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Cytomegalovirus infection

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 Infectious Diseases Society of America (IDSA/CDC/NIH/HIVMA 2023), the Japanese Society of Respiratory Care Medicine (JSRCM/JSICM 2022), the British Transplantation Society (BTS 2022), the British Society for Haematology (BSH 2022; 2014), the Society of Obstetricians and Gynaecologists of Canada (SOGC 2021), the American College of Gastroenterology (ACG 2021; 2019), the European Society of Gastrointestinal Endoscopy (ESGE 2021), the World Society of Emergency Surgery (WSES/AAST 2021), the International Federation of Gynecology and Obstetrics (FIGO 2021), the European Society of Medical Oncology (ESMO 2021), the Kidney Disease: Improving Global Outcomes Foundation (KDIGO 2020), the Histiocyte Society (HS 2019; 2015), the American Society of Clinical Oncology (ASCO 2018), the International Workshop on Chronic Lymphocytic Leukemia (iwCLL 2018), the Infectious Diseases Society of America (IDSA 2017; 2008), the Blood and Marrow Transplant Clinical Trial Group (BMT CTN/IMDSF/EBMT/ELN 2017), the American College of Obstetricians and Gynecologists (ACOG 2015), the American College of Medical Genetics (ACMG 2014), the Royal College of Obstetricians and Gynaecologists (RCOG 2013), and the Association of British Neurologists (ABN/BIA 2012).
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Guidelines

1.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, organ transplant recipients

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2.Diagnostic investigations

Indications for testing, respiratory tract infections: as per JSRCM 2022 guidelines, consider obtaining BAL fluid PCR and blood antigen testing for suspected CMV pneumonia in patients with ARDS.
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  • Indications for testing, HIV complications

  • Indications for testing, intrauterine growth restriction

  • Indications for testing, congenital hearing loss

3.Medical management

Management of retinitis, general principles: 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

  • ART

4.Specific circumstances

Pregnant patients, screening, SOGC
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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  • Pregnant patients (diagnosis)

  • Pregnant patients (treatment)

  • Pregnant patients (counseling)

5.Preventative measures

Prevention of transmission: 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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