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Clinical Diagnosis and Treatment

Primary infection with CMV is usually unrecognized because most persons are asymptomatic or have non-specific symptoms. Primary CMV infection should be suspected if a patient

  • has symptoms of infectious mononucleosis but has negative test results for Epstein-Barr virus or
  • shows signs of hepatitis, but has negative test results for hepatitis A, B, and C.

Screening for CMV Infection in Pregnant Women

Routine screening for CMV infection is not recommended during pregnancy because laboratory tests currently available in the United States cannot, in most situations, conclusively determine whether a primary CMV infection has occurred during pregnancy. For more information, see Interpretation of Laboratory Tests.

Diagnosis of Congenital CMV Infection in Infants

Congenital CMV infection can be diagnosed if an infant has the virus detected in his or her urine, saliva, blood or other tissues within 2-3 weeks after birth. Only tests that detect CMV, as opposed to antibodies to the virus, can be used to establish a diagnosis of congenital CMV infection. Because about half of all women of child-bearing age in the United States have antibodies to CMV and because maternal antibodies to CMV pass through the placenta during pregnancy, CMV antibody testing of infants will reflect maternal antibody status and is not diagnostic of active infection in the infant. Congenital CMV infection cannot be diagnosed if the baby is tested more than 2-3 weeks after birth because a positive test cannot distinguish between congenital infection and infection that occurred after birth.

Treatment

  • No treatment is currently indicated for CMV infection in the healthy individual.
  • Antiviral treatment is used for patients with depressed immunity who have either sight-related or life-threatening illnesses due to CMV infection.
  • There is limited data on using antiviral medications such as ganciclovir to treat congenital CMV infection with central nervous system (CNS) involvement. There is some evidence that ganciclovir may prevent hearing loss and developmental outcomes in infants with symptomatic congenital CMV infection with CNS involvment. However, ganciclovir is not licensed for this purpose. Ganciclovir can have serious side effects and has only been studied in infants with severe symptoms from congenital CMV infection.
  • Any infant diagnosed with congenital CMV infection should have his or her hearing and vision tested regularly. Most CMV-infected babies grow up with normal health, but if the child has delayed hearing or vision problems, early detection can help his or her development.
  • Recent studies suggest that CMV hyperimmune globulin may reduce the risk of congenital infection and disease when given to pregnant women experiencing a primary CMV infection; however, these results have not yet been confirmed by other studies.

Vaccine Research

Vaccines are still in the research and development stage.

Also see general information about Prevention.

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