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Acquired cytomegalovirus infection in infants, children, and adolescents

Author
Gail J Demmler-Harrison, MD
Section Editors
Morven S Edwards, MD
Leonard E Weisman, MD
Deputy Editor
Carrie Armsby, MD, MPH

INTRODUCTION

Cytomegalovirus (CMV) is a ubiquitous virus that commonly infects people across the spectrum of all ages, races, and ethnic groups, and those from a variety of socioeconomic, cultural, and geographic backgrounds. Although most CMV infections are asymptomatic or cause mild disease, the virus can cause serious disease in newborns and immunocompromised children [1]. Discerning which role, if any, CMV is playing in a disease process, as well as the need for treatment, can be difficult because of its ubiquity (table 1). Such decisions require a thorough knowledge of CMV virology, epidemiology, clinical manifestations, laboratory diagnosis, and indications for treatment.

Postnatally acquired CMV infection in infants, children, and adolescents will be reviewed here. Congenital CMV infection is discussed separately. (See "Congenital cytomegalovirus infection: Clinical features and diagnosis" and "Congenital cytomegalovirus infection: Management and outcome".)

VIROLOGY

Cytomegalovirus (CMV) is a member of the Herpesvirus family, along with Epstein-Barr virus (EBV); herpes simplex viruses (HSV)-1 and 2; varicella-zoster virus (VZV); and human herpesviruses (HHV)-6, -7, and -8. These viruses all share properties, including a genome of double-stranded linear DNA, a virus capsid of icosahedral symmetry, and a viral envelope [2]. They also share the biological properties of latency and reactivation, which cause recurrent infections in the host.

CMV is a member of the subfamily beta Herpesviridae, which also contains HHV-6 and -7. CMV will replicate slowly, often taking as long as 24 hours to produce virus progeny in infected cells and several days to weeks to produce visible cytopathic effect in laboratory cell lines (picture 1). No distinct serotypes of CMV exist; however, strain differences can be detected by molecular analysis of DNA, providing a classification of genotypes [3].

EPIDEMIOLOGY AND TRANSMISSION

Infection with cytomegalovirus (CMV) occurs commonly; seroepidemiologic studies have shown the prevalence of antibody to CMV is influenced by age, geography, cultural and socioeconomic status, and child-rearing practices. In developing countries, most children are infected by three years of age, whereas in developed countries, such as the United States or United Kingdom, infection occurs throughout childhood and adolescence, with as many as 60 to 80 percent of the population infected with CMV by adulthood [1].

                      

