Cytomegalovirus infection natural history, complications and prognosis

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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]

Natural History, Complications and Prognosis

Natural History

Primary CMV infection takes place in childhood and early adolescence is asymptomatic. After the resolution of the primary infection CMV is latent in the mononuclear leukocytes. Reactivation of the virus can occur during states of stress and immunosuppression. Reactivation in immunocompetent patients presents with mononucleosis like syndrome, but severe infection presents with clinical manifestations affecting the gastrointestinal tract and the central nervous system. Retinitis and pneumonitis are uncommon in immunocompetent patients when compared to immunocompromised patients. Reactivation of CMV infection in immunocompromised patients results in CMV end organ infection affecting multiple organs.

Complications

Common complications of CMV infection in immunocompromised patients include:

• CMV retinitis
• CMV colitis
• CMV encephalitis
• CMV pneumonia
• Increased risk of secondary bacterial and fungal infections

Complications in critically ill immunocompetent patients include:

• Increased mortality rate
• Prolonged intensive care unit and hospital length of stay
• Prolonged mechanical ventilation
• Nosocomial infections