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Cytomegalovirus infection

Last reviewed: 12 Nov 2024
Last updated: 03 Sep 2024

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
Full details

Other diagnostic factors

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

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
Full details

Diagnostic tests

1st tests 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
Full details

Tests 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

ACUTE

acquired self-limited illness: immunocompetent

infection in transplant recipient: no known drug resistance

infection in patient with AIDS: no known drug resistance

refractory/resistant infection

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 participated in Advisory Boards of MSD, Takeda, Astra-Zeneca, and Biotest.

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

Joseph Sassine, MD

Assistant Professor of Medicine

Transplant Infectious Diseases

University of Oklahoma Health Sciences Center

Oklahoma City

OK

Disclosures

JS reports research grants paid to his institution from Ansun BioPharma, Cidara Therapeutics, Community Infusion Solutions, F2G, and Shionogi.

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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