Approach to the diagnosis of cytomegalovirus infection
- Angela M Caliendo, MD, PhD
Angela M Caliendo, MD, PhD
- Executive Vice Chair of Medicine
- Brown University
Cytomegalovirus (CMV) is a common infection, and, although serious disease is rare in immunocompetent individuals, CMV is a major pathogen for immunocompromised patients, including solid organ transplant recipients, hematopoietic cell transplant recipients, HIV-infected patients, and patients treated with immunomodulating drugs.
The range of clinical disease due to CMV in immunocompromised patients is broad and includes febrile syndromes, hepatitis, pneumonitis, retinitis, encephalitis, esophagitis, and colitis. Since the signs and symptoms of CMV disease often overlap with other infectious processes and rejection, the diagnosis is made by integrating the clinical history, clinical presentation, and laboratory data. Because CMV produces lifelong latent infection, distinguishing active disease from latent infection and asymptomatic reactivation presents an additional diagnostic challenge.
The diagnosis and monitoring of CMV infection and tissue invasive disease will be discussed here, with an emphasis on the role of diagnostic tests and their strengths and limitations. An overview of the diagnostic tests for CMV is presented separately. The manifestations of CMV in immunocompetent and immunocompromised patients are also discussed elsewhere. (See "Overview of diagnostic tests for cytomegalovirus infection" and "Epidemiology, clinical manifestations, and treatment of cytomegalovirus infection in immunocompetent adults" and "Clinical manifestations, diagnosis, and treatment of cytomegalovirus infection in lung transplant recipients" and "Clinical manifestations, diagnosis, and management of cytomegalovirus disease in kidney transplant recipients" and "Pathogenesis, clinical manifestations, and diagnosis of AIDS-related cytomegalovirus retinitis" and "AIDS-related cytomegalovirus gastrointestinal disease" and "Cytomegalovirus infection as a cause of pulmonary disease in HIV-infected patients" and "AIDS-related cytomegalovirus neurologic disease" and "Acquired cytomegalovirus infection in children" and "Cytomegalovirus infection in pregnancy" and "Congenital cytomegalovirus infection: Clinical features and diagnosis" and "Congenital cytomegalovirus infection: Management and outcome".)
INFECTION VERSUS DISEASE
Cytomegalovirus (CMV) infection and disease are not synonymous terms; not all patients with infection develop overt clinical disease.
●CMV infection is defined as evidence of CMV replication regardless of symptoms or signs [1,2].
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- INFECTION VERSUS DISEASE
- IMMUNOCOMPROMISED HOSTS
- Approach to diagnosis
- - CMV DNA and antigen tests
- Choice of test
- Predictive role
- - Initial viral load
- - Rate of increase
- - Serology
- Testing based on type of disease
- - Viral syndrome
- - Tissue invasive disease
- Gastrointestinal disease
- Central nervous system disease
- Monitoring response to treatment
- Resistance testing
- IMMUNOCOMPETENT HOSTS
- Critically ill patients
- SUMMARY AND RECOMMENDATIONS