Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Congenital cytomegalovirus infection: Clinical features and diagnosis

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


Congenital cytomegalovirus (CMV) infection is common worldwide. It is the leading cause of nonhereditary sensorineural hearing loss (SNHL) and can cause other long-term neurodevelopmental disabilities, including cerebral palsy, intellectual disability, vision impairment, and seizures. At birth, most infants with congenital CMV are asymptomatic, but approximately 10 percent have symptoms.

The clinical features and diagnosis of congenital CMV infection will be reviewed below. The management and outcome of congenital CMV infection, other TORCH infections, CMV in pregnancy, and CMV infections in older infants and children are discussed separately:

(See "Congenital cytomegalovirus infection: Management and outcome".)

(See "Overview of TORCH infections".)

(See "Cytomegalovirus infection in pregnancy".)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Feb 21, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  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. Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 2007; 17:253.
  3. Goderis J, De Leenheer E, Smets K, et al. Hearing loss and congenital CMV infection: a systematic review. Pediatrics 2014; 134:972.
  4. Waters A, Jennings K, Fitzpatrick E, et al. Incidence of congenital cytomegalovirus infection in Ireland: implications for screening and diagnosis. J Clin Virol 2014; 59:156.
  5. Cannon MJ, Schmid DS, Hyde TB. Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection. Rev Med Virol 2010; 20:202.
  6. 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.
  7. Snider M, Noyola D, Griesser C, Demmler GJ. Congenital cytomegalovirus disease (C-CMV-D) Registry 1990-2007: Targets for treatment and prevention revealed. Abstract Presentation at Pediatric Academic Societies Annual Meeting, Honolulu, Hawaii May 1, 2008.
  8. 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.
  9. Pass RF, Hutto C, Ricks R, Cloud GA. Increased rate of cytomegalovirus infection among parents of children attending day-care centers. N Engl J Med 1986; 314:1414.
  10. Picone O, Vauloup-Fellous C, Cordier AG, et al. A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome. Prenat Diagn 2013; 33:751.
  11. Williamson WD, Demmler GJ, Percy AK, Catlin FI. Progressive hearing loss in infants with asymptomatic congenital cytomegalovirus infection. Pediatrics 1992; 90:862.
  12. Fowler KB, McCollister FP, Dahle AJ, et al. Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection. J Pediatr 1997; 130:624.
  13. Azam AZ, Vial Y, Fawer CL, et al. Prenatal diagnosis of congenital cytomegalovirus infection. Obstet Gynecol 2001; 97:443.
  14. Liesnard C, Donner C, Brancart F, et al. Prenatal diagnosis of congenital cytomegalovirus infection: prospective study of 237 pregnancies at risk. Obstet Gynecol 2000; 95:881.
  15. La Torre R, Nigro G, Mazzocco M, et al. Placental enlargement in women with primary maternal cytomegalovirus infection is associated with fetal and neonatal disease. Clin Infect Dis 2006; 43:994.
  16. Simonazzi G, Guerra B, Bonasoni P, et al. Fetal cerebral periventricular halo at midgestation: an ultrasound finding suggestive of fetal cytomegalovirus infection. Am J Obstet Gynecol 2010; 202:599.e1.
  17. Malinger G, Lev D, Zahalka N, et al. Fetal cytomegalovirus infection of the brain: the spectrum of sonographic findings. AJNR Am J Neuroradiol 2003; 24:28.
  18. Picone O, Teissier N, Cordier AG, et al. Detailed in utero ultrasound description of 30 cases of congenital cytomegalovirus infection. Prenat Diagn 2014; 34:518.
  19. Sampath V, Narendran V, Donovan EF, et al. Nonimmune hydrops fetalis and fulminant fatal disease due to congenital cytomegalovirus infection in a premature infant. J Perinatol 2005; 25:608.
  20. Dogan Y, Yuksel A, Kalelioglu IH, et al. Intracranial ultrasound abnormalities and fetal cytomegalovirus infection: report of 8 cases and review of the literature. Fetal Diagn Ther 2011; 30:141.
