CMV infection

Cytomegalovirus infections

Updated: 08/15/2025

© Jun Wang, MD, PhD

 

General features

  • AKA Herpes virus type 5
  • Double stranded DNA virus of Herpes virus family
  • High mortality rate if end-organ involvement: retina, lung, brain
  • 3 patterns of infection

o   Latent: most common, immunocompetent patients

o   Mononucleosis-like syndrome: immunocompetent patients

o   Tissue invasive disease: immunocompromised patients

Pathogenesis

  • Inhaled pneumocystis attach to alveolar wall
  • Macrophages could not eradicate pneumocystis due to lack of CD4+ lymphocytes
  • Local inflammation results in alveolar injury

Clinical presentations

  • Depending on organ affected
  • Commonly involves esophagus, colon, and retina

Pathological features

CMV retinitis

  • Most common ocular complication in AIDS patients
  • Associated with full-thickness retinal necrosis and subsequent fibrosis
  • Presentation depending on site of infection, commonly include blurring or loss of central vision, blind spots, floaters, or photopsia (flashing lights)
  • Vision loss commonly due to retinal detachment
  • Retinal findings: cotton wools spots, retinal whitening, intraretinal hemorrhage, described as "pizza pie" or "cottage cheese with ketchup" appearance
  • Diagnosed by retinal findings, in the context of other clinical and laboratory findings
  • Common laboratory findings

o   CD4+ cells<50/mcl

o   High levels of CMV viremia

o   High levels of plasma HIV RNA (>100k/mL)

Diagnosis

  • Based on pathology, serology and molecular tests findings

Managements

  • Antiviral agents
  • ART

 

 

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