Cytomegalovirus infection

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

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
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

ACUTE

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

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

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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