Clinical manifestations of cytomegalovirus disease

This topic covers treatment of active cytomegalovirus (CMV) disease and secondary prophylaxis. For information about primary prophylaxis and pre-emptive therapy in transplant recipients, see Cytomegalovirus prophylaxis in immunocompromised adults without HIV infection.

Up to 60% of adults are seropositive for CMV; in the majority of cases, asymptomatic infection is acquired in childhood.

In immunocompetent adults, CMV can cause a self-limited mononucleosis-like syndrome or self-limited hepatitis—these do not require antiviral therapy.

CMV disease—including colitis, oesophagitis, pneumonitis, hepatitis, encephalitis and retinitis—usually occurs in immunocompromised patients. It can also complicate established ulcerative colitis, and may present as an apparent exacerbation of the disease; this is more common in patients treated with immunosuppressive therapy but can also occur in untreated patients.

A CMV syndrome is also seen in transplant recipients; this consists of CMV viraemia plus other features that may include fever, malaise, cytopenias, atypical lymphocytosis or elevated liver aminotransferases, in the absence of tissue invasive disease.

CMV can infect babies in utero (approximately 7 per 1000 live births). Although the majority of infected babies are asymptomatic at birth, CMV can cause significant disease including multisystem organ failure, growth retardation, neurodevelopmental problems and sensorineural hearing loss. Sensorineural hearing loss is the most common sequela, occurring in 10 to 15% of infected infants.