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Literature review current through: Jun 2015. | This topic last updated: Jun 5, 2015.
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References
Top
  1. Harrison GJ. Cytomegalovirus. In: Feigin and Cherry’s Textbook of Pediatric Infectious Diseases, 7th ed, Cherry JD, Harrison GJ, Kaplan SL, et al (Eds), Elsevier Saunders, Philadelphia 2014. p.1969.
  2. Mocarski ES. Cytomegaloviruses and their resplication. In: Fields Virology, 3rd ed, Fields B, Knipe D, Howley P (Eds), Lippincott-Raven, Philadelphia 1996. Vol 2, p.2447.
  3. Walker A, Petheram SJ, Ballard L, et al. Characterization of human cytomegalovirus strains by analysis of short tandem repeat polymorphisms. J Clin Microbiol 2001; 39:2219.
  4. Lanzieri TM, Dollard SC, Josephson CD, et al. Breast milk-acquired cytomegalovirus infection and disease in VLBW and premature infants. Pediatrics 2013; 131:e1937.
  5. Hamprecht K, Maschmann J, Vochem M, et al. Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding. Lancet 2001; 357:513.
  6. Maschmann J, Hamprecht K, Dietz K, et al. Cytomegalovirus infection of extremely low-birth weight infants via breast milk. Clin Infect Dis 2001; 33:1998.
  7. Gunkel J, Wolfs TF, de Vries LS, Nijman J. Predictors of severity for postnatal cytomegalovirus infection in preterm infants and implications for treatment. Expert Rev Anti Infect Ther 2014; 12:1345.
  8. Josephson CD, Caliendo AM, Easley KA, et al. Blood transfusion and breast milk transmission of cytomegalovirus in very low-birth-weight infants: a prospective cohort study. JAMA Pediatr 2014; 168:1054.
  9. Mehler K, Oberthuer A, Lang-Roth R, Kribs A. High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk. Neonatology 2014; 105:27.
  10. Adler SP. Cytomegalovirus transmission among children in day care, their mothers and caretakers. Pediatr Infect Dis J 1988; 7:279.
  11. Adler SP. Cytomegalovirus and child day care. Evidence for an increased infection rate among day-care workers. N Engl J Med 1989; 321:1290.
  12. Istas AS, Demmler GJ, Dobbins JG, Stewart JA. Surveillance for congenital cytomegalovirus disease: a report from the National Congenital Cytomegalovirus Disease Registry. Clin Infect Dis 1995; 20:665.
  13. Fowler KB, Stagno S, Pass RF. Maternal age and congenital cytomegalovirus infection: screening of two diverse newborn populations, 1980-1990. J Infect Dis 1993; 168:552.
  14. Demmler GJ. Infectious Diseases Society of America and Centers for Disease Control. Summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev Infect Dis 1991; 13:315.
  15. Demmler GJ, Yow MD, Spector SA, et al. Nosocomial cytomegalovirus infections within two hospitals caring for infants and children. J Infect Dis 1987; 156:9.
  16. American Academy of Pediatrics. Cytomegalovirus infection. In: Red Book: 2015 Report of the Committee on Infectious Diseases, 30th, Kimberlin DW. (Ed), American Academy of Pediatrics, Elk Grove Village, IL 2015. p.317.
  17. Tengsupakul S, Birge ND, Bendel CM, et al. Asymptomatic DNAemia heralds CMV-associated NEC: case report, review, and rationale for preemption. Pediatrics 2013; 132:e1428.
  18. Neuberger P, Hamprecht K, Vochem M, et al. Case-control study of symptoms and neonatal outcome of human milk-transmitted cytomegalovirus infection in premature infants. J Pediatr 2006; 148:326.
  19. Vollmer B, Seibold-Weiger K, Schmitz-Salue C, et al. Postnatally acquired cytomegalovirus infection via breast milk: effects on hearing and development in preterm infants. Pediatr Infect Dis J 2004; 23:322.
  20. Goelz R, Meisner C, Bevot A, et al. Long-term cognitive and neurological outcome of preterm infants with postnatally acquired CMV infection through breast milk. Arch Dis Child Fetal Neonatal Ed 2013; 98:F430.
  21. Bevot A, Hamprecht K, Krägeloh-Mann I, et al. Long-term outcome in preterm children with human cytomegalovirus infection transmitted via breast milk. Acta Paediatr 2012; 101:e167.
  22. Brecht KF, Goelz R, Bevot A, et al. Postnatal human cytomegalovirus infection in preterm infants has long-term neuropsychological sequelae. J Pediatr 2015; 166:834.
  23. Lindemann PC, Foshaugen I, Lindemann R. Characteristics of breast milk and serology of women donating breast milk to a milk bank. Arch Dis Child Fetal Neonatal Ed 2004; 89:F440.
  24. Goodrich JM, Boeckh M, Bowden R. Strategies for the prevention of cytomegalovirus disease after marrow transplantation. Clin Infect Dis 1994; 19:287.
  25. Kovacs A, Schluchter M, Easley K, et al. Cytomegalovirus infection and HIV-1 disease progression in infants born to HIV-1-infected women. Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection Study Group. N Engl J Med 1999; 341:77.
  26. Gunkel J, Wolfs TF, Nijman J, et al. Urine is superior to saliva when screening for postnatal CMV infections in preterm infants. J Clin Virol 2014; 61:61.
  27. van den Berg AP, Klompmaker IJ, Haagsma EB, et al. Antigenemia in the diagnosis and monitoring of active cytomegalovirus infection after liver transplantation. J Infect Dis 1991; 164:265.
  28. Weinberg A, Hodges TN, Li S, et al. Comparison of PCR, antigenemia assay, and rapid blood culture for detection and prevention of cytomegalovirus disease after lung transplantation. J Clin Microbiol 2000; 38:768.
  29. Kotton CN, Kumar D, Caliendo AM, et al. Updated international consensus guidelines on the management of cytomegalovirus in solid-organ transplantation. Transplantation 2013; 96:333.
  30. Crumpacker CS. Ganciclovir. N Engl J Med 1996; 335:721.
  31. Asberg A, Rollag H, Hartmann A. Valganciclovir for the prevention and treatment of CMV in solid organ transplant recipients. Expert Opin Pharmacother 2010; 11:1159.
  32. Adler SP, Finney JW, Manganello AM, Best AM. Prevention of child-to-mother transmission of cytomegalovirus by changing behaviors: a randomized controlled trial. Pediatr Infect Dis J 1996; 15:240.
  33. Vauloup-Fellous C, Picone O, Cordier AG, et al. Does hygiene counseling have an impact on the rate of CMV primary infection during pregnancy? Results of a 3-year prospective study in a French hospital. J Clin Virol 2009; 46 Suppl 4:S49.
  34. Demmler GJ, O'Neil GW, O'Neil JH, et al. Transmission of cytomegalovirus from husband to wife. J Infect Dis 1986; 154:545.
  35. Paya CV. Prevention of cytomegalovirus disease in recipients of solid-organ transplants. Clin Infect Dis 2001; 32:596.
  36. Plotkin SA. Vaccination against cytomegalovirus, the changeling demon. Pediatr Infect Dis J 1999; 18:313.
  37. Pass RF, Duliegè AM, Boppana S, et al. A subunit cytomegalovirus vaccine based on recombinant envelope glycoprotein B and a new adjuvant. J Infect Dis 1999; 180:970.
  38. Pass RF, Zhang C, Evans A, et al. Vaccine prevention of maternal cytomegalovirus infection. N Engl J Med 2009; 360:1191.