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General Medicine

Cytomegalovirus (CMV) Inclusion Disease

David L. Lee, MD, Munima Nasir, MD and Jarrett Sell, MD, AAHIVS Reviewed 06/2018
 


BASICS

A ubiquitous and common infection impacting people of all ages, ethnic and socioeconomic groups, and geographic areas 

  • Although most cytomegalovirus (CMV) infections are asymptomatic or cause mi...

DIAGNOSIS

HISTORY

  • Congenital

    • ~1% (0.2–2.2%) of newborns are congenitally infected with CMV (3).

    • Most infected newborns appear normal and are asymptomatic, although as many as 7–15% develop sensorineural ...

TREATMENT

MEDICATION

First Line

  • Congenital disease: ganciclovir 6 mg/kg IV q12h for 6 weeks (3)[A], alternately valganciclovir 16 mg/kg PO q12h for 6 weeks if patient is >7 days old and can tolerate ...

ONGOING CARE

FOLLOW-UP RECOMMENDATIONS

Patient Monitoring

  • CMV urine culture at birth for all HIV-infected or exposed with annual testing in CMV seronegative/HIV+ children

  • Patients with CD4 counts <50 ...

REFERENCES

1
Panel on Opportunistic Infections in HIV-Infected Adults and Adolescents. Guidelines for the prevention and treatment of opportunistic infections in HIV-infected adults and adolescents: re...

ADDITIONAL READING

  • Amir J, Wolf DG, Levy I. Treatment of symptomatic congenital cytomegalovirus infection with intravenous ganciclovir followed by long-term oral valganciclovir. Eur J Pediatr.  2...

CODES

ICD10

  • B25.9 Cytomegaloviral disease, unspecified

  • P35.1 Congenital cytomegalovirus infection

  • B25.8 Other cytomegaloviral diseases

ICD9

  • 078.5 Cytomegaloviral disease

  • 771.1 Congenital cytomegalovirus inf...

CLINICAL PEARLS

  • CMV is a major cause of sensorineural hearing loss in young children.

  • Up to 97% of adults worldwide have antibodies to CMV.

  • CMV mononucleosis syndrome has less cervical adenopathy and/or...

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Related Images
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FIGURE 42-2 Clinical appearance and radiologic findings of infants with congenital cytomegalovirus. A. Infant with severe congenital CMV with stigmata of disease, including petechial rash, microcephaly, jaundice, and abnormal posture of upper extremities secondary to central nervous system (CNS) damage. B. Computerized tomographic image of an infant with CNS damage secondary to congenital CMV with severe periventricular calcificatio...
FIGURE 42-2 Clinical appearance and radiologic findings of infants with congenital cytomegalovirus. A. Infant with severe congenital CMV w...
FIGURE 58.1. A: Lung tissue with characteristic "owl's-eye" cytomegalovirus nuclear inclusion and cytoplasmic inclusions (H&E, 31,000, oil). B: Esophageal tissue with herpes virus intranuclear inclusions with multinucleation (H&E, 31,000, oil). C: Lung tissue with a "smudged" intranuclear inclusion characteristic of adenovirus (center H&E, 31,000, oil). D: Heart tissue with an intramyocardial Toxoplasma cyst (H3E, 31,000, oil).(continued)
FIGURE 58.1. A: Lung tissue with characteristic "owl's-eye" cytomegalovirus nuclear inclusion and cytoplasmic inclusions (H&E, 31,000, ...
An infant with congenital cytomegalovirus infection. Infant had jaundice, hepatosplenomegaly, and petechiae.
An infant with congenital cytomegalovirus infection. Infant had jaundice, hepatosplenomegaly, and petechiae.
Congenital CMV "blueberry muffin" baby with jaundice and thrombocytopenia purpura.
Congenital CMV "blueberry muffin" baby with jaundice and thrombocytopenia purpura.
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