Clinical manifestations and suggested treatment for cytomegalovirus infections in infants, children, and adolescents

Clinical manifestations	Suggested treatment
Congenital CMV (cCMV) infection
Approximately 90% of affected newborns are asymptomatic. Among newborns with symptomatic cCMV, clinical and laboratory findings can include: Petechial rash Jaundice at birth Hepatosplenomegaly Small size for gestational age Thrombocytopenia Microcephaly Intracranial calcifications Polymicrogyria Ventriculomegaly Sensorineural hearing loss Chorioretinitis Seizures	Asymptomatic infants do not require antiviral treatment. For infants with symptomatic cCMV, treatment consists of IV ganciclovir or oral valganciclovir.^*
Early postnatal CMV infection
Term infants – Most infants are asymptomatic. Clinical and laboratory findings are usually transient and can include: Fever Hepatosplenomegaly Mild pneumonitis Abnormal blood counts Abnormal liver function tests Preterm VLBW infants – Infection can be severe and life-threatening. Clinical and laboratory manifestations can include: Sepsis-like syndrome Hepatosplenomegaly Pneumonitis Hepatitis NEC Abnormal blood counts	Most otherwise healthy term infants and asymptomatic preterm infants do not require antiviral treatment. For infants with severe manifestations of postnatal CMV infection, treatment consists of IV ganciclovir or oral valganciclovir.^*
CMV infection in immunocompetent children and adolescents
In most cases, the infection does not cause symptoms or causes nonspecific symptoms consistent with other childhood viral illnesses. Symptoms can include: Fever Fatigue Pharyngitis Mononucleosis-like syndrome Adenopathy Headache Abdominal pain Diarrhea Arthralgias Rash Laboratory abnormalities may include: Elevated transaminases Lymphocytosis or lymphopenia Thrombocytopenia Unlike mononucleosis caused by EBV, the monospot test is negative in CMV mononucleosis.	Supportive care with hydration and fever control. Antiviral treatment is generally not indicated.
Infection in immunocompromised children and adolescents
Infection can be severe and life-threatening. Clinical and laboratory findings can include: Fever Malaise Leukopenia Hepatitis Pneumonitis Colitis Graft loss (in patients with organ transplant) Myocarditis Retinitis Meningoencephalitis	IV ganciclovir or oral valganciclovir.^*

CMV: cytomegalovirus; HIV: human immunodeficiency virus; IV: intravenous; NEC: necrotizing enterocolitis; VLBW: very low birth weight.

* Refer to UpToDate's topics on CMV infections in infants and children for additional details regarding antiviral therapy.

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Clinical manifestations and suggested treatment for cytomegalovirus infections in infants, children, and adolescents