Ganciclovir (or valganciclovir) is the treatment of choice for CMV infection
The correct answer is C: Ganciclovir is the treatment of choice for CMV infection. 1, 2
Why the other options are incorrect:
Option A is FALSE: CMV is NOT usually asymptomatic in immunocompromised individuals
- In immunocompromised patients (transplant recipients, CAR T-cell therapy, hematological malignancies), CMV causes significant clinical disease 1
- CMV infection rates reach 17-56% after CAR T-cell therapy, with clinically significant infection in 7-15% of cases 1
- In immunocompetent individuals, CMV is typically asymptomatic 3, 4, but this is the opposite in immunocompromised hosts
- The question specifically asks about CMV in general, not limited to immunocompetent hosts
Option B is FALSE: CMV does NOT most frequently affect the urinary system
- Gastrointestinal manifestations are the most common presenting feature (51.1% of CMV-positive patients) 5
- In HIV patients, the retina is the most common site of CMV pathology 4
- CMV can affect multiple organ systems including CNS, eyes, GI tract, and lungs 1
Option D is FALSE: Diagnosis is NOT made only via PCR
- While PCR (quantitative real-time PCR) is the preferred method for detecting active infection and viral load 5
- CMV serology (IgG and IgM antibodies) remains the standard for pretransplant screening 2
- IgM serology combined with low IgG avidity is used for diagnosing maternal infection 6
- Congenital CMV can be confirmed by virus detection in urine, blood, or saliva by culture OR PCR 7
Option E is FALSE: CMV DOES affect newborns
- Congenital CMV is the leading cause of non-genetic sensorineural hearing loss and neurodevelopmental disability in infants 3, 7, 8
- Congenital transmission rates reach 50% in women with primary infection during pregnancy 3
- Approximately 10% of infected infants have clinical signs at birth, with another 10-15% developing late-onset sequelae 3
Why Option C is CORRECT:
Ganciclovir (IV) and valganciclovir (oral) remain the drugs of choice for CMV management across multiple clinical scenarios:
- First-line treatment: Valganciclovir or IV ganciclovir are recommended for pre-emptive therapy and treatment of CMV disease 1, 2
- Solid organ transplant: Valganciclovir and IV ganciclovir are mainstays of CMV prevention and treatment 2
- Pediatric patients: Ganciclovir or valganciclovir are first-line options 1
Alternative agents exist but are second-line:
- Foscarnet: Used when ganciclovir cannot be given (renal impairment, neutropenia) 1
- Maribavir: Approved for resistant/refractory CMV but NOT first-line; has poor CNS/eye penetration 1
- Cidofovir: Reserved for resistant cases 1
Common pitfall to avoid:
Do not confuse letermovir (prophylaxis only) with treatment agents—it is NOT indicated for treating active CMV infection 1