Snapshot An HIV/AIDS patient presents to his primary care physician complaining of objects "floating" in his eyes. His partner reports that he has seemed unsteady on his feet lately, bumping into walls and knocking objects off of counter tops by accident. Introduction Most common congenital infection TORCH infection (Toxoplasmosis, Other [Syphilis], Rubella, CMV, and Herpes) Transmitted via body fluids including respiratory droplet blood transfusion sexual contact breast milk Epidemiology 70% of adults in the United States have been infected transmission occurs in 1% of all births 10% of infected infants manifest congenital defects of varying severity 10% of asymptomatic but infected infants develop neurologic sequelae later Risk factors reactivation may occur within 100 days of tissue or bone marrow transplant secondary to immunocompromised state HIV/AIDS patients with CD4 < 100 and viral load > 10,000 Presentation Symptoms most primary infections are asymptomatic systemic infection may resemble EBV manifestations of disease range across organ system including visual field changes GI disturbances dry cough fever mental status changes neurologic dysfunction Physical exam congenital defects may include microcephaly neurologic dysfunction as evidenced on neuro exam severe mental retardation chorioretinitis IUGR petechial rash, similar to "blueberry muffin" rash of Rubella multiple, nonspecific GI and hepatobiliary symptoms CMV implicated in AIDS cholangiopathy CMV pneumonitis symptoms including unproductive cough with fever very high mortality rate CNS involvement including polyradiculopathy subacute encephalitis (CD4 < 50) transverse myelitis Evaluation Imaging shows periventricular calcifications Viral culture slow but may isolate pathogen Tissue biopsy may be used to histologically identify CMV pathogen PCR fast way to identify CMV pathogen Differential Other TORCH infections, EBV, HIV/AIDS Treatment Medical management gancyclovir or foscarnet indicated in all cases of CMV treat underlying infections HIV/AIDS taper steroids when possible Prognosis, Prevention, and Complications Prognosis good, in healthy individuals with early diagnosis and treatment poor to fatal, in individuals with immunocompromised states or untreated Prevention avoid contact with bodily fluids, serology prior to pregnancy can reduce transmission Complications multiple organ systems affected, as described above