Last reviewed: 28 Oct 2021
Last updated: 30 Jul 2021

Summary

Definition

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

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

  • 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

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

Treatment algorithm

Contributors

Authors

Matteo Mombelli, MD

Infectious Disease Service and Transplantation Center

University Hospital (CHUV)

University of Lausanne

Lausanne

Switzerland

Disclosures

MM declares that he has no competing interests.

Oriol Manuel, MD

Infectious Disease Service and Transplantation Center

University Hospital (CHUV)

University of Lausanne

Lausanne

Switzerland

Disclosures

OM has received research grants from Lophius and consultancy fees from MSD and Gilead.

Acknowledgements

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.

Disclosures

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

MD

Disclosures

GHT declares that he has no competing interests.

Simon Barton, MD, FRCOG, FRCPEd, FRCP

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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