Diagnosis of primary, acute phase infection with cytomegalovirus (CMV), especially in patients with infectious mononucleosis and pregnant women who, based on clinical signs or exposure, may have primary CMV infection
Cytomegalovirus (CMV) is a significant cause of morbidity and mortality, especially in organ transplant recipients and individuals with AIDS. CMV is also responsible for congenital disease of the newborn. The most common infections with CMV in immunocompromised hosts result from reactivation of the virus (latent) from a previous infection, transmission of the virus from a donor organ or blood product, or initial or primary contact with the virus in a seronegative patient. Infection in immunologically normal patients can cause mononucleosis similar to that produced by infection with Epstein-Barr virus.
Infections with cytomegalovirus (CMV), a member of the herpesvirus family, are common in humans and are usually mild and asymptomatic; however, infection in pregnant women, newborns, and immunocompromised individuals may pose a significant medical risk. In utero infection may result in sequelae of varying degree including mental retardation, choriorentinitis, hearing loss and neurologic problems. An individual may undergo primary infection with CMV, reinfection with exogenous virus or reactivation of latent virus.
The presence of CMV specific IgG antibody does not assure protection from disease. The renal transplant patient with primary infection develops significantly more viremia and symptomatic diseases than does the patient with recurrent infection. The provision of seronegative blood products to selected patients remains a vital consideration in patient management. Serologic tests can be used to identify seronegative individuals and seronegative donors of organs or blood products.
CMV acquisition in infants can occur transplacentally following maternal infection, during birth by contact with the virus excreted from the cervix or following birth through the ingestion of infected maternal breast milk. Both seronegative individuals and infants may acquire CMV through infected blood products or contact with an infected individual. Children beyond the neonatal period are susceptible to infection and subsequent transmission of CMV when in day care. CMV has been isolated from contaminated environmental surfaces; however, the role of fomites in CMV transmission has not been established.
Anti-CVM IgM: NONREACTIVE
A NONREACTIVE CMV IgM result indicates no recent CMV infection. However, a negative result does not rule out primary CMV infection.
A REACTIVE CMV IgM result indicates a recent infection (primary, reactivation, or reinfection).
Whenever possible, serological diagnosis of CMV infection should be confirmed by other virologic methods such as viral culture.
Crumpacker II, C. S., and Zhang, J. L. 2010. Cytomegalovirus, p. 1971-1987. In Mandell, D., Bennett, J. E., and Dolin, R. Principles and practice of infectious diseases, 7th ed., vol. 2. Churchill Livingstone, Elsevier, Philadelphia, PA.
Hodinka, R. L. 2007. Human Cytomegalovirus, p. 1549-1563. In Murray, P. R., Baron, E. J., Jorgensen, J. H., Landry, M. L., and Pfaller, M. A. Manual of Clinical Microbiology, 9th ed., vol. 2. ASM Press, American Society for Microbiology, Washington, DC.
Abbott. 2007. Architect System CMV IgM Package insert. Abbott Ireland, Diagnostics Division, Sligo, Ireland.
Abbott. 2008. Architect System CMV IgG Package insert. Abbott Ireland, Diagnostics Division, Sligo, Ireland.