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Cytomegalovirus infection

Guidelines

Key sources

The following summarized guidelines for the evaluation and management of cytomegalovirus infection are prepared by our editorial team based on guidelines from the Transplantation Society (TTS 2025), the Infectious Diseases Society of America (IDSA/CDC/NIH/HIVMA 2024), the British Society for Haematology (BSH 2022,2014), the British Transplantation Society (BTS 2022), the Japanese Society of Respiratory Care Medicine (JSRCM/JSICM 2022), the American College ...
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Screening and diagnosis

Indications for screening, pregnancy
As per SOGC 2021 guidelines:
Consider obtaining screening for CMV primary infection with IgG and IgM antibodies followed by IgG avidity testing if IgM-positive in pregnant females in the first trimester in areas where CMV IgG avidity testing is available, especially in individuals at high risk (having a child under 3 years at home).
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Do not obtain screening for CMV infection during pregnancy in areas where CMV IgG avidity testing is not available.
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  • Indications for screening, HSC and organ donors

  • Indications for screening, organ transplant recipients

  • Indications for screening, hematologic malignancies

Diagnostic investigations

Indications for testing, respiratory tract infections: as per JSICM/JSRCM 2022 guidelines, consider obtaining bronchoalveolar lavage fluid PCR and blood antigen testing for suspected CMV pneumonia in patients with ARDS.
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  • Indications for testing, acute hepatitis

  • Indications for testing, IBD

  • Indications for testing, CNS infection

  • Indications for testing, immune checkpoint inhibitor-associated TTP

  • Indications for testing, hemophagocytic lymphohistiocytosis

  • Indications for testing, HIV complications

  • Indications for testing, intrauterine growth restriction

  • Indications for testing, congenital hearing loss

Medical management

Management of retinitis, general principles: as per CDC/HIVMA/IDSA/NIH 2024 guidelines, treat CMV retinitis ideally with the active participation of an ophthalmologist familiar with the diagnosis and management of this condition.
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  • Management of retinitis (immediate sight-threatening lesions)

  • Management of retinitis (peripheral lesions)

  • Management of retinitis (maintenance therapy)

  • Management of retinitis (immune recovery uveitis)

  • Management of pneumonitis

  • Management of esophagitis/colitis

  • Management of neurologic disease

  • Management of CNS infections

  • Antiretroviral therapy

Specific circumstances

Pregnant patients, screening
As per SOGC 2021 guidelines:
Consider obtaining screening for CMV primary infection with IgG and IgM antibodies followed by IgG avidity testing if IgM-positive in pregnant females in the first trimester in areas where CMV IgG avidity testing is available, especially in individuals at high risk (having a child under 3 years at home).
C
Do not obtain screening for CMV infection during pregnancy in areas where CMV IgG avidity testing is not available.
D
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  • Pregnant patients (diagnosis)

  • Pregnant patients (treatment)

  • Pregnant patients (counseling)

  • Organ transplant recipients (testing)

Preventative measures

Prevention of transmission: as per CDC/HIVMA/IDSA/NIH 2024 guidelines, counsel patients with HIV that CMV is shed in semen, cervical secretions, and saliva and that latex condoms used during sexual contact reduce the risk of exposure to CMV and other sexually transmitted pathogens.
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