Astellas, Chimerix, and Roche.

Peer reviewers

Gregory H. Taylor, MD

Assistant Professor

Department of Family Medicine

University of Maryland School of Medicine



GHT declares that he has no competing interests.

Simon Barton, MD, FRCOG, FRCPEd, FRCP

Clinical Director

HIV and Sexual Health

Chelsea and Westminster Hospital




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

  • Cytomegalovirus infection images
  • Differentials

    • Infectious mononucleosis
    • HIV
    • Toxoplasmosis
    More Differentials
  • Guidelines

    • Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents
    • Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7)
    More Guidelines
  • Patient leaflets


    More Patient leaflets
  • padlock-lockedLog in or subscribe to access all of BMJ Best Practice

Use of this content is subject to our disclaimer