Cytomegalovirus infection classification

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aravind Kuchkuntla, M.B.B.S[2]


Cytomegalovirus infection can be classified based on the organ system involved into the following: CMV retinitis, CMV colitis, CMV esophagitis, CMV pneumonitis and CMV encephalitis.


Cytomegalovirus infection can be classified based on the organ system involved into the following:[1]

CMV retinitis

  • It is the most common clinical manifestation of cytomegalovirus infection.
  • Retinitis is initially unilateral but progress to affect the contralateral side in the absence of therapy and immunosuppression.
  • In patients with CD4 < 50cells/mm³ bilateral retinal involvement is high.
  • Peripheral retinitis can be asymptomatic or present with floaters, scotomata, or peripheral visual field defects whereas central retinal lesions or lesions impinging on the macula or optic nerve are result in decreased visual acuity and central field defects.
  • On fundus examination the following findings can be demonstrated:
    • Fluffy yellow-white retinal lesions, with or without intraretinal hemorrhage.
    • Inflammation of the vitreous can be demonstrated in patients with severe immunosuppression.
    • Blood vessels appear sheathed.
    • If left untreated, retinitis is a rapidly progressive condition and on fundus examination it demonstrates a characteristic brushfire pattern, with a granular, white leading edge advancing before an atrophic gliotic scar.

CMV colitis

CMV esophagitis

CMV pneumonitis

  • Cytomegalovirus pneumonitis is a uncommon condition and is usually asymptomatic.
  • It is usually diagnosed on bronchoalveolar lavage and co-exists with an underlying pulmonary infection.
  • Chest X-Ray demonstrates diffuse pulmonary interstitial infiltrates and diagnosis confirmation requires a correlation of the clinical features to imaging findings.

Neurologic disease

Cytomegalovirus infection of the neurological system includes dementia, ventriculoencephalitis and polymyeloradiculopathies. Diagnosis of neurological disease requires correlation between the clinical symptoms and a positive PCR for cytomegalovirus of the cerebrospinal fluid.


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