From the Guidelines
Cytomegalovirus (CMV) infection is best diagnosed through PCR (polymerase chain reaction) of blood, urine, or other body fluids to detect viral DNA, as well as serologic testing for CMV-specific antibodies (IgM indicates recent infection while IgG shows past exposure) 1.
Diagnostic Tests for CMV Infection
The following diagnostic tests are used to diagnose CMV infection:
- PCR (polymerase chain reaction) of blood, urine, or other body fluids to detect viral DNA
- Serologic testing for CMV-specific antibodies (IgM indicates recent infection while IgG shows past exposure)
- Viral culture
- Histopathology with immunohistochemistry on tissue samples
Treatment Options for CMV Infection
Treatment options for CMV infection depend on the patient's immune status and disease severity.
- For immunocompetent patients with mild symptoms, treatment is usually supportive care only as the infection typically resolves on its own.
- For severe cases or immunocompromised patients, first-line treatment is intravenous ganciclovir at 5 mg/kg every 12 hours for 2-3 weeks, followed by oral valganciclovir 900 mg daily for maintenance 1.
- Alternative medications include foscarnet (90 mg/kg every 12 hours) for ganciclovir-resistant cases or cidofovir (5 mg/kg once weekly) with probenecid.
- Letermovir is used for prophylaxis in stem cell transplant recipients, with a daily oral or intravenous dose of 480 mg/day (or 240 mg/day in patients taking ciclosporin) for 14 weeks after transplantation 1.
Monitoring and Side Effects
Treatment duration varies based on clinical response and immune recovery, with monitoring of viral load to assess effectiveness.
- These antivirals work by inhibiting viral DNA polymerase, preventing CMV replication.
- Side effects require monitoring, including nephrotoxicity, myelosuppression, and electrolyte imbalances depending on the specific medication used 1.
From the FDA Drug Label
The diagnosis of CMV retinitis should be made by indirect ophthalmoscopy. Other conditions in the differential diagnosis of CMV retinitis include candidiasis, toxoplasmosis, histoplasmosis, retinal scars and cotton wool spots, any of which may produce a retinal appearance similar to CMV For this reason it is essential that the diagnosis of CMV be established by an ophthalmologist familiar with the retinal presentation of these conditions. The diagnosis of CMV retinitis may be supported by culture of CMV from urine, blood, throat or other sites, but a negative CMV culture does not rule out CMV retinitis
The diagnostic tests for CMV infection include:
- Indirect ophthalmoscopy to diagnose CMV retinitis
- Culture of CMV from urine, blood, throat, or other sites to support the diagnosis 2
From the Research
Diagnostic Tests for CMV Infection
- The detection of IgM antibodies against cytomegalovirus can be done using various methods such as direct antibody radioimmunoassay (RIA), M-antibody capture RIA (MACRIA), enzyme-linked immunosorbent assay (ELISA), and the immunofluorescent antibody (IFA) test 3.
- A novel multiplexed enzyme-linked immunosorbent assay has been developed for the detection of IgG seroreactivity to Cytomegalovirus (CMV) UL144, which can help in differentiating natural infection from CMV vaccines that lack UL144 4.
Treatment Options for CMV Infection
- Antiviral therapies such as ganciclovir, valganciclovir, foscarnet, and cidofovir are available for the treatment of CMV infection in neonates and infants 5.
- Valganciclovir is an orally administered prodrug of ganciclovir and is effective for the treatment of AIDS-related CMV retinitis and prophylaxis of CMV infection and disease in high-risk solid organ transplant recipients 6.
- Novel compounds such as maribavir and analogs of cidofovir are being developed as alternative treatments for CMV infection, with promising preliminary data from pre-clinical and phase I trials 7.
Key Considerations for Treatment
- The choice of antiviral therapy should be based on the patient's renal function, as some drugs such as ganciclovir and valganciclovir require dose adjustment in patients with impaired renal function 5.
- The potential toxicities of antiviral therapies, such as neutropenia, renal toxicity, and carcinogenesis, should be carefully considered when selecting a treatment option 5, 6.