eMedicine Specialties > Infectious Diseases > Viral Infections

Cytomegalovirus: Follow-up

Author: Todd S Wills, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, University of South Florida College of Medicine
Contributor Information and Disclosures

Updated: Apr 28, 2009

Follow-up

Further Inpatient Care

  • Patients with cytomegalovirus (CMV) disease must be well hydrated.
  • Nutrition is an important factor because many patients are debilitated by transplant or HIV disease.
  • As with any patient, attention must focus on avoiding iatrogenic infections and problems.
  • Patients who develop CMV disease are immunocompromised and are at greater risk for bacterial and fungal infections. If possible, the patient's level of immunosuppression should be lowered.

Further Outpatient Care

  • When ganciclovir is administered on an outpatient basis for the treatment of retinitis, follow-up with a CBC count once per week (monitoring for hematological toxicity) is necessary. Also, monitoring electrolytes at the same time is a good idea. Ganciclovir should be stopped when neutrophil counts are less than 500 cells/µL. Starting growth factors, such as GM-CSF or G-CSF, may be necessary. A switch to foscarnet may be required at this time.
  • If treating a patient who has CMV retinitis, regular ophthalmological examinations should be performed.

Deterrence/Prevention

  • See Treatment for a discussion about early treatment versus prophylaxis with ganciclovir.
  • Other drugs have been used for prophylaxis, but none are as effective as ganciclovir. Acyclovir and valacyclovir have been used for prophylaxis and early treatment in patients who have received allogeneic marrow transplants. Acyclovir has also been used in patients who have received other types of transplants.
  • Congenital infection with CMV is an important cause of hearing, cognitive, and motor impairments in newborns. A phase II, placebo-controlled, randomized, double blind trial by Pass et al (2009) evaluated a recombinant CMV vaccine (envelope glycoprotein B with MF59 adjuvant). Three doses of the CMV vaccine or placebo were administered at 0, 1, and 6 months to 464 CMV-seronegative women within 1 year after they had given birth. After a minimum follow-up period of 1 year, 49 confirmed CMV infections were reported—18 in the vaccine group and 31 in the placebo group. One infant in the vaccine group was found to have congenital CMV infection, while 3 infants from the placebo group were infected. Ongoing research continues to evaluate the potential for a CMV vaccine to decrease maternal and congenital CMV infection.1

Complications

Prognosis

  • The prognosis of patients with CMV hepatitis is generally good. Most patients recover completely. Symptoms can persist, usually in the form of fatigue, for several months after primary infection.
  • CMV pneumonia in patients who have received marrow transplants once carried a mortality rate higher than 85%. The use of ganciclovir plus high-dose Ig for the treatment of CMV pneumonia in patients who have received allogeneic marrow transplants has lowered the mortality rate to 30-60%.
  • Because patients who develop CMV disease are immunocompromised, their prognosis may be determined by their underlying disease. The need for mechanical ventilation is a poor prognostic sign.

Patient Education

Miscellaneous

Medicolegal Pitfalls

  • Because of the toxicity of the antivirals used to treat cytomegalovirus (CMV) disease, consulting a physician familiar in the use and adverse effects of these drugs is important.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous coauthor James M Goodrich, MD, PHD, to the development and writing of this article.



More on Cytomegalovirus

Overview: Cytomegalovirus
Differential Diagnoses & Workup: Cytomegalovirus
Treatment & Medication: Cytomegalovirus
Follow-up: Cytomegalovirus
Multimedia: Cytomegalovirus
References
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Further Reading

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Keywords

cytomegalovirus, CMV, Betaherpesvirinae, Herpesviridae, mononucleosis, pneumonia, hepatitis, encephalitis, colitis, uveitis, retinitis, neuropathy, HIV, CMV syndrome, fever of unknown origin, FUO, STDs, transplant infections

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Contributor Information and Disclosures

Author

Todd S Wills, MD, Assistant Professor, Department of Internal Medicine, Division of Infectious Diseases, University of South Florida College of Medicine
Todd S Wills, MD is a member of the following medical societies: Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Medical Editor

Douglas A Drevets, MD, Assistant Professor, Department of Medicine, Section of Infectious Disease, Oklahoma University Health Sciences Center
Douglas A Drevets, MD is a member of the following medical societies: American Association of Immunologists, American Society for Microbiology, Central Society for Clinical Research, and Christian Medical & Dental Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

John W King, MD, Professor of Medicine, Section of Infectious Diseases, Louisiana State University Health Sciences Center; Director, Viral Therapeutics Clinics for Hepatitis; Consulting Staff, Department of Infectious Diseases, Overton Brook Veterans Affairs Medical Center
John W King, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Microbiology, Association of Subspecialty Professors, Infectious Diseases Society of America, and Sigma Xi
Disclosure: emedicine $50.00 author of chapter

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

 
 
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