Cytomegalovirus (CMV) is a common virus for people of all ages. It belongs to the Herpesviridae family and is highly evolved and adapted to humans. The global seroprevalence of the virus is estimated to be approximately 83% among the general population. In the United States, nearly one in three children is already infected with CMV by age five. Over half of the adults have been infected with CMV by age 40.
CMV can be transmitted through contact with infectious bodily fluids such as blood, saliva, urine, tears, seminal fluid, cervical secretions, and breast milk. In addition, infection is possible following solid organ and stem cell transplantation, with CMV representing the most common opportunistic infection among solid organ transplant recipients.
Once CMV is in a person’s body, it establishes latency. Meaning it stays there for life. Healthy immunocompetent people with CMV infection have no symptoms and aren’t aware that they have been infected.
In some cases, an infection can cause mild illnesses that may include:
Occasionally, CMV can cause mononucleosis or hepatitis (liver problem).
Immunosuppressed individuals, specifically transplant patients, have a higher risk for CMV reactivation. This is due to the immunosuppression needed to prevent organ/graft rejection. CMV reactivation may result in CMV syndrome (fever, malaise, leukopenia…) or “end-organ disease” (pneumonitis, colitis, retinitis…), which can lead to organ/graft rejection or even death.
Cardiothoracic transplant patients at the highest risk for CMV disease are CMV seronegative organ recipients (R-) from a seropositive donor (D+). Therefore, the third international consensus guidelines on managing CMV in solid-organ transplantation recommend that these mismatched (D+/R-) patients receive either pre-emptive or prophylactic treatment with antiviral therapies. Antivirals prevent CMV replication inside the cell but cannot prevent free viral particles outside the cell from infecting healthy cells.
Prophylaxis with Cytogam and antiviral therapy may help transplant patients get better CMV control after transplantation.
