Immunocompromised patients.
Patients with defects in cell-mediated immunity are
more susceptible to CMV infection (solid organ transplant, haematopoietic stem
cell transplant, HIV infected, recipients of chemotherapy, congenital immune
deficiencies). CMV disease in immunocompromised patients may be due to primary
infection, reactivation or re-infection. Symptoms vary in severity and site
affected. Frequent manifestations include retinitis, colitis and pneumonitis,
in addition to non-specific symptoms such as malaise, fever, myalgia, leukopenia,
thrombocytopenia and mild hepatitis.
Congenital / Perinatal infection
Congenital CMV infection can occur as a result of
maternal primary infection or reactivation. Congenital infections can have
severe manifestations: intra-uterine growth retardation, jaundice, petechiae,
myocarditis, pneumonitis, chorioretinitis, neurological symptoms and sequelae.
Peri-partum infection can occur via exposure to the birth canal or breast milk.
Urine and saliva are the most sensitive specimen types for the diagnosis of
congenital / post-partum CMV in new-borns.
Immunocompetent
CMV infection in immunocompetent individuals is
usually asymptomatic. Symptomatic infection in immunocompetent hosts manifests
as a mononucleosis-like syndrome (prolonged fever, myalgia, atypical
lymphocytosis, mild hepatitis), although can cause severe disease (colitis,
meningoencephalitis, haemolytic anaemia, thrombocytopenia, arterial or venous
thrombosis, ocular complications, hepatitis, pneumonitis