What are the potential complications of CMV infection that I should monitor for in my patients?

Potential complications of cytomegalovirus (CMV) infection to monitor in patients include:

• In immunocompetent individuals: CMV infection is often asymptomatic or causes a mild mononucleosis-like illness, but rarely can lead to severe organ-specific complications such as hepatitis, pneumonitis, or colitis.
• In pregnancy: CMV can cause congenital infection leading to sensorineural hearing loss, neurodevelopmental delay, and fetal growth restriction, necessitating close monitoring of pregnant patients for signs of fetal involvement Yinon et al. 2010.
• In immunocompromised patients, especially solid organ transplant recipients: CMV can cause invasive disease including pneumonitis, gastrointestinal ulceration and colitis, hepatitis, retinitis, and encephalitis. These complications can lead to graft dysfunction and increased mortality, so vigilant monitoring for symptoms and viral load is essential de la Torre-Cisneros et al. 2011.
• In allogeneic hematopoietic stem cell transplant recipients: CMV reactivation is common and can cause severe complications such as CMV pneumonia, gastrointestinal disease, and increased risk of graft-versus-host disease exacerbation. Early detection and pre-emptive treatment are critical to prevent morbidity and mortality Piñana et al. 2024.

Summary: Monitor for systemic symptoms, organ-specific signs (lung, liver, gastrointestinal, eye, CNS), and in pregnancy, fetal complications. Immunosuppressed patients require close surveillance for invasive CMV disease to prevent severe outcomes NICE CG165 Yinon et al. 2010de la Torre-Cisneros et al. 2011Piñana et al. 2024.