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Cytomegalovirus (CMV) – Infection, Symptoms & Treatment

Cytomegalovirus (CMV) is a widespread herpesvirus that is usually harmless in healthy individuals but can cause serious disease in immunocompromised patients and unborn children.

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Things worth knowing about "Cytomegalovirus"

Cytomegalovirus (CMV) is a widespread herpesvirus that is usually harmless in healthy individuals but can cause serious disease in immunocompromised patients and unborn children.

What is Cytomegalovirus?

Cytomegalovirus (CMV), formally known as Human herpesvirus 5 (HHV-5), belongs to the Herpesviridae family. Its name derives from the Greek for large cell, referring to the characteristic swelling of infected cells. CMV is one of the most common viral infections worldwide, with 50 to 80 percent of adults carrying the virus in a latent (dormant) state. Once infected, the virus remains in the body for life and can reactivate when the immune system is weakened.

Causes and Transmission

CMV spreads through close contact with infected body fluids, including:

Saliva (e.g., kissing or sharing utensils)
Urine, especially from young children
Blood and blood products
Breast milk
Semen and vaginal fluids
Mother-to-child transmission during pregnancy (congenital CMV infection)
Organ or stem cell transplantation

Symptoms

In immunocompetent individuals

In people with a healthy immune system, CMV infection is most often completely asymptomatic or resembles a mild flu-like illness with fever, fatigue, sore throat, and swollen lymph nodes, similar to infectious mononucleosis (CMV mononucleosis syndrome).

In immunocompromised individuals

In people with a weakened immune system, such as organ transplant recipients, individuals with HIV/AIDS, or those undergoing immunosuppressive therapy, CMV can cause severe and life-threatening disease:

CMV retinitis: Inflammation of the retina, which can lead to blindness
CMV pneumonia: Lung inflammation
CMV colitis: Inflammation of the large intestine causing diarrhea and abdominal pain
CMV encephalitis: Inflammation of the brain
CMV hepatitis: Liver inflammation

Congenital CMV infection (in newborns)

A primary CMV infection during pregnancy can harm the unborn child. Potential consequences include:

Hearing loss or deafness
Developmental delays
Microcephaly (abnormally small head)
Visual impairment and brain damage

Diagnosis

CMV infection is diagnosed using several methods:

Blood test (serology): Detection of CMV-specific antibodies (IgM and IgG) to distinguish between recent and past infection
PCR (polymerase chain reaction): Direct detection of CMV DNA in blood, urine, or other body fluids
Virus culture: Growing the virus from patient samples (rarely used in routine clinical practice)
Histology: Microscopic identification of characteristic owl-eye inclusion bodies in tissue samples

Treatment

No specific treatment is usually required in healthy individuals. For severe or life-threatening cases, antiviral medications are used:

Ganciclovir (intravenous): First-line treatment for severe CMV disease
Valganciclovir (oral): Used for maintenance therapy and prophylaxis in transplant patients
Foscarnet and Cidofovir: Alternative agents in cases of resistance or intolerance to ganciclovir

In symptomatic congenital CMV infection, early antiviral therapy with valganciclovir can help reduce hearing loss and neurological complications.

Prevention

There is currently no approved vaccine against CMV. Preventive measures include:

Frequent and thorough handwashing, especially after contact with the urine or saliva of young children
Avoiding sharing of utensils, glasses, or toothbrushes
Practicing safe sex
CMV screening and antiviral prophylaxis in transplant patients
Regular CMV testing during pregnancy for high-risk groups

References

World Health Organization (WHO): Cytomegalovirus (CMV) and Congenital CMV Infection. Available at: https://www.who.int
Centers for Disease Control and Prevention (CDC): Cytomegalovirus (CMV) and Congenital CMV Infection. Available at: https://www.cdc.gov/cmv
Revello MG, Gerna G. Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant. Clinical Microbiology Reviews, 2002; 15(4):680-715.

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