Cytomegalovirus infection

Cytomegalovirus (CMV) infection is often asymptomatic or manifests as infectious mononucleosis-like syndrome (fever, lymphadenopathy, and atypical lymphocytosis) in people with normal immune systems.

In immunocompromised individuals (patients with AIDS and transplant recipients), disease manifests with fever, bone marrow suppression, and tissue-invasive disease such as pneumonitis, hepatitis, colitis, nephritis, and retinitis.

In the fetus, CMV infection may lead to cytomegalic inclusion disease, characterized by severe neurologic abnormalities, intellectual disability, and hearing defects.

Tests for diagnosis include: serology, pp65 antigenemia test, histopathology, and nucleic acid amplification and detection systems, most commonly quantitative polymerase chain reaction-based assays.

In immunocompetent individuals, infection is usually self-limited; therefore, treatment is usually not indicated.

In patients with compromised immune function, the treatment of choice is oral valganciclovir or intravenous ganciclovir. Intravenous foscarnet and cidofovir are less preferred agents.

Cytomegalovirus (CMV) is a ubiquitous beta-herpes virus that infects the majority of humans. Primary infection in individuals with normal immune function is usually asymptomatic. After primary infection, CMV establishes a state of lifelong latency in various host cells, with periodic subclinical reactivations that are controlled by a functioning immune system. When reactivation (or primary infection) occurs in patients with severely compromised immune function (transplant patients or patients with AIDS and CD4 count <50 cells/microliter), uncontrolled CMV replication often ensues, which leads to the clinical manifestations characterized by fever, bone marrow suppression, and tissue-invasive disease.​[1]Razonable RR, Humar A. Cytomegalovirus in solid organ transplant recipients - Guidelines of the American Society of Transplantation Infectious Diseases Community of Practice. Clin Transplant. 2019 Sep;33(9):e13512. http://www.ncbi.nlm.nih.gov/pubmed/30817026?tool=bestpractice.com ​​[2]HIV.gov, US National Institutes of Health. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. Jul 2021 [internet publication]. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection/cytomegalovirus-disease?view=full ​