Severe Cytomegalovirus Infection in Apparently Immunocompetent Patients: a Systematic Review

Overview

Journal Virol J

Publisher Biomed Central

Specialty Microbiology

Date 2008 Mar 29

PMID 18371229

Citations 229

Authors

Petros I Rafailidis

Eleni G Mourtzoukou

Ioannis C Varbobitis

Matthew E Falagas

Affiliations

Soon will be listed here.

Abstract

Background: The morbidity and mortality associated with cytomegalovirus (CMV) infection in immunocompromised patients (especially in HIV-infected patients and transplant recipients), as well as with congenital CMV infection are well known. In contrast, relatively little attention has been paid to the morbidity and mortality that CMV infection may cause in immunocompetent patients.

Methods: We reviewed the evidence associated with severe manifestations of CMV infection in apparently immunocompetent patients and the potential role of antiviral treatment for these infections. We searched in PubMed, Scopus, and the Cochrane Library for the period of 1950-2007 to identify relevant articles.

Results: We retrieved 89 articles reporting on severe CMV infection in 290 immunocompetent adults. Among these reports, the gastrointestinal tract (colitis) and the central nervous system (meningitis, encephalitis, transverse myelitis) were the most frequent sites of severe CMV infection. Manifestations from other organ-systems included haematological disorders (haemolytic anaemia, thrombocytopenia), thrombosis of the venous or arterial vascular system, ocular involvement (uveitis), and lung disease (pneumonitis). The clinical practice reported in the literature has been to prescribe antiviral treatment for the most severe manifestations of monophasic meningoencephalitis (seizures and coma), ocular involvement, and lung involvement due to CMV.

Conclusion: Severe life-threatening complications of CMV infection in immunocompetent patients may not be as rare as previously thought.

Citing Articles

Hemolytic Anemia Linked to Epstein-Barr Virus Infectious Mononucleosis: A Systematic Review of the Literature.

Meloni D, Fare P, Milani G, Lava S, Bianchetti M, Renzi S J Clin Med. 2025; 14(4).

PMID: 40004813 PMC: 11856085. DOI: 10.3390/jcm14041283.

Clinical Features and Outcomes of Cytomegalovirus Retinitis in Immunosuppressed Non-HIV Patients.

Alkhuraiji A, Refka M, Aldebasi T, Elzahrani M, Alotaibi M, Alhazzazi M Middle East Afr J Ophthalmol. 2025; 30(4):220-228.

PMID: 39959593 PMC: 11823542. DOI: 10.4103/meajo.meajo_55_24.

Clinical, molecular, and immunologic mechanisms of CMV retinitis: Evolving understanding in HIV and non-HIV immunosuppressed patients.

Song H, Begley J, Asheim C, Albini T, Conrady C, Yeh S Expert Rev Ophthalmol. 2025; 20(1):19-28.

PMID: 39925880 PMC: 11805338. DOI: 10.1080/17469899.2024.2417067.

Cytomegalovirus Infection in an Immunocompetent Host Presenting as Hemophagocytic Lymphohistiocytosis.

Matias-Lopes I, Atalaia-Barbacena H, Guiomar M, Soares R, Barao C, Ferreira A Eur J Case Rep Intern Med. 2025; 11(12):005071.

PMID: 39790850 PMC: 11716311. DOI: 10.12890/2024_005071.

The Association Between Cytomegalovirus Infection and Kidney Damage in the Liver Transplant Setting.

Saidy R, Eurich F, Globke B, Schoning W, Ollinger R, Raschzok N Viruses. 2025; 16(12.

PMID: 39772140 PMC: 11680441. DOI: 10.3390/v16121830.

References

Patra S, Samal S, Chacko A, MATHAN V, Mathan M . Cytomegalovirus infection of the human gastrointestinal tract. J Gastroenterol Hepatol. 1999; 14(10):973-6. DOI: 10.1046/j.1440-1746.1999.01986.x. View

Ofotokun I, Carlson C, Gitlin S, Elta G, Singleton T, Markovitz D . Acute cytomegalovirus infection complicated by vascular thrombosis: a case report. Clin Infect Dis. 2001; 32(6):983-6. DOI: 10.1086/319353. View

Miyahara M, Shimamoto Y, Yamada H, Shibata K, Matsuzaki M, Ono K . Cytomegalovirus-associated myelodysplasia and thrombocytopenia in an immunocompetent adult. Ann Hematol. 1997; 74(2):99-101. DOI: 10.1007/s002770050265. View

