Cytomegalovirus Infection: Causes, Symptoms and Treatment
Cytomegalovirus (CMV) infection is a common viral disease caused by the cytomegalovirus. It is usually harmless in healthy individuals but can pose serious risks to pregnant women, unborn children, and immunocompromised patients.
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Cytomegalovirus (CMV) infection is a common viral disease caused by the cytomegalovirus. It is usually harmless in healthy individuals but can pose serious risks to pregnant women, unborn children, and immunocompromised patients.
What is Cytomegalovirus Infection?
Cytomegalovirus (CMV) infection, also known as cytomegaly, is caused by the cytomegalovirus, a member of the herpesvirus family. CMV is found worldwide, and it is estimated that 50 to 80 percent of adults have been infected at some point in their lives, often without knowing it. Once contracted, the virus remains dormant in the body for life but is kept under control by a healthy immune system.
Causes and Transmission
CMV spreads through close contact with infected body fluids, including:
- Saliva (e.g., kissing or sharing utensils)
- Urine (especially common in young children)
- Blood and blood products
- Breast milk
- Sexual transmission through semen and vaginal secretions
- From mother to unborn child (congenital CMV infection)
Young children in daycare settings frequently shed the virus in their urine and saliva over extended periods, making them a common source of transmission to adults, particularly pregnant women.
Symptoms
In Healthy Individuals
In people with a healthy immune system, CMV infection typically causes no symptoms or only mild, flu-like complaints. Occasionally, a mononucleosis-like syndrome may develop, characterized by:
- Persistent fatigue and exhaustion
- Low-grade fever
- Swollen lymph nodes
- Sore throat
- Muscle and joint pain
In Immunocompromised Individuals
In people with weakened immune systems -- such as organ transplant recipients, HIV-positive individuals, or those receiving immunosuppressive therapy -- CMV can cause severe, potentially life-threatening disease:
- CMV retinitis: Inflammation of the retina that can lead to vision loss
- CMV pneumonia: Lung infection caused by CMV
- CMV colitis: Inflammation of the large intestine
- CMV encephalitis: Inflammation of the brain
Congenital CMV Infection (in Newborns)
If a pregnant woman is infected with CMV for the first time during pregnancy, the virus can be transmitted to the unborn child. Congenital CMV is the most common congenital viral infection worldwide. Potential complications in the child include:
- Hearing loss (the leading non-hereditary cause of hearing loss in children)
- Intellectual and developmental delays
- Visual impairment
- Microcephaly (abnormally small head circumference)
- Liver damage and jaundice
Diagnosis
CMV infection is diagnosed using several laboratory methods:
- Blood test: Detection of CMV-specific antibodies (IgG and IgM) to determine whether the infection is recent or past
- PCR test: Direct detection of CMV genetic material (DNA) in blood, urine, or other body fluids -- especially important in immunocompromised patients and newborns
- Virus culture: Growing the virus from body fluids (less commonly used)
- Prenatal diagnosis: If congenital infection is suspected, amniotic fluid is tested for CMV DNA via amniocentesis
Treatment
In Healthy Individuals
Healthy individuals generally do not require specific treatment, as the immune system controls the virus on its own. Supportive measures such as rest and adequate fluid intake are sufficient to manage mild symptoms.
In Immunocompromised Individuals
For severe or life-threatening CMV disease, antiviral medications are used:
- Ganciclovir (intravenous): First-line treatment for serious CMV disease
- Valganciclovir (oral): Used for prophylaxis and maintenance therapy
- Foscarnet and Cidofovir: Alternatives in cases of ganciclovir resistance
In Newborns with Congenital CMV
Newborns with symptomatic congenital CMV infection are treated with oral valganciclovir. Clinical studies have shown that early treatment can reduce the risk of hearing loss and neurological damage.
Prevention
No licensed vaccine against CMV is currently available. Pregnant women in particular are advised to take the following preventive measures:
- Frequent and thorough handwashing, especially after changing diapers
- Avoid sharing utensils, cups, or toothbrushes with young children
- Avoid kissing young children on the mouth
References
- Centers for Disease Control and Prevention (CDC): Cytomegalovirus (CMV) and Congenital CMV Infection. Available at: www.cdc.gov
- Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Reviews in Medical Virology, 2010; 20(4): 202-213.
- Kimberlin DW et al. Valganciclovir for symptomatic congenital cytomegalovirus disease. New England Journal of Medicine, 2015; 372(10): 933-943.
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