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Pediatric Cytomegalovirus Infection

Background

Human cytomegalovirus (CMV) is 1 of 8 human herpesviruses. It is a member of the beta-herpesvirus subfamily, which also includes the roseolaviruses, human herpesvirus type 6, and human herpesvirus type 7.

Infection with CMV is ubiquitous and generally asymptomatic in healthy children and adults. However, several high-risk groups, including immunocompromised organ transplant recipients and individuals infected with human immunodeficiency virus (HIV), are at risk of developing life-threatening and sight-threatening CMV disease. CMV is also a major cause of morbidity and occasional mortality in newborn infants. In recent years, it has become evident that CMV is the most important cause of congenital infection in the developed world, and that it frequently leads to mental retardation and developmental disability. In addition, increasing evidence suggests that CMV may cause long-term health consequences in healthy adults, including immunosenescence and an increased risk of malignancy and vascular disease.

In 1904, Ribbert first identified histopathological evidence of CMV, probably in tissues from a congenitally infected infant. Ribbert mistakenly assumed that the large inclusion-bearing cells he observed at autopsy were from protozoa (incorrectly named Entamoebamortinatalium). In 