  21. Pereira L, Petitt M, Fong A, et al. Intrauterine growth restriction caused by underlying congenital cytomegalovirus infection. J Infect Dis 2014; 209:1573.
  22. Boppana SB, Ross SA, Fowler KB. Congenital cytomegalovirus infection: clinical outcome. Clin Infect Dis 2013; 57 Suppl 4:S178.
  23. Kylat RI, Kelly EN, Ford-Jones EL. Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection. Eur J Pediatr 2006; 165:773.
  24. Dreher AM, Arora N, Fowler KB, et al. Spectrum of disease and outcome in children with symptomatic congenital cytomegalovirus infection. J Pediatr 2014; 164:855.
  25. Boppana SB, Pass RF, Britt WJ, et al. Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality. Pediatr Infect Dis J 1992; 11:93.
  26. Rivera LB, Boppana SB, Fowler KB, et al. Predictors of hearing loss in children with symptomatic congenital cytomegalovirus infection. Pediatrics 2002; 110:762.
  27. Foulon I, Naessens A, Foulon W, et al. A 10-year prospective study of sensorineural hearing loss in children with congenital cytomegalovirus infection. J Pediatr 2008; 153:84.
  28. Grosse SD, Ross DS, Dollard SC. Congenital cytomegalovirus (CMV) infection as a cause of permanent bilateral hearing loss: a quantitative assessment. J Clin Virol 2008; 41:57.
  29. Ghekiere S, Allegaert K, Cossey V, et al. Ophthalmological findings in congenital cytomegalovirus infection: when to screen, when to treat? J Pediatr Ophthalmol Strabismus 2012; 49:274.
  30. Britt W. Cytomegalovirus. In: Infectious Diseases of the Fetus and Newborn Infant, 7th ed, Remington JS, Klein JO, Wilson CB, et al (Eds), Elsevier Saunders, Philadelphia 2011. p.706.
  31. Mena W, Royal S, Pass RF, et al. Diabetes insipidus associated with symptomatic congenital cytomegalovirus infection. J Pediatr 1993; 122:911.
  32. Besbas N, Bayrakci US, Kale G, et al. Cytomegalovirus-related congenital nephrotic syndrome with diffuse mesangial sclerosis. Pediatr Nephrol 2006; 21:740.
  33. Salisbury S, Embil JA. Graves disease following congenital cytomegalovirus infection. J Pediatr 1978; 92:954.
  34. Lopez AS, Ortega-Sanchez IR, Bialek SR. Congenital cytomegalovirus-related hospitalizations in infants <1 year of age, United States, 1997-2009. Pediatr Infect Dis J 2014; 33:1119.
  35. Turner KM, Lee HC, Boppana SB, et al. Incidence and impact of CMV infection in very low birth weight infants. Pediatrics 2014; 133:e609.
  36. Boppana SB, Fowler KB, Vaid Y, et al. Neuroradiographic findings in the newborn period and long-term outcome in children with symptomatic congenital cytomegalovirus infection. Pediatrics 1997; 99:409.
  37. Noyola DE, Demmler GJ, Nelson CT, et al. Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 2001; 138:325.
  38. Capretti MG, Lanari M, Tani G, et al. Role of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection. Brain Dev 2014; 36:203.
  39. Fink KR, Thapa MM, Ishak GE, Pruthi S. Neuroimaging of pediatric central nervous system cytomegalovirus infection. Radiographics 2010; 30:1779.
  40. Alarcon A, Martinez-Biarge M, Cabañas F, et al. Clinical, biochemical, and neuroimaging findings predict long-term neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 2013; 163:828.
  41. Fowler KB, Boppana SB. Congenital cytomegalovirus (CMV) infection and hearing deficit. J Clin Virol 2006; 35:226.
  42. Coats DK, Demmler GJ, Paysse EA, et al. Ophthalmologic findings in children with congenital cytomegalovirus infection. J AAPOS 2000; 4:110.
  43. Stehel EK, Shoup AG, Owen KE, et al. Newborn hearing screening and detection of congenital cytomegalovirus infection. Pediatrics 2008; 121:970.
  44. Hanshaw JB, Scheiner AP, Moxley AW, et al. School failure and deafness after "silent" congenital cytomegalovirus infection. N Engl J Med 1976; 295:468.
  45. Noyola DE, Demmler GJ, Williamson WD, et al. Cytomegalovirus urinary excretion and long term outcome in children with congenital cytomegalovirus infection. Congenital CMV Longitudinal Study Group. Pediatr Infect Dis J 2000; 19:505.
  46. Temple RO, Pass RF, Boll TJ. Neuropsychological functioning in patients with asymptomatic congenital cytomegalovirus infection. J Dev Behav Pediatr 2000; 21:417.
  47. Zhang XW, Li F, Yu XW, et al. Physical and intellectual development in children with asymptomatic congenital cytomegalovirus infection: a longitudinal cohort study in Qinba mountain area, China. J Clin Virol 2007; 40:180.
  48. Townsend CL, Forsgren M, Ahlfors K, et al. Long-term outcomes of congenital cytomegalovirus infection in Sweden and the United Kingdom. Clin Infect Dis 2013; 56:1232.
  49. Pinninti SG, Ross SA, Shimamura M, et al. Comparison of saliva PCR assay versus rapid culture for detection of congenital cytomegalovirus infection. Pediatr Infect Dis J 2015; 34:536.
  50. Leruez-Ville M, Vauloup-Fellous C, Couderc S, et al. Prospective identification of congenital cytomegalovirus infection in newborns using real-time polymerase chain reaction assays in dried blood spots. Clin Infect Dis 2011; 52:575.
  51. Boudewyns A, Declau F, Smets K, et al. Cytomegalovirus DNA detection in Guthrie cards: role in the diagnostic work-up of childhood hearing loss. Otol Neurotol 2009; 30:943.
  52. Boppana SB, Ross SA, Novak Z, et al. Dried blood spot real-time polymerase chain reaction assays to screen newborns for congenital cytomegalovirus infection. JAMA 2010; 303:1375.
  53. Smithers-Sheedy H, Raynes-Greenow C, Badawi N, et al. Congenital Cytomegalovirus among Children with Cerebral Palsy. J Pediatr 2017; 181:267.
  54. Sakamoto A, Moriuchi H, Matsuzaki J, et al. Retrospective diagnosis of congenital cytomegalovirus infection in children with autism spectrum disorder but no other major neurologic deficit. Brain Dev 2015; 37:200.
  55. Ogawa H, Baba Y, Suzutani T, et al. Congenital cytomegalovirus infection diagnosed by polymerase chain reaction with the use of preserved umbilical cord in sensorineural hearing loss children. Laryngoscope 2006; 116:1991.
  56. Uematsu M, Haginoya K, Kikuchi A, et al. Asymptomatic congenital cytomegalovirus infection with neurological sequelae: A retrospective study using umbilical cord. Brain Dev 2016; 38:819.
  57. Williams EJ, Kadambari S, Berrington JE, et al. Feasibility and acceptability of targeted screening for congenital CMV-related hearing loss. Arch Dis Child Fetal Neonatal Ed 2014; 99:F230.
  58. de Vries JJ, Vossen AC, Kroes AC, van der Zeijst BA. Implementing neonatal screening for congenital cytomegalovirus: addressing the deafness of policy makers. Rev Med Virol 2011; 21:54.
  59. Cannon MJ, Griffiths PD, Aston V, Rawlinson WD. Universal newborn screening for congenital CMV infection: what is the evidence of potential benefit? Rev Med Virol 2014; 24:291.
  60. Nishida K, Morioka I, Nakamachi Y, et al. Neurological outcomes in symptomatic congenital cytomegalovirus-infected infants after introduction of newborn urine screening and antiviral treatment. Brain Dev 2016; 38:209.
  61. Fowler KB, McCollister FP, Sabo DL, et al. A Targeted Approach for Congenital Cytomegalovirus Screening Within Newborn Hearing Screening. Pediatrics 2017; 139.
  62. Utah Department of Health, Children with Special Health Care Needs, Children’s Hearing and Speech Services, Cytomegalovirus (CMV) Public Health Initiative. Available at: www.health.utah.gov/cshcn/CHSS/CMV.html (Accessed on November 18, 2014).
  63. Diener ML, Zick CD, McVicar SB, et al. Outcomes From a Hearing-Targeted Cytomegalovirus Screening Program. Pediatrics 2017; 139.
  64. Demmler-Harrison GJ. Congenital cytomegalovirus: Public health action towards awareness, prevention, and treatment. J Clin Virol 2009; 46 Suppl 4:S1.
  65. Heo J, Petheram S, Demmler G, et al. Polymorphisms within human cytomegalovirus chemokine (UL146/UL147) and cytokine receptor genes (UL144) are not predictive of sequelae in congenitally infected children. Virology 2008; 378:86.
  66. Gantt S, Dionne F, Kozak FK, et al. Cost-effectiveness of Universal and Targeted Newborn Screening for Congenital Cytomegalovirus Infection. JAMA Pediatr 2016; 170:1173.
  67. Demmler-Harrison GJ. Congenital Cytomegalovirus Infection: The Elephant in Our Living Room. JAMA Pediatr 2016; 170:1142.