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Updated: Dec 24 2021

Cytomegalovirus (CMV) (Pediatric)

  • Snapshot
    • An 8-year-old boy is brought by his parents to the pediatrician with complaint of a fever and sore throat for the past few days. He says that he has felt tired and that his "neck is sore." Physical examination is notable for the finding seen in the image. A heterophile antibody test is negative.
  • Introduction
    • Overview
      • cytomegalovirus (CMV) infection is widespread and general asymptomatic in healthy children
        • can cause CMV mononucleosis in young adults
        • major case of congenital infections that can lead to congenital defects, developmental delay, and neurologic sequelae
  • Epidemiology
    • Incidence
      • adult seroprevalence
        • approximately 50% by early adulthood in developed countries
        • almost 100% by early adulthood in developing countries
      • congenital infection
        • about 1% of all births
    • Pathophysiology
      • CMV, also known as human herpesvirus type 5 (HHV-5), is in the family of human herpesviruses
      • transmission
        • sexual contact
        • transplacental (congenital infection)
        • breast milk
        • respiratory droplets
        • blood transfusions
  • Presentation
    • Symptoms
      • congenital CMV infection
        • 90% of babies will be asymptomatic
        • petechial/purpuric rash
        • hearing loss
        • seizures
      • acquired CMV infection
        • fever
        • malaise
        • cervical lymphadenopathy
    • Physical exam
      • petechial or "blueberry muffin" rash (congenital infection)
      • cervical lymphadenopathy
  • Imaging
    • Head CT scan
      • indications
        • required for infants with microcephaly or suspected congenital CMV infection
      • findings
        • presence of periventricular calcifications
  • Studies
    • Viral culture
    • Viral PCR
      • used to monitor status of CMV replication
  • Differential
    • Congenital toxoplasmosis
      • key distinguishing factor
        • intracranial calcifications are scattered diffusely and are not in a periventricular distribution
    • EBV mononucleosis
      • key distinguishing factor
        • positive heterophile antibody test
  • Treatment
    • Medical
      • antiviral agents
        • ganciclovir
        • cidofovir
        • foscarnet
  • Complications
    • Sensorineural hearing loss
      • incidence
        • 10-15% of babies with congenital CMV infection
    • Developmental and motor delay
      • incidence
        • 5% of babies with congenital CMV infection
    • Chorioretinitis
      • incidence
        • 2% of babies with congenital CMV infection
    • Microcephaly
      • incidence
        • 5% of babies with congenital CMV infection
  • Prognosis
    • Maternal seroconversion during the late 1st and early 2nd trimester of pregnancy is associated with more severe congenital CMV infection with CNS disease
    • Asymptomatic congenital CMV infection has a better long-term prognosis than symptomatic infection
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