From the Guidelines
A comprehensive workup for a 4-year-old with suspected cytomegalovirus (CMV) infection should include serology testing, PCR testing of bodily fluids, and assessments for organ involvement, with treatment decisions guided by the presence of symptoms and consultation with pediatric specialists. The workup should begin with serology testing, including CMV IgG and IgM antibodies to determine current or past infection 1. PCR testing of blood, urine, or saliva can detect active viral replication, with urine being particularly useful in children. Complete blood count, liver function tests, and inflammatory markers should be included to assess organ involvement. If neurological symptoms are present, consider cerebrospinal fluid analysis and brain imaging. Ophthalmologic examination is important to evaluate for retinitis.
For symptomatic congenital or severe acquired CMV, treatment with ganciclovir (5 mg/kg/dose twice daily administered intravenously) or oral valganciclovir may be indicated, with dosing and duration guided by the severity of the infection and the presence of any complications, such as neutropenia or renal toxicity 1. The major side effect of ganciclovir is myelosuppression, and dose reduction or interruption might be necessary in up to 40% of patients because of hematologic toxicity; granulocyte colony-stimulating factor can be used to ameliorate marrow suppression.
Key components of the workup include:
- Serology testing for CMV IgG and IgM antibodies
- PCR testing of bodily fluids (blood, urine, or saliva)
- Complete blood count, liver function tests, and inflammatory markers
- Cerebrospinal fluid analysis and brain imaging if neurological symptoms are present
- Ophthalmologic examination to evaluate for retinitis
- Consideration of treatment with ganciclovir or oral valganciclovir for symptomatic congenital or severe acquired CMV, with careful monitoring for side effects and adjustment of dosing as needed.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Workup for a 4-year-old with Cytomegalovirus (CMV) Infection
The workup for a 4-year-old with CMV infection may involve the following:
- Laboratory investigations, including complete blood counts to check for hematological abnormalities, such as neutropenia or anemia 2, 3
- Urine or saliva CMV Polymerase Chain Reaction (PCR) test to confirm the diagnosis 4, 3
- Imaging studies, such as ultrasound or MRI scans, to assess for any organ involvement or abnormalities 4
- Monitoring of viral load and hematologic parameters during antiviral therapy 2, 3
- Consideration of antiviral therapy, such as valganciclovir or ganciclovir, to reduce the risk of complications and improve outcomes 5, 2, 4, 3
Antiviral Therapy
Antiviral therapy for CMV infection in children may involve the use of:
- Valganciclovir, which has been shown to be effective in reducing hearing loss and improving neurodevelopmental outcomes in infants with congenital CMV infection 2, 4
- Ganciclovir, which is also effective against CMV, but may have a higher risk of adverse events, such as neutropenia and renal toxicity 5, 6
- Other antiviral agents, such as foscarnet and cidofovir, which may be used in certain cases, but have a higher risk of adverse events 5, 6
Monitoring and Follow-up
Regular monitoring and follow-up are essential for children with CMV infection, including:
- Regular blood counts and viral load measurements to monitor the effectiveness of antiviral therapy and detect any potential adverse events 2, 3
- Audiological and neurological assessments to monitor for any hearing or developmental abnormalities 4
- Regular ultrasound or MRI scans to monitor for any organ involvement or abnormalities 4