Cytomegalovirus Infections

Stuart P. Adler; Beth Marshall

doi:10.1542/pir.28-3-92

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Stuart P. Adler, MD*
Beth Marshall, MD*

^*Department of Pediatrics, Virginia Commonwealth University, Medical College of Virginia Campus, Richmond, Va

Objectives

After completing this article, readers should be able to:

Discuss the risk factors for a mother acquiring a cytomegalovirus (CMV) infection during pregnancy.
Diagnose a primary CMV infection in pregnant women and healthy people.
Describe the fetal and newborn physical findings suggestive of a congenital CMV infection.
List the criteria for the diagnosis of CMV disease in immunocompromised patients.
Delineate the therapies most likely to be effective for treating CMV infections in pregnant women, newborns, and immunocompromised patients.

Introduction

Cytomegalovirus (CMV), a member of the herpesvirus family, has the largest genome of all the viruses that infect humans. Because the genome contains about 230 kb of double-stranded DNA and encodes for more than 100 proteins, it is difficult to determine how CMV infection occurs. CMV has adapted to the human immune system and spreads among humans via viral excretion in nearly all body fluids, including urine, saliva, and semen. In most CMV infections, there is no apparent impact on the immune system, and most infected people are disease-free. Disease associated with CMV infection generally occurs when the immune system is compromised, as in patients who have human immunodeficiency virus (HIV) infection or who have received organ transplants. Recent observations suggest that CMV disease associated with congenital infection may be due partly to placental dysfunction caused by CMV infection of the placenta.

Virus and Transmission

CMV viral particles are structurally similar to other human herpesviruses. The virus has a 65-nm inner core containing the viral DNA. The inner core is within an icosahedral protein capsid comprised of 162 capsomeres. This structure is surrounded by a tegument layer and an outer enveloped membrane containing glycoproteins. The envelope glycoproteins are antigenic and responsible for triggering an immune response. Most of the neutralizing antibodies induced by CMV antigens are directed against the major CMV glycoprotein gB, although other …