Table 1.
Disease manifestation | Definition | Risk factors |
---|---|---|
General population | ||
Latent CMV | Asymptomatic, no clinically detectable active replication | Female sex, older age, high crowding index, and low household income or education [2] |
Mononucleosis-like syndrome | Predominant constitutional, mononucleosis-like symptoms with intact immune system | Blood transfusions, second or third decades of life, exposure to bodily fluids of infected host [14] |
Tissue-invasive CMV | Predominant symptoms localizable to a specific tissue site | Critical illness (especially with sepsis or intubation at time of admission), active malignancy (especially with low BMI, lymphopenia, or steroid use), hematologic malignancy, blood transfusion [27] |
Inflammatory bowel disease ∗ | ||
Tissue-invasive CMV | Predominant symptoms typically localizable to the GI tract, mimicking IBD flare | Endoscopic inflammation [107], immunosuppressant-refractory ulcerative colitis |
Liver transplant ∗∗ | ||
CMV syndrome | Positive CMV serum PCR with 2 of the following: (i) Fever ≥ 38°C for at least 2 days (ii) New fatigue or malaise (iii) Leukopenia or neutropenia (iv) ≥5% atypical lymphocytes (v) Platelets < 100,000 cell/μL or >20% decrease (vi) >2 xULN ALT or AST |
R-/D+ status, acute allograft rejection, immunosuppression with antilymphocyte antibodies, mycophenolate dose > 2 grams/day, viral coinfection, toll-like receptor polymorphisms [108] |
Tissue-invasive CMV | Predominant symptoms localizable to a specific tissue site |
∗Latent CMV and mononucleosis-like syndrome definition and risk factors are as with the general population. ∗∗Latent CMV definition and risk factors are as with the general population.