Cytomegalovirus (CMV) is a common herpesvirus that most healthy people catch without noticing, after which it stays dormant for life. It causes serious disease in transplant recipients, people with advanced HIV and babies infected before birth, where it is a leading cause of hearing loss.
Key symptoms
- Prolonged fever and fatigue, like a mild mononucleosis
- Floaters, blind spots or blurred vision
- Painful swallowing
- Diarrhea, sometimes bloody, with abdominal pain
- Cough and shortness of breath in transplant recipients
What you find on exam
- Swollen lymph nodes and enlarged liver or spleen
- Dilated eye exam: white retinal patches with bleeding
- Abdominal tenderness
- Low oxygen saturation and crackles
- Newborn: small head, jaundice, petechiae, enlarged liver and spleen
Tests
- Blood count with atypical lymphocytes and liver tests
- CMV IgM and IgG in healthy patients
- Quantitative CMV PCR in blood for transplant and HIV patients
- Biopsy showing inclusion bodies for colitis or esophagitis; newborn saliva or urine PCR within 3 weeks
Treatment basics
- Healthy patients: rest and supportive care
- Tissue-invasive disease: IV ganciclovir or oral valganciclovir
- Foscarnet for resistant virus
- Letermovir or valganciclovir prevention after transplant
- Symptomatic newborns: oral valganciclovir for 6 months, with hearing follow-up
Red flags
- New floaters or vision loss in a weakened immune system
- Bloody diarrhea or severe abdominal pain
- Breathlessness and low oxygen after a transplant
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Sources: NCCPA PANCE Content Blueprint; NBOME COMLEX-USA clinical presentations. Written by Making Synapses. Making Synapses is not affiliated with these organizations.