In individuals with normal immune systems, cytomegalovirus (CMV) infection is often asymptomatic or manifests as infectious mononucleosis-like syndrome (fever, lymphadenopathy, and atypical lymphocytosis).
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.
History and exam
Key diagnostic factors
- 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
- 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
- inflammatory bowel disease
- acute illness in intensive care setting
- newborn in CMV infection during pregnancy
1st investigations to order
- serum creatinine
- serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT)
- serum alkaline phosphatase
- 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
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
- Infectious mononucleosis
- Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents
- Guidelines for the management of cytomegalovirus infection in patients with haematological malignancies and after stem cell transplantation from the 2017 European Conference on Infections in Leukaemia (ECIL 7)
CytomegalovirusMore Patient leaflets
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