Cytomegalovirus Infections in Non-HIV Patients

Abstract

CMV infections are common, with seroprevalence estimated at 42% in France. After primo-infection, the virus persists in a latent state, and can be reactivated in patients with T-cell immunosuppression. Diagnosis is based on serology for primary infection and CMV PCR for reactivation. Organ involvement varies according to the patient's condition, with frequent hematological and digestive disorders. Physicians working in intensive care units need to be aware of three situations: primo-infection in an immunocompetent patient, exceptionally severe (notably Guillain-Barré syndrome, macrophage activation syndrome, acute hepatitis), primo-infection or reactivation of a latent virus in an immunocompromised patient, the most at-risk population being marrow and solid organ transplant patients, with dedicated preventive strategies given the direct effects of the virus but also indirect immunological effects, and latent CMV replication in an intensive care patient. Treatment is based on antiviral inhibitors of viral DNA polymerase (ganciclovir, valganciclovir, foscavir). Other antivirals (maribavir, letermovir) are currently being added to the therapeutic arsenal.