Cytomegalovirus (CMV); Symptoms, Diagnosis, Treatment & Prevention

Diagnosis and treatment

The signs and symptoms of cytomegalovirus are sometimes very similar to Epstein-Barr’s. In that case, we include these symptoms in a mononucleosis-like syndrome. Differentiation of cytomegalovirus in these cases can be challenging because some immunoglobulin tests have a cross-reaction between cytomegalovirus and Epstein-Barr. In other words, your test may have a positive result for Epstein-Barr when you’re infected with cytomegalovirus.

The most common laboratory studies in patients with cytomegalovirus include:

• Complete blood count and blood chemistry: They are helpful to determine cytopenias, bilirubin levels, and transaminases, which are often abnormal in these patients.
• Antigen testing: It is used to determine more accurately if the patient has been exposed to cytomegalovirus. Antigens are immune responses against the virus and may stay negative in immunocompromised patients. But in those with an intact immune system, it is a valuable test to guide antiviral therapy.
• PCR test: This is more sensitive than antigen testing and is more helpful in transplant recipients and other immunocompromised patients.
• Cytopathology: In some cases, the only way to diagnose cytomegalovirus and differentiate this ailment from Epstein-Barr would be taking a cytology sample and looking under the microscope. There’s a formation known as owl’s eye, representing viral inclusions in infected cells.
• Chest radiographs: It is helpful to detect and treat cytomegalovirus pneumonia. The infiltrate follows an interstitial pattern.

After diagnosing cytomegalovirus, medical treatment depends on the patient morbidity and risks. Asymptomatic patients and those with mild disease may receive therapy to prevent complications, but it is usually reserved for immunocompromised and critically ill patients. They may receive valacyclovir or acyclovir in high doses to treat the infection. Another drug recommended in these cases is letermovir, used in transplant recipients with around 25% success in clearing the infection.

One of the most common symptoms is fatigue, so many of these patients are recommended to follow a resting period that may extend to one or two months. Patients are advised to resume their usual activities and engage in physical activity as soon as they can tolerate it.