Cytomegalovirus (CMV) Questions & Answers

1. Bennett J, Dolin R, Blaser M. Mandell, Douglas, and Bennett's principles and practice of infectious diseases. 9th edition. Elsevier/Saunders; 2015.

2. Hodson EM, Jones CA, Webster AC, Strippoli GF, Barclay PG, Kable K. Antiviral medications to prevent cytomegalovirus disease and early death in recipients of solid-organ transplants: a systematic review of randomised controlled trials. Lancet. 2005 Jun 18-24. 365(9477):2105-15. [QxMD MEDLINE Link].

3. Zhang LJ, Hanff P, Rutherford C, Churchill WH, Crumpacker CS. Detection of human cytomegalovirus DNA, RNA, and antibody in normal donor blood. J Infect Dis. 1995 Apr. 171(4):1002-6. [QxMD MEDLINE Link].

4. Collier AC, Meyers JD, Corey L, Murphy VL, Roberts PL, Handsfield HH. Cytomegalovirus infection in homosexual men. Relationship to sexual practices, antibody to human immunodeficiency virus, and cell-mediated immunity. Am J Med. 1987 Mar 23. 82(3 Spec No):593-601. [QxMD MEDLINE Link].

5. Guinan ME, Thomas PA, Pinsky PF, Goodrich JT, Selik RM, Jaffe HW. Heterosexual and homosexual patients with the acquired immunodeficiency syndrome. A comparison of surveillance, interview, and laboratory data. Ann Intern Med. 1984 Feb. 100(2):213-8. [QxMD MEDLINE Link].

6. Staras SA, Dollard SC, Radford KW, Flanders WD, Pass RF, Cannon MJ. Seroprevalence of cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis. 2006 Nov 1. 43(9):1143-51. [QxMD MEDLINE Link].

7. Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis. 2010 Jun 1. 50(11):1439-47. [QxMD MEDLINE Link].

8. Ljungman P, Griffiths P, Paya C. Definitions of cytomegalovirus infection and disease in transplant recipients. Clin Infect Dis. 2002 Apr 15. 34(8):1094-7. [QxMD MEDLINE Link].

9. Cunha BA. Cytomegalovirus pneumonia: community-acquired pneumonia in immunocompetent hosts. Infect Dis Clin North Am. 2010 Mar. 24(1):147-58. [QxMD MEDLINE Link].

10. Deayton JR, Prof Sabin CA, Johnson MA, Emery VC, Wilson P, Griffiths PD. Importance of cytomegalovirus viraemia in risk of disease progression and death in HIV-infected patients receiving highly active antiretroviral therapy. Lancet. 2004 Jun 26. 363(9427):2116-21. [QxMD MEDLINE Link].

11. Stagno S, Pass RF, Cloud G, Britt WJ, Henderson RE, Walton PD. Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAMA. 1986 Oct 10. 256(14):1904-8. [QxMD MEDLINE Link].

12. Stagno S. Cytomegalovirus. Remington JS, Klein JO. Infectious Diseases of the Fetus and Newborn Infant. Philadelphia: WB Saunders; 2001. 389-424.

13. Arora N, Novak Z, Fowler KB, Boppana SB, Ross SA. Cytomegalovirus viruria and DNAemia in healthy seropositive women. J Infect Dis. 2010 Dec 15. 202(12):1800-3. [QxMD MEDLINE Link]. [Full Text].

14. Walter EA, Greenberg PD, Gilbert MJ. Reconstitution of cellular immunity against cytomegalovirus in recipients of allogeneic bone marrow by transfer of T-cell clones from the donor. N Engl J Med. 1995 Oct 19. 333(16):1038-44. [QxMD MEDLINE Link].

15. Kabani N, Ross SA. Congenital Cytomegalovirus Infection. J Infect Dis. 2020. 221(Suppl 1):S9-S14. [Full Text].

16. Institute of Medicine (US) Committee to Study Priorities for Vaccine Development, Stratton KR, Durch JS, Lawrence RS, eds. Vaccines for the 21st Century: A Tool for Decisionmaking. National Academies Press (US). 2000.

17. Morton CC, Nance WE. Newborn hearing screening--a silent revolution. N Engl J Med. 2006. 354(20):2151-2164. [Full Text].

18. Leruez-Ville M, Foulon I, Pass R, Ville Y. Cytomegalovirus infection during pregnancy: state of the science. Am J Obstet Gynecol. 2020. 223(3):330-349. [Full Text].

