<i>Cytomegalovirus</i>: An Overview of Pathogenesis and Clinical Impact

Abstract

Context: Human cytomegalovirus (hCMV) is a prevalent viral infection, affecting 60 - 90% of the global population. It is also called human herpesvirus 5 (HHV-5), and transmission occurs through infected bodily fluids. It presents a substantial threat to immunocompromised individuals, such as transplant recipients, individuals with HIV/AIDS, and neonates. The clinical significance of cytomegalovirus (CMV) infection is highlighted by its complex pathogenesis, characterized by sophisticated immune evasion strategies and the risk of recurrent reactivation, potentially leading to significant end-organ damage. Evidence Acquisition: Congenital CMV is diagnosed by testing saliva or urine using polymerase chain reaction (PCR) or culture methods within the first 2-3 weeks of life. In immunocompromised patients, plasma/blood quantitative polymerase chain reaction (qPCR) diagnoses active CMV while pp65 antigenemia is an alternative. Results: Ganciclovir remains the standard treatment, and the emergence of newer antivirals such as letermovir and maribavir introduces concerns regarding combination therapy and resistance development. Conclusions: The development of effective vaccines and antivirals represents a critical priority in global public health to prevent congenital infections and improve outcomes in vulnerable patient groups. This narrative review aims to synthesize current knowledge on the molecular pathogenesis and clinical impact of hCMV, providing a unified resource for understanding diagnostics, treatments, and prevention.