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For further information, see CMDT Part 32-01: Human Herpesviruses
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Most CMV infections are asymptomatic
CMV seroprevalence increases with
Age
Lower socioeconomic status
Number of sexual partners
History of prior sexually transmitted infections
Employment in child day care centers
Acute acquired CMV infection is similar to infectious mononucleosis, except pharyngeal symptoms unusual
Virus can be isolated from a variety of tissues under nonpathogenic conditions
Serious disease occurs primarily in immunocompromised persons
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Perinatal disease and CMV inclusion disease
Jaundice, hepatosplenomegaly, thrombocytopenia, purpura, microcephaly, periventricular CNS calcifications, mental retardation, and motor disability
Hearing loss develops in greater than 50% of infants who are symptomatic at birth
Most infected neonates are asymptomatic, but neurologic deficits may ensue later in life, including hearing loss in 15% and mental retardation in 10–20%
Perinatal infection acquired through breast-feeding or blood products typically shows a benign clinical course
CMV infection in immunocompetent persons
Mononucleosis-like syndrome with negative heterophil antibodies
The mononucleosis-like syndrome can also occur post-splenectomy, often years later
Fever, malaise, myalgias and arthralgias, splenomegaly, atypical lymphocytes, and abnormal liver function tests
Cutaneous rashes are common
Typically, leukopenia is followed by leukocytosis
Complications
CMV infection in immunocompromised persons
CMV retinitis, with neovascular and proliferative retinal lesions, occurs primarily in advanced AIDS
GI and hepatobiliary CMV, with esophagitis, small bowel inflammation, colitis, or cholangiopathy, occurs in AIDS or with high-dose chemotherapy
Pneumonitis occurs in transplant recipients and AIDS
Neurologic manifestations include polyneuropathy, transverse myelitis, encephalitis
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Characteristic clinical symptoms in immunosuppressed patients
Tzanck smear, CMV antibodies, and polymerase chain reaction (PCR) helpful in the proper clinical context
Tissue biopsy showing characteristic histology is used to document invasive disease
Pregnant women should be tested for CMV viremia every 3 months if an assay during the first trimester is seropositive
An ELISPOT assay is superior to Quantiferon assays in reports from China and may show potential for both diagnosis and monitoring disease in transplant recipients
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In immunocompetent persons, CMV infection is usually self-limited and no specific antiviral therapy is needed
In immunocompromised persons, treatment of CMV disease is necessary
Intravenous ganciclovir: recommended dose is 5 mg/kg every 12 hours (although this needs to be adjusted for kidney function) until two CMV PCRs 1 week apart are negative (usually 14–21 days)
Oral valganciclovir dose: 900 mg every 12 hours (also needs to be adjusted for kidney function) is an acceptable alternative in patients with non–life-threatening disease
Pneumonia due to CMV in hematopoietic stem cell transplant recipients is treated even more aggressively
5 mg/kg of ganciclovir intravenously every 12 hours for 21 days followed by 5 mg/kg daily for 3–4 weeks plus CMV immunoglobulin (500 mg/kg)
CMV immunoglobulin (150 mg/kg) twice per week for 2 weeks and then once ...