Diagnostic Considerations

The differential diagnosis for cytomegalovirus (CMV) infection depends on the disease category, the age of the patient, and epidemiologic considerations.

In the neonate with congenital infection, the differential diagnosis includes any of the TORCH agents. Congenital toxoplasmosis may mimic congenital CMV infection but is much less common in the United States; however, in parts of Europe, particularly France and Belgium, congenital toxoplasmosis is a common and significant problem. In contrast to congenital CMV, the intracranial calcifications observed in congenital toxoplasmosis tend to be scattered diffusely throughout the brain and not in the classic periventricular distribution of CMV, which may be an important clue.

Other congenital infections to be considered include lymphocytic choriomeningitis virus (LCMV) infection,^[44]herpes simplex virus (HSV) infection, syphilis, enteroviral disease, HIV infection, and rubella.

In older patients, differentiating CMV infection from Epstein-Barr virus (EBV) infection may be clinically difficult. EBV is a more common cause of mononucleosis syndrome than CMV, and the heterophile antibody test results (ie, Monospot) are generally positive, allowing for ready differentiation of the diseases.

In immunocompromised patients, disease syndromes caused by CMV may be difficult to differentiate from other opportunistic infections. For example, CMV pneumonitis following bone marrow transplantation must be differentiated from Pneumocystis carinii infection and other viral infections, such as adenovirus and human herpesvirus 6 (HHV-6) infection. Appropriate diagnostic specimens obtained by studies such as bronchoalveolar lavage are indicated.

Differential Diagnoses

Congenital or perinatal parecho virus infection
Herpesvirus 6 Infection
Pediatric Enteroviral Infections
Pediatric Herpes Simplex Virus Infection
Pediatric Lymphocytic Choriomeningitis Virus
Pediatric Rubella
Toxoplasmosis

Workup

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Media Gallery

Epidemiology patterns of congenital cytomegalovirus infection. Approximately 10% of cases of congenital cytomegalovirus occur in women with primary infection during pregnancy, and 90% of these infants have neurological sequelae. Although preexisting immunity (eg, maternal recurrent infection) protects against severe disease, approximately 15% of these infants have sequelae, particularly sensorineural hearing loss.
Cranial CT scan of infant born with symptomatic congenital cytomegalovirus infection. Neurological involvement is evident, manifest as ventriculomegaly and periventricular calcifications.