Last reviewed: December 2018
Last updated: January  2017



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
  • allograft rejection
  • graft-versus-host disease
  • immunosuppressive drugs
  • severe immunodeficiency
  • organ or hematopoietic stem cell transplant
  • viral coinfections
  • bacterial infections
  • newborn in primary CMV infection during pregnancy

Diagnostic investigations

1st investigations to order

  • CBC
  • serum creatinine
  • serum AST and ALT
  • serum alk phos
  • serology
  • pp65 antigenemia
  • nucleic acid detection
  • viral culture
  • CD4 count
  • CXR
Full details

Investigations to consider

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

Treatment algorithm


Authors VIEW ALL


Multi Organ Transplant Program

Toronto General Hospital





AH has done consultancy work for Astellas, Chimerix, and Roche.

Dr Atul Humar would like to gratefully acknowledge Dr Raymund R. Razonable, a previous contributor to this monograph. RRR is an author of a number of references cited in this monograph.

Peer reviewers VIEW ALL

Assistant Professor

Department of Family Medicine

University of Maryland School of Medicine



GHT declares that he has no competing interests.

Clinical Director

HIV and Sexual Health

Chelsea and Westminster Hospital




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

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