Cytomegalovirus is a ubiquitous human virus: 50% of adults in developed countries harbor antibodies, which are usually acquired during the first 5 years of life. The virus can be isolated from all body fluids, even in the presence of circulating neutralizing antibodies, for up to several years after infection. Serologic and PCR testing is available to assist in the diagnosis of CMV infection. The pp65 antigen assay is a sensitive and specific test used to guide antiviral therapy in transplant recipients and detect subclinical disease in high-risk patients.
Congenital CMV disease carries a 20% incidence of hearing loss or cognitive impairment and a 0.1% incidence of various other severe congenital disorders, including jaundice, hepatosplenomegaly, anemia, microcephaly, and chorioretinitis. Infections in adults include heterophile-negative mononucleosis, pneumonia, hepatitis, and Guillain-Barré syndrome. In immunocompromised patients, CMV interstitial pneumonia carries a 90% mortality rate. Disseminated spread to the gastrointestinal tract, CNS, and eyes is common in patients with AIDS. Latent infection within leukocytes causes transfusion-associated disease. CMV retinitis has been reported following intravitreal corticosteroid injections.
Allice T, Cerutti F, Pittaluga F, et al. Evaluation of a novel real-time PCR system for cytomegalovirus DNA quantitation on whole blood and correlation with pp65-antigen test in guiding pre-emptive antiviral treatment. J VirolMethods.2008;148(1–2):9–16.
Excerpted from BCSC 2020-2021 series: Section 1 - Update on General Medicine. For more information and to purchase the entire series, please visit https://www.aao.org/bcsc.