19. Dreher AM, Arora N, Fowler KB, et al. Spectrum of disease and outcome in children with symptomatic congenital cytomegalovirus infection. J Pediatr. 2014. 164(4):855-859. [Full Text].

20. Chiopris G, Veronese P, Cusenza F, et al. Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment. Microorganisms. 2020. 8(10):1516. [Full Text].

21. Davis NL, King CC, Kourtis AP. Cytomegalovirus infection in pregnancy. Birth Defects Res. 2017. 109(5):336-346. [Full Text].

22. Fonseca Brito L, Brune W, Stahl FR. Cytomegalovirus (CMV) Pneumonitis: Cell Tropism, Inflammation, and Immunity. Int J Mol Sci. 2019. 20(16):3865. [Full Text].

23. Bonkowsky HL, Lee RV, Klatskin G. Acute granulomatous hepatitis. Occurrence in cytomegalovirus mononucleosis. JAMA. 1975 Sep 22. 233(12):1284-8. [QxMD MEDLINE Link].

24. Meiselman MS, Cello JP, Margaretten W. Cytomegalovirus colitis. Report of the clinical, endoscopic, and pathologic findings in two patients with the acquired immune deficiency syndrome. Gastroenterology. 1985 Jan. 88(1 Pt 1):171-5. [QxMD MEDLINE Link].

25. Orlikowski D, Porcher R, Sivadon-Tardy V, et al. Guillain-Barre Syndrome following Primary Cytomegalovirus Infection: A Prospective Cohort Study. Clin Infect Dis. 2011 Apr. 52(7):837-44. [QxMD MEDLINE Link].

26. Jabs DA, Van Natta ML, Kempen JH, Reed Pavan P, Lim JI, Murphy RL, et al. Characteristics of patients with cytomegalovirus retinitis in the era of highly active antiretroviral therapy. Am J Ophthalmol. 2002 Jan. 133(1):48-61. [QxMD MEDLINE Link].

27. Karavellas MP, Plummer DJ, Macdonald JC, Torriani FJ, Shufelt CL, Azen SP. Incidence of immune recovery vitritis in cytomegalovirus retinitis patients following institution of successful highly active antiretroviral therapy. J Infect Dis. 1999 Mar. 179(3):697-700. [QxMD MEDLINE Link].

28. Wohl DA, Kendall MA, Owens S, Holland G, Nokta M, Spector SA. The safety of discontinuation of maintenance therapy for cytomegalovirus (CMV) retinitis and incidence of immune recovery uveitis following potent antiretroviral therapy. HIV Clin Trials. 2005 May-Jun. 6(3):136-46. [QxMD MEDLINE Link].

29. Wright ME, Suzman DL, Csaky KG, Masur H, Polis MA, Robinson MR. Extensive retinal neovascularization as a late finding in human immunodeficiency virus-infected patients with immune recovery uveitis. Clin Infect Dis. 2003 Apr 15. 36(8):1063-6. [QxMD MEDLINE Link].

30. Richardson WP, Colvin RB, Cheeseman SH. Glomerulopathy associated with cytomegalovirus viremia in renal allografts. N Engl J Med. 1981 Jul 9. 305(2):57-63. [QxMD MEDLINE Link].

31. Torok-Storb B, Boeckh M, Hoy C. Association of specific cytomegalovirus genotypes with death from myelosuppression after marrow transplantation. Blood. 1997 Sep 1. 90(5):2097-102. [QxMD MEDLINE Link].

32. Manuel O, Asberg A, Pang X, Rollag H, Emery VC, Preiksaitis JK. Impact of genetic polymorphisms in cytomegalovirus glycoprotein B on outcomes in solid-organ transplant recipients with cytomegalovirus disease. Clin Infect Dis. 2009 Oct 15. 49(8):1160-6. [QxMD MEDLINE Link].

33. Iwasenko JM, Howard J, Arbuckle S, et al. Human cytomegalovirus infection is detected frequently in stillbirths and is associated with fetal thrombotic vasculopathy. J Infect Dis. 2011 Jun. 203(11):1526-33. [QxMD MEDLINE Link].

34. Klemola E, Von Essen R, Henle G, Henle W. Infectious-mononucleosis-like disease with negative heterophil agglutination test. Clinical features in relation to Epstein-Barr virus and cytomegalovirus antibodies. J Infect Dis. 1970 Jun. 121(6):608-14. [QxMD MEDLINE Link].

35. Cohen JI, Corey GR. Cytomegalovirus infection in the normal host. Medicine (Baltimore). 1985 Mar. 64(2):100-14. [QxMD MEDLINE Link].

36. Horwitz CA, Henle W, Henle G. Clinical and laboratory evaluation of cytomegalovirus-induced mononucleosis in previously healthy individuals. Report of 82 cases. Medicine (Baltimore). 1986 Mar. 65(2):124-34. [QxMD MEDLINE Link].

37. Klemola E, Stenström R, von Essen R. Pneumonia as a clinical manifestation of cytomegalovirus infection in previously healthy adults. Scand J Infect Dis. 1972. 4(1):7-10. [QxMD MEDLINE Link].

38. Jaber S, Chanques G, Borry J, Souche B, Verdier R, Perrigault PF. Cytomegalovirus infection in critically ill patients: associated factors and consequences. Chest. 2005 Jan. 127(1):233-41. [QxMD MEDLINE Link].

39. von Müller L, Klemm A, Weiss M, et al. Active cytomegalovirus infection in patients with septic shock. Emerg Infect Dis. 2006 Oct. 12(10):1517-22. [QxMD MEDLINE Link]. [Full Text].

40. Kalil AC, Florescu DF. Prevalence and mortality associated with cytomegalovirus infection in nonimmunosuppressed patients in the intensive care unit. Crit Care Med. 2009 Aug. 37(8):2350-8. [QxMD MEDLINE Link].

41. Cook CH, Yenchar JK, Kraner TO, Davies EA, Ferguson RM. Occult herpes family viruses may increase mortality in critically ill surgical patients. Am J Surg. 1998 Oct. 176(4):357-60. [QxMD MEDLINE Link].

42. De Vlieger G, Meersseman W, Lagrou K, et al. Cytomegalovirus serostatus and outcome in nonimmunocompromised critically ill patients. Crit Care Med. 2012 Jan. 40(1):36-42. [QxMD MEDLINE Link].

43. Jerry Teng CL, Wang PN, Chen YC, Ko BS. Cytomegalovirus management after allogeneic hematopoietic stem cell transplantation: A mini-review. J Microbiol Immunol Infect. 2021. [Full Text].

44. Reed EC, Bowden RA, Dandliker PS. Treatment of cytomegalovirus pneumonia with ganciclovir and intravenous cytomegalovirus immunoglobulin in patients with bone marrow transplants. Ann Intern Med. 1988 Nov 15. 109(10):783-8. [QxMD MEDLINE Link].

45. Eid AJ, Arthurs SK, Deziel PJ, Wilhelm MP, Razonable RR. Clinical predictors of relapse after treatment of primary gastrointestinal cytomegalovirus disease in solid organ transplant recipients. Am J Transplant. 2010 Jan. 10(1):157-61. [QxMD MEDLINE Link].

46. Dieterich DT, Rahmin M. Cytomegalovirus colitis in AIDS: presentation in 44 patients and a review of the literature. J Acquir Immune Defic Syndr. 1991. 4 Suppl 1:S29-35. [QxMD MEDLINE Link].

47. McCutchan JA. Cytomegalovirus infections of the nervous system in patients with AIDS. Clin Infect Dis. 1995 Apr. 20(4):747-54. [QxMD MEDLINE Link].

48. Shanahan A, Malani PN, Kaul DR. Relapsing cytomegalovirus infection in solid organ transplant recipients. Transpl Infect Dis. 2009 Dec. 11(6):513-8. [QxMD MEDLINE Link].

49. Martín-Dávila P, Fortún J, Gutiérrez C, Martí-Belda P, Candelas A, Honrubia A, et al. Analysis of a quantitative PCR assay for CMV infection in liver transplant recipients: an intent to find the optimal cut-off value. J Clin Virol. 2005 Jun. 33(2):138-44. [QxMD MEDLINE Link].

50. Aitken C, Barrett-Muir W, Millar C, Templeton K, Thomas J, Sheridan F. Use of molecular assays in diagnosis and monitoring of cytomegalovirus disease following renal transplantation. J Clin Microbiol. 1999 Sep. 37(9):2804-7. [QxMD MEDLINE Link]. [Full Text].

51. Gerna G, Zipeto D, Parea M, Revello MG, Silini E, Percivalle E. Monitoring of human cytomegalovirus infections and ganciclovir treatment in heart transplant recipients by determination of viremia, antigenemia, and DNAemia. J Infect Dis. 1991 Sep. 164(3):488-98. [QxMD MEDLINE Link].

52. Tanabe K, Tokumoto T, Ishikawa N, Koyama I, Takahashi K, Fuchinoue S. Comparative study of cytomegalovirus (CMV) antigenemia assay, polymerase chain reaction, serology, and shell vial assay in the early diagnosis and monitoring of CMV infection after renal transplantation. Transplantation. 1997 Dec 27. 64(12):1721-5. [QxMD MEDLINE Link].

53. Anti-Cytomegalovirus (CMV) Immediate Early Antigen Monoclonal Antibody, Unconjugated, Clone 3G9.2 from CHEMICON. www.chemicon.com. Available at http://www.bio-medicine.org/biology-products/Anti-Cytomegalovirus--28CMV-29-Immediate-Early-Antigen-Monoclonal-Antibody--Unconjugated--Clone-3G9-2-from-CHEMICON-2132-1/. Accessed: March 17, 2010.

54. Boppana SB, Ross SA, Shimamura M, Palmer AL, Ahmed A, Michaels MG, et al. Saliva polymerase-chain-reaction assay for cytomegalovirus screening in newborns. N Engl J Med. 2011 Jun 2. 364(22):2111-8. [QxMD MEDLINE Link]. [Full Text].

55. Sanghavi SK, Abu-Elmagd K, Keightley MC, St George K, Lewandowski K, Boes SS. Relationship of cytomegalovirus load assessed by real-time PCR to pp65 antigenemia in organ transplant recipients. J Clin Virol. 2008 Aug. 42(4):335-42. [QxMD MEDLINE Link].

56. Jabs DA, Martin BK, Forman MS, Ricks MO. Cytomegalovirus (CMV) blood DNA load, CMV retinitis progression, and occurrence of resistant CMV in patients with CMV retinitis. J Infect Dis. 2005 Aug 15. 192(4):640-9. [QxMD MEDLINE Link].

57. Roche Molecular Diagnostics. COBAS AMPLICOR CMV MONITOR test. Available at http://molecular.roche.com/assays/Pages/COBASAMPLICORCMVMONITORTest.aspx. Accessed: July 10, 2012.

58. Roche Molecular Diagnostics. COBAS AmpliPrep/COBAS TaqMan CMV test. Available at http://molecular.roche.com/assays/Pages/COBASAmpliPrepCOBASTaqManCMVTest.aspx. Accessed: July 10, 2012.

59. Smith TF, Espy MJ, Mandrekar J, Jones MF, Cockerill FR, Patel R. Quantitative real-time polymerase chain reaction for evaluating DNAemia due to cytomegalovirus, Epstein-Barr virus, and BK virus in solid-organ transplant recipients. Clin Infect Dis. 2007 Oct 15. 45(8):1056-61. [QxMD MEDLINE Link].

60. Razonable RR. Drug-resistant cytomegalovirus: clinical implications of specific mutations. Curr Opin Organ Transplant. 2018. 23(4):388-394. [Full Text].

61. Marty FM, Ljungman P, Chemaly RF, Maertens J, Dadwal SS, Duarte RF, et al. Letermovir Prophylaxis for Cytomegalovirus in Hematopoietic-Cell Transplantation. N Engl J Med. 2017 Dec 6. [QxMD MEDLINE Link]. [Full Text].

62. Acosta E, Bowlin T, Brooks J, et al. Advances in the Development of Therapeutics for Cytomegalovirus Infections. J Infect Dis. 2020. 221(Suppl 1):S32-S44. [Full Text].

63. Limaye AP, Budde K, Humar A, Vincenti F, Kuypers DRJ, Carroll RP, et al. Letermovir vs Valganciclovir for Prophylaxis of Cytomegalovirus in High-Risk Kidney Transplant Recipients: A Randomized Clinical Trial. JAMA. 2023 Jun 6. [QxMD MEDLINE Link].

64. No authors listed. Valganciclovir: new preparation. CMV retinitis: a simpler, oral treatment. Prescrire Int. 2003 Aug. 12(66):133-5. [QxMD MEDLINE Link].

65. Caldés A, Gil-Vernet S, Armendariz Y, Colom H, Pou L, Niubó J, et al. Sequential treatment of cytomegalovirus infection or disease with a short course of intravenous ganciclovir followed by oral valganciclovir: efficacy, safety, and pharmacokinetics. Transpl Infect Dis. 2009 Dec 9. [QxMD MEDLINE Link].

66. Dieterich DT, Chachoua A, Lafleur F. Ganciclovir treatment of gastrointestinal infections caused by cytomegalovirus in patients with AIDS. Rev Infect Dis. 1988 Jul-Aug. 10 Suppl 3:S532-7. [QxMD MEDLINE Link].

67. Kalil AC, Mindru C, Florescu DF. Effectiveness of valganciclovir 900 mg versus 450 mg for cytomegalovirus prophylaxis in transplantation: direct and indirect treatment comparison meta-analysis. Clin Infect Dis. 2011 Feb. 52(3):313-21. [QxMD MEDLINE Link].

68. Avery RK. Low-dose valganciclovir for cytomegalovirus prophylaxis in organ transplantation: is less really more?. Clin Infect Dis. 2011 Feb. 52(3):322-4. [QxMD MEDLINE Link].

69. Legendre C, Pascual M. Improving outcomes for solid-organ transplant recipients at risk from cytomegalovirus infection: late-onset disease and indirect consequences. Clin Infect Dis. 2008 Mar 1. 46(5):732-40. [QxMD MEDLINE Link].

70. Cytomegalovirus. Am J Transplant. 2004 Nov. 4 Suppl 10:51-8. [QxMD MEDLINE Link].

71. Bodro M, Sabé N, Lladó L, et al. Prophylaxis versus preemptive therapy for cytomegalovirus disease in high-risk liver transplant recipients. Liver Transpl. 2012 Sep. 18(9):1093-9. [QxMD MEDLINE Link].

72. Paudice N, Mehmetaj A, Zanazzi M, Moscarelli L, Piperno R, Di Maria L. Preemptive therapy for the prevention of cytomegalovirus disease in renal transplant recipients: our preliminary experience. Transplant Proc. 2009 May. 41(4):1204-6. [QxMD MEDLINE Link].

73. Boeckh M, Gooley TA, Myerson D. Cytomegalovirus pp65 antigenemia-guided early treatment with ganciclovir versus ganciclovir at engraftment after allogeneic marrow transplantation: a randomized double-blind study. Blood. 1996 Nov 15. 88(10):4063-71. [QxMD MEDLINE Link].

74. Avery RK, Marty FM, Strasfeld L, Lee I, Arrieta A, Chou S. Oral maribavir for treatment of refractory or resistant cytomegalovirus infections in transplant recipients. Transpl Infect Dis. 2010 Dec. 12(6):489-96. [QxMD MEDLINE Link].

75. Marty FM, Ljungman P, Papanicolaou GA, Winston DJ, Chemaly RF, Strasfeld L. Maribavir prophylaxis for prevention of cytomegalovirus disease in recipients of allogeneic stem-cell transplants: a phase 3, double-blind, placebo-controlled, randomised trial. Lancet Infect Dis. 2011 Apr. 11(4):284-92. [QxMD MEDLINE Link].

76. Trofe J, Pote L, Wade E, Blumberg E, Bloom RD. Maribavir: a novel antiviral agent with activity against cytomegalovirus. Ann Pharmacother. 2008 Oct. 42(10):1447-57. [QxMD MEDLINE Link].

77. John GT, Manivannan J, Chandy S, Peter S, Jacob CK. Leflunomide therapy for cytomegalovirus disease in renal allograft recepients. Transplantation. 2004 May 15. 77(9):1460-1. [QxMD MEDLINE Link].

78. John GT, Manivannan J, Chandy S, Peter S, Fleming DH, Chandy SJ, et al. A prospective evaluation of leflunomide therapy for cytomegalovirus disease in renal transplant recipients. Transplant Proc. 2005 Dec. 37(10):4303-5. [QxMD MEDLINE Link].

79. Levi ME, Mandava N, Chan LK, Weinberg A, Olson JL. Treatment of multidrug-resistant cytomegalovirus retinitis with systemically administered leflunomide. Transpl Infect Dis. 2006 Mar. 8(1):38-43. [QxMD MEDLINE Link].

80. Battiwalla M, Paplham P, Almyroudis NG, McCarthy A, Abdelhalim A, Elefante A. Leflunomide failure to control recurrent cytomegalovirus infection in the setting of renal failure after allogeneic stem cell transplantation. Transpl Infect Dis. 2007 Mar. 9(1):28-32. [QxMD MEDLINE Link].

81. Valantine HA, Luikart H, Doyle R, Theodore J, Hunt S, Oyer P. Impact of cytomegalovirus hyperimmune globulin on outcome after cardiothoracic transplantation: a comparative study of combined prophylaxis with CMV hyperimmune globulin plus ganciclovir versus ganciclovir alone. Transplantation. 2001 Nov 27. 72(10):1647-52. [QxMD MEDLINE Link].

82. Go V, Pollard RB. A cytomegalovirus vaccine for transplantation: are we closer?. J Infect Dis. 2008 Jun 15. 197(12):1631-3. [QxMD MEDLINE Link].

83. Schleiss MR. A cytomegalovirus vaccine tames the troll of transplantation. Lancet. 2011 Apr 9. 377(9773):1216-8. [QxMD MEDLINE Link].

84. Pass RF, Zhang C, Evans A, Simpson T, Andrews W, Huang ML, et al. Vaccine prevention of maternal cytomegalovirus infection. N Engl J Med. 2009 Mar 19. 360(12):1191-9. [QxMD MEDLINE Link]. [Full Text].

85. Price NB, Prichard MN. Progress in the development of new therapies for herpesvirus infections. Curr Opin Virol. 2011 Dec. 1(6):548-54. [QxMD MEDLINE Link].

86. Torres-Madriz G, Boucher HW. Immunocompromised hosts: perspectives in the treatment and prophylaxis of cytomegalovirus disease in solid-organ transplant recipients. Clin Infect Dis. 2008 Sep 1. 47(5):702-11. [QxMD MEDLINE Link].

87. Wolf DG, Shimoni A, Resnick IB, Stamminger T, Neumann AU, Chou S. Human cytomegalovirus kinetics following institution of artesunate after hematopoietic stem cell transplantation. Antiviral Res. 2011 Jun. 90(3):183-6. [QxMD MEDLINE Link].

88. Shapira MY, Resnick IB, Chou S, et al. Artesunate as a potent antiviral agent in a patient with late drug-resistant cytomegalovirus infection after hematopoietic stem cell transplantation. Clin Infect Dis. 2008 May 1. 46(9):1455-7. [QxMD MEDLINE Link].

89. Kaul DR, Stoelben S, Cober E, Ojo T, Sandusky E, Lischka P. First report of successful treatment of multidrug-resistant cytomegalovirus disease with the novel anti-CMV compound AIC246. Am J Transplant. 2011 May. 11(5):1079-84. [QxMD MEDLINE Link].

Ricardo Cedeno-Mendoza, MD Fellow in Infectious Diseases, Cooper University Hospital, Cooper Medical School of Rowan University

Ricardo Cedeno-Mendoza, MD is a member of the following medical societies: American Medical Association

Disclosure: Nothing to disclose.

Lisa Vanchhawng Pedroza, MD Assistant Professor of Medicine, Attending Physician, Division of Infectious Diseases, Cooper University Hospital

Lisa Vanchhawng Pedroza, MD is a member of the following medical societies: Infectious Diseases Society of America

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

John W King, MD Professor of Medicine, Chief, Section of Infectious Diseases, Director, Viral Therapeutics Clinics for Hepatitis, Louisiana State University School of Medicine in Shreveport; Consultant in Infectious Diseases, Overton Brooks 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, Sigma Xi, The Scientific Research Honor Society

Disclosure: Nothing to disclose.

Michael Stuart Bronze, MD David Ross Boyd Professor and Chairman, Department of Medicine, Stewart G Wolf Endowed Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center; Master of the American College of Physicians; Fellow, Infectious Diseases Society of America; Fellow of the Royal College of Physicians, London

Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American Medical Association, Association of Professors of Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, Southern Society for Clinical Investigation

Disclosure: Nothing to disclose.

Todd S Wills, MD Associate Professor, Department of Medicine, Division of Infectious Disease and International Medicine, Program Director, Infectious Disease Fellowship Program, 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.

Kauser Akhter, MD Assistant Professor, Department of Internal Medicine, Florida State University College of Medicine; Associate Program Director, Infectious Diseases Fellowship Program, Orlando Health

Disclosure: Nothing to disclose.

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous coauthor Todd S Wills, MD to the development and writing of this article.

• Print this section
• Print the entire contents of
• Print the entire contents of article