Cytomegalovirus (CMV) infection

B25.9

DESCRIPTION

CMV is an extremely common childhood infection, with almost all children infected by 5 years of age.
Majority of childhood infections are asymptomatic or present with a mononucleosis-like syndrome NOT requiring anti-viral treatment.
CMV can cause clinically significant disease following congenital infection and infections in immunocompromised children (especially HIV infected children, transplant recipients).

DIAGNOSTIC CRITERIA

Clinical:

  • Congenital infections vary from asymptomatic through isolated neural deafness, to severe disease including microcephaly.
  • Infections in immunocompromised children can develop. pneumonia, encephalitis, retinitis and gastrointestinal infections.

Investigations:

Diagnostic tests should be only performed if clinical disease is suspected.
Congenital Infections (performed within 3 weeks post-delivery - in children with suspected CMV older than 3 weeks, discuss with a specialist):

  • Serology: CMV IgM indicate recent infection
  • CMV PCR – qualitative: blood, or urine/saliva in viral transport medium.
    Hearing assessment at baseline and annually for the first 5 years of life

Infections in Immunocompromised children:

  • Serology: Presence of antibodies to CMV does not imply active infection or causality.
  • CMV PCR – qualitative: blood, or urine/saliva in viral transport medium.
  • Quantitative CMV PCR (CMV Viral load > 10 000 copies/ml)
  • Intranuclear inclusion bodies may be seen in biopsy material.


AND

  • Clinical features suggestive of CMV disease

MEDICINE TREATMENT

Symptomatic congenital infections:

  • Valganciclovir, oral, 16 mg/kg, 12 hourly for 6 months.
    • Monitor FBC, AST/ALT weekly initially, then monthly.

  • If unable to tolerate oral medication:
    • Ganciclovir, IV, 5 mg/kg administered over 1 hour, 12 hourly until able to tolerate oral medication.

Infections in Immunocompromised children:
Pneumonia and biopsy-proven GIT disease (Specialist initiated)

  • Initial therapy:
    • Ganciclovir, IV, 5 mg/kg administered over 1 hour, 12 hourly for 7 days.
    • Follow with: Valganciclovir, oral, 16 mg/kg, 12 hourly for 5 weeks.
  • Maintenance therapy: Not indicated

CNS disease (Specialist initiated)

  • Initial therapy:
    • Ganciclovir, IV: 5 mg/kg administered over 1 hour, 12 hourly for 7 days.
    • Follow with: Valganciclovir, oral, 16 mg/kg, 12 hourly for 5 weeks.
  • Maintenance therapy: Indicated for patients with good clinical response
    • Valganciclovir, oral, 16 mg/kg, daily until CD4 count rises to >100cell/mm³ on ART, if available

Retinitis:
See Chapter: Eye Conditions - Cytomegalovirus (CMV) Retinitis .

REFERRAL

  • All cases of severe organ-related disease or disseminated disease.