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Section 3. Summaries of Infectious Diseases
Cytomegalovirus Infection
Clinical ManifestationsEtiology
Epidemiology
Diagnostic Tests
Treatment
Isolation of the Hospitalized Patient
Control Measures
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CLINICAL MANIFESTATIONS
Manifestations of acquired human cytomegalovirus (CMV) infection vary with the age and immunocompetence of the host. Asymptomatic infections are the most common, particularly in children. An infectious mononucleosis-like syndrome with prolonged fever and mild hepatitis, occurring in the absence of heterophil antibody production, may occur in adolescents and adults. Pneumonia, colitis, and retinitis may occur in immunocompromised hosts, including people receiving treatment for malignant neoplasms, people infected with human immunodeficiency virus (HIV), and people receiving immunosuppressive therapy for organ transplantation.
Congenital infection has a spectrum of manifestations but usually is not evident at birth (asymptomatic congenital CMV infection). Approximately 10% of infants with congenital CMV infection have involvement that is evident at birth (symptomatic congenital CMV disease), with manifestations including intrauterine growth retardation, jaundice, purpura, hepatosplenomegaly, microcephaly, intracerebral calcifications, and retinitis; developmental delays are common among these infants as they grow. Sensorineural hearing loss (SNHL) is the most common sequela following congenital CMV infection, with the likelihood of SNHL being higher among infants with symptomatic infection. Congenital CMV infection is the leading nongenetic cause of sensorineural hearing loss in children in the United States. Approximately 21% of all hearing loss at birth is attributable to congenital CMV infection (10% symptomatic and 11% asymptomatic), and 25% of all hearing loss at 4 years of age is attributable to congenital CMV infection. Late-onset and progressive hearing losses occur following congenital CMV infection. Hearing loss following congenital CMV infection may be present at birth or occur later in the first years of life. Approximately 33% to 50% of SNHL attributable to congenital CMV infection is late-onset loss. Approximately 50% of children with SNHL following congenital CMV infection will continue
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