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  • Authors: M. Veronica Dioverti1, Raymund R. Razonable2,3
  • Editors: Randall T. Hayden4, Donna M. Wolk5, Karen C. Carroll6, Yi-Wei Tang7
    Affiliations: 1: Division of Infectious Diseases, Department of Medicine; 2: Division of Infectious Diseases, Department of Medicine; 3: The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic College of Medicine, Rochester, MN 55905; 4: St. Jude Children’s Research Hospital, Memphis, TN; 5: Geisinger Clinic, Danville, PA; 6: Johns Hopkins University Hospital, Baltimore, MD; 7: Memorial Sloan-Kettering Institute, New York, NY
  • Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
  • Received 27 October 2015 Accepted 09 February 2016 Published 15 July 2016
  • Raymund R. Razonable, [email protected]
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  • Abstract:

    Cytomegalovirus (CMV), the largest of the herpesviruses, causes a wide range of clinical syndromes, from asymptomatic infection to severe disease in immunocompromised hosts. Laboratory methods for diagnosis include molecular testing, antigenemia, culture, serology, and histopathology. Treatment of CMV infection and disease is indicated in selected immunocompromised hosts, and preventive approaches are indicated in high-risk groups. This chapter reviews the epidemiology, clinical aspects, and the laboratory diagnosis and management of CMV in immunocompromised hosts.

  • Citation: Dioverti M, Razonable R. 2016. Cytomegalovirus. Microbiol Spectrum 4(4):DMIH2-0022-2015. doi:10.1128/microbiolspec.DMIH2-0022-2015.


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Cytomegalovirus (CMV), the largest of the herpesviruses, causes a wide range of clinical syndromes, from asymptomatic infection to severe disease in immunocompromised hosts. Laboratory methods for diagnosis include molecular testing, antigenemia, culture, serology, and histopathology. Treatment of CMV infection and disease is indicated in selected immunocompromised hosts, and preventive approaches are indicated in high-risk groups. This chapter reviews the epidemiology, clinical aspects, and the laboratory diagnosis and management of CMV in immunocompromised hosts.

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Cytomegalovirus-induced cytopathic effects. Unstained preparation; 100X magnification.

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
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Detection of CMV antigens in the nucleic acid of infected MCR-5 cells. Following shell-vial culture, cells are stained with fluorescently-labeled antibodies which detect CMV immediate early antigen. Magnification 200X.

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
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This biopsy specimen from a patient with cytomegalovirus colitis shows a classic “owl-eye” intranuclear inclusion (arrow) and intracytoplasmic inclusions. The dense intranuclear inclusion with surrounding halo is formed when the mass of viral particles shrinks away from the nuclear membrane during fixation. While herpes simplex virus intranuclear inclusions can have a similar appearance, CMV is the only member of the herpesviridae family that contains both intranuclear and intracytoplasmic inclusions. Hematoxylin and eosin stain, 1000x oil immersion.

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
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Immunoperoxidase staining of CMV antigens in a biopsy from a patient with CMV colitis. Viral inclusions stain brown (blue counterstain, 1000x oil immersion).

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
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Diagnostic algorithm for transplant recipients and their donors with the use of CMV serology.

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
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An illustrative algorithm utilizing various diagnostic assays in a transplant recipient prior to transplantation and during the period following transplantation.

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
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Algorithm for the diagnosis of CMV disease in an immunocompromised patient.

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
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Risk factors and clinical manifestations of cytomegalovirus disease in immunocompromised patients

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015
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Laboratory methods for the diagnosis of CMV infection

Source: microbiolspec July 2016 vol. 4 no. 4 doi:10.1128/microbiolspec.DMIH2-0022-2015

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