Cytomegalovirus Infection

Cytomegalovirus (CMV), or human herpesvirus-5 (HHV-5), is a ubiquitous DNA virus belonging to the herpesvirus family. Most infections are asymptomatic in immunocompetent hosts, but CMV can reactivate from latency in bone marrow and other tissues when immunity wanes. Transmission occurs via blood, saliva, urine, breast milk, sexual contact, and transplanted organs.

Clinical Features

In healthy adults and children, CMV may cause a self-limited mononucleosis-like syndrome with fever, fatigue, sore throat, lymphadenopathy, myalgia, and occasionally rash or mild hepatitis. Congenital CMV can lead to intrauterine growth restriction, hepatosplenomegaly, jaundice, microcephaly, sensorineural hearing loss, and neurodevelopmental delay. In immunocompromised patients—such as transplant recipients or those with advanced HIV—CMV may cause pneumonitis, colitis, hepatitis, retinitis, encephalitis, and graft dysfunction.

Diagnosis and Management

Diagnosis relies on CMV IgM/IgG serology, PCR quantification of viral DNA in blood or fluids, and tissue biopsy with histopathology in invasive disease. Healthy individuals typically require supportive care only. Severe or high-risk cases are treated with systemic antivirals—oral valganciclovir or intravenous ganciclovir—as first-line therapy; alternatives include foscarnet or cidofovir for resistant strains. Prevention emphasizes hygiene, screening of donors, and prophylaxis in high-risk transplant populations per updated 2025 guidelines.