Cytomegalovirus Infection

Seroprevalence increases with age and low socioeconomic status in USA: From 58.9% in those aged ≥6 y to 90.8% in those ≥80 y. Also higher in non-Hispanic blacks, Mexican Americans, and women.

Severe disease from CMV is rare in immunocompetent individuals.

Risk for CMV disease in transplant recipients: 10–40% with preventive measures.

Risk for CMV disease in HIV-positive pts: 20–30% (increased risk with low CD4 count).

Approximately 1:150 children is born with congenital CMV.

CMV transmission from tissue or blood products from a CMV-seropositive donor to a seronegative recipient

Related to severity of CMV-induced organ dysfunction (if present): Pulmonary, CNS, hepatic, GI, cardiac, bone marrow, adrenal

Giving CMV-seropositive blood products to a CMV-seronegative immunocompromised host; filters that remove leukocytes from the blood can be used to prevent transmission of CMV if CMV-seropositive blood donors are used.

Abnormal hepatic metabolism if CMV hepatitis is present may alter drug clearance.

Elevated ICP if CMV encephalitis/meningitis.

Abnormal oxygenation if CMV pneumonitis.

Myocardial dysfunction or arrhythmias if CMV myocarditis.

Perforated viscus secondary to colonic/gastric CMV.

Bone marrow suppression resulting in abnormal bleeding from thrombocytopenia, anemia, and neutropenia.

Adrenal insufficiency due to CMV adrenalitis.

Double-stranded DNA betaherpesvirus; member of the Herpesviridae family—largest virus to infect humans.

Vast majority of North American adults have had prior exposures and are CMV seropositive.

Establishes latency after primary infection. Secondary infection occurs after reactivation of a latent virus in an immunocompromised host.

Transmission through close contact, blood and blood products, organ transplantation, and sexually and perinatally.

Immunocompetent host: Asymptomatic, heterophile antibody–negative mononucleosis-like syndrome

Immunocompromised host: Symptomatic or asymptomatic viremia with or without organ involvement—retinitis, encephalitis, meningitis, myelitis, polyneuropathy, pneumonitis, esophagitis, gastritis, colitis, hepatitis, cholangitis, myocarditis, adrenalitis, vasculitis, and bone marrow suppression

Neonates: Petechial rash, jaundice with hepatosplenomegaly; neurologic abnormalities, such as microcephaly and lethargy, eye involvement with chorioretinitis and optic nerve atrophy, prematurity and low birth weight, and sensorineural hearing loss