From the Guidelines
Common Symptoms and Presentation of CMV Infection in Adults
Adults with CMV infection typically present with fever, fatigue, swollen glands, and sore throat 1. In severe cases, symptoms can also involve the lungs, liver, and gastrointestinal tract, leading to pneumonia, hepatitis, and colitis. Some individuals may experience a mononucleosis-like syndrome, characterized by fever, sore throat, and lymphadenopathy.
Symptoms in Immunocompromised Adults
In immunocompromised adults, such as those with HIV/AIDS or organ transplant recipients, CMV infection can cause more severe and life-threatening illnesses, including:
- Retinitis
- Encephalitis
- Colitis 1.
Diagnosis and Treatment
The diagnosis of CMV infection is based on the detection of the virus in blood, tissue, or other bodily fluids, and can be confirmed by viral culture, antigenemia, or DNA/RNA-based assays 1. Antiviral medications like ganciclovir, valganciclovir, or foscarnet may be prescribed to treat CMV infection, with dosages and durations varying depending on the severity of the disease and the individual's immune status 1.
Key Points
- CMV infection can occur through reactivation or primary infection 1
- The risk of CMV reactivation and disease is highest among HCT recipients with CMV-seropositive status prior to transplant 1
- Letermovir has been shown to be effective in preventing CMV infection in allogeneic HCT recipients 1
- Valganciclovir and ganciclovir are the agents of choice for first-line pre-emptive therapy, while foscarnet is more commonly used for patients who cannot tolerate ganciclovir or for second-line pre-emptive therapy 1
From the Research
Common Symptoms of CMV Infection in Adults
- CMV infection in healthy adults is usually asymptomatic or causes a mild mononucleosis-like syndrome 2
- Symptoms can include fever, malaise, cephalgia, and enlargement of the spleen 3
- Patients may also experience relative lymphocytosis, elevated levels of alanine aminotransferase (ALT) and lactate dehydrogenase (LDH), and slightly elevated C-reactive protein 3
- CMV disease can present with a wide range of manifestations, including colitis, which is the most common 2
- In immunocompetent patients, CMV infection can cause a variety of clinical syndromes, including gastrointestinal, central or peripheral nervous system, and ocular disease, as well as hematological, pulmonary, cardiac, and cutaneous disease 4
Presentation of CMV Infection in Adults
- CMV infection can mimic other diagnoses, posing a significant diagnostic challenge, especially in immunocompetent adults 2
- The disease can be self-limiting, but treatment with intravenous ganciclovir or oral valganciclovir may be required in some cases 5, 4
- Certain populations, such as critically ill patients, pregnant women, elderly patients, and those with inflammatory bowel disease, may be more susceptible to CMV infection 4
- Systemic symptoms, such as fever, sweats, and weight loss, lymphocytosis, and hepatitis, can be useful clues in diagnosing CMV infection 4
- Non-invasive testing for CMV, including serology tests and PCR amplification, can facilitate early diagnosis if used appropriately 2, 6