Galiatsatos P, Shrier I, Lamoureux E, Szilagyi A . Meta-analysis of outcome of cytomegalovirus colitis in immunocompetent hosts. Dig Dis Sci. 2005; 50(4):609-16. DOI: 10.1007/s10620-005-2544-6. View

Cohen J, Corey G . Cytomegalovirus infection in the normal host. Medicine (Baltimore). 1985; 64(2):100-14. DOI: 10.1097/00005792-198503000-00003. View

Eddleston M, Peacock S, Juniper M, Warrell D . Severe cytomegalovirus infection in immunocompetent patients. Clin Infect Dis. 1997; 24(1):52-6. DOI: 10.1093/clinids/24.1.52. View

Karakozis S, GONGORA E, Caceres M, Brun E, Cook J . Life-threatening cytomegalovirus colitis in the immunocompetent patient: report of a case and review of the literature. Dis Colon Rectum. 2001; 44(11):1716-20. DOI: 10.1007/BF02234398. View

Abgueguen P, Delbos V, Chennebault J, Payan C, Pichard E . Vascular thrombosis and acute cytomegalovirus infection in immunocompetent patients: report of 2 cases and literature review. Clin Infect Dis. 2003; 36(11):E134-9. DOI: 10.1086/374664. View

Devetag F, Boscariolo L . Cytomegalovirus meningoencephalitis with paroxysmal course in immunocompetent adults: a new nosographical entity. Clinical, diagnostic and therapeutic correlations, and pathogenetic hypothesis. Eur Neurol. 2000; 44(4):242-7. DOI: 10.1159/000008244. View

10.

Bonnet F, Morlat P, Neau D, Viallard J, Ragnaud J, Dupon M . [Hematologic and immunologic manifestations of primary cytomegalovirus infections in non-immunocompromised hospitalized adults]. Rev Med Interne. 2000; 21(7):586-94. DOI: 10.1016/s0248-8663(00)80003-x. View

11.

Squizzato A, Ageno W, Cattaneo A, Brumana N . A case report and literature review of portal vein thrombosis associated with cytomegalovirus infection in immunocompetent patients. Clin Infect Dis. 2006; 44(2):e13-6. DOI: 10.1086/509641. View

12.

Rahbar A, Bostrom L, Lagerstedt U, Magnusson I, Soderberg-Naucler C, Sundqvist V . Evidence of active cytomegalovirus infection and increased production of IL-6 in tissue specimens obtained from patients with inflammatory bowel diseases. Inflamm Bowel Dis. 2003; 9(3):154-61. DOI: 10.1097/00054725-200305000-00002. View

13.

Studahl M, Bergstrom T, Ricksten A . Detection of cytomegalovirus DNA in cerebrospinal fluid in immunocompetent patients as a sign of active infection. J Med Virol. 1995; 46(3):274-80. DOI: 10.1002/jmv.1890460319. View

14.

Markomichelakis N, Canakis C, Zafirakis P, Marakis T, Mallias I, Theodossiadis G . Cytomegalovirus as a cause of anterior uveitis with sectoral iris atrophy. Ophthalmology. 2002; 109(5):879-82. DOI: 10.1016/s0161-6420(02)00961-2. View

15.

Staras S, Dollard S, Radford K, Flanders W, Pass R, Cannon M . Seroprevalence of cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis. 2006; 43(9):1143-51. DOI: 10.1086/508173. View

16.

Wreghitt T, Teare E, Sule O, Devi R, Rice P . Cytomegalovirus infection in immunocompetent patients. Clin Infect Dis. 2003; 37(12):1603-6. DOI: 10.1086/379711. View

17.

Nomura K, Matsumoto Y, Kotoura Y, Shimizu D, Kamitsuji Y, Horiike S . Thrombocytopenia due to cytomegalovirus infection in an immunocompetent adult. Hematology. 2005; 10(5):405-6. DOI: 10.1080/10245330500141556. View

18.

Faucher J, Abraham B, Segondy M, Jonquet O, Reynes J, Janbon F . [Acquired cytomegalovirus infections in immunocompetent adults: 116 cases]. Presse Med. 1998; 27(35):1774-9. View

19.

de Schryver I, Rozenberg F, Cassoux N, Michelson S, Kestelyn P, LeHoang P . Diagnosis and treatment of cytomegalovirus iridocyclitis without retinal necrosis. Br J Ophthalmol. 2006; 90(7):852-5. PMC: 1857164. DOI: 10.1136/bjo.2005.086546. View