Diagnosis and Screening

• CMV PCR: Polymerase chain reaction (PCR) testing for CMV DNA is the gold standard for diagnosing active CMV infections. This test can be used on blood, urine, and tissues.

• Serology: Testing for CMV IgM and IgG antibodies helps determine past or recent infection, though it is less useful for diagnosing active disease.

• Screening: Regular screening in high-risk patients, such as transplant recipients, can help in early detection and management.

Clinical Manifestations

• Asymptomatic: Many CMV infections are asymptomatic, particularly in healthy individuals.

• Symptomatic: In immunocompromised patients, CMV can cause more severe diseases such as retinitis, colitis, encephalitis, and pneumonia.

• Congenital CMV: Newborns can acquire CMV in utero, leading to developmental delays, sensorineural hearing loss, and other severe disabilities.

Antiviral Treatment

• Ganciclovir and Valganciclovir: These are the primary treatments for CMV infections. Valganciclovir, an oral prodrug of ganciclovir, is commonly used for treatment and prophylaxis.

• Foscarnet and Cidofovir: Used for ganciclovir-resistant CMV infections but have significant nephrotoxicity risks.

• Dose Adjustments: Dosing must often be adjusted based on renal function, particularly with ganciclovir and valganciclovir.

Prophylactic Strategies

• Preemptive Therapy: Monitoring CMV DNA levels and initiating treatment upon detection can prevent symptomatic disease in high-risk patients.

• Immunoprophylaxis: Using CMV immunoglobulin in certain high-risk scenarios, such as organ transplantation from a CMV-positive donor to a CMV-negative recipient.

Drug Interactions

• Bone Marrow Suppression: Ganciclovir and valganciclovir can cause neutropenia and anemia. Monitoring blood counts is essential.

• Interactions with Other Drugs: These agents can interact with other medications that affect renal function or bone marrow toxicity.

Patient Counseling

• Adherence: Emphasize the importance of medication adherence, especially in prophylactic or treatment settings.

• Side Effects: Inform patients about potential side effects like gastrointestinal disturbances, hematologic changes, and the signs of nephrotoxicity.

Special Populations

• Pregnant Women: Balancing the risks of congenital CMV infection against the potential toxicities of antiviral agents to the fetus.

• Pediatric: Considerations for dosing and long-term outcomes, especially in congenitally infected children.