Cytomegalovirus (CMV) Infection
Description Diagnostic criteria Medicine treatment Referral ICD-10 code: B25.9 DESCRIPTION CMV is an extremely common childhood infection, with almost all children infected by 5 years of age. The 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
ICD-10 code: B25.9
DESCRIPTION
CMV is an extremely common childhood infection, with almost all children infected by 5 years of age.
The 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 and transplant recipients).
DIAGNOSTIC CRITERIA
Clinical
- Congenital infections vary from asymptomatic through isolated neural deafness, to severe disease, including microcephaly.
- Infections in immunocompromised children can result in 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 indicates 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 & differential white cell count, 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 for > 6 months to > 15% (< 6 years) or > 100 cells/mm3 (> 6 years) on ART.
Retinitis:
See: Cytomegalovirus (CMV) retinitis.
REFERRAL
- All cases of severe organ-related disease or disseminated disease.
Standard Treatment Guidelines and Essential Medicines List for South Africa Paediatric Hospital _2023, 5th edition_Updated July 2024
Chapter 8: Infective/Infectious Diseases, 8.7 Cytomegalovirus (CMV) Infection