Cytomegalovirus Infection

Erin J. Plosa; Jennifer C. Esbenshade; M. Paige Fuller; Jörn-Hendrik Weitkamp

doi:10.1542/pir.33-4-156

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Erin J. Plosa, MD^*
Jennifer C. Esbenshade, MD, MPH^†
M. Paige Fuller, PharmD^‡
Jörn-Hendrik Weitkamp, MD^†

^*Instructor in Pediatrics, Department of Pediatrics, Vanderbilt University School of Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN.
^†Assistant Professor of Pediatrics, Department of Pediatrics , Vanderbilt University School of Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN.
^‡Departments of Pediatrics and Pharmacy, Vanderbilt University School of Medicine, Monroe Carell Jr Children's Hospital at Vanderbilt, Nashville, TN.

Author Disclosure
Drs Plosa, Esbenshade, Fuller, and Weitkamp have disclosed no financial relationships relevant to this article. This commentary does contain a discussion of an unapproved/investigative use of a commercial product/device.

Abbreviations:

CMV:: cytomegalovirus
R⁻:: recipient negative for CMV infection
SNHL:: sensorineural hearing loss
U_L:: unique long region

Educational Gap

There is wide variation among centers regarding prophylactic versus preemptive therapy for posttransplantation cytomegalovirus infection.

Objectives

After completing this article, readers should be able to:

Understand the mother-infant cytomegalovirus (CMV) transmission risk based on maternal antibody status.
Recognize the clinical manifestations of congenital and postnatal CMV infection.
Explain the appropriate methods for the diagnosis of congenital CMV infection.
Describe the specific risk of neurodevelopmental impairment in infants with congenital CMV infection.
State the major antiviral agents for treatment of CMV infection in the immunocompromised host.

Introduction

Cytomegalovirus (CMV) has been identified as an important viral pathogen in humans for more than a century. The histopathology of CMV was first described in 1904, but the virus itself was not isolated until 1957 by Craig et al. (1) CMV infects multiple human cell types, including salivary gland epithelial cells, hence the original name of the virus: salivary gland virus. In 1960, Weller designated the virus as CMV based on the appearance of the swollen virus-infected cells labeled as cytomegalia. (2) Over the next several decades, the prevalence and importance of CMV as a human pathogen became more apparent. CMV causes the most common perinatal viral infection in developed countries. CMV infects nearly 1% of all newborns, ∼40,000 infants per year, in the United States. Infection with CMV is the most common cause of nonhereditary sensorineural hearing loss (SNHL). (3) In addition to congenital and perinatal infection, CMV causes significant morbidity in immunocompromised patients, including chorioretinitis, pneumonia, colitis, and neuropathy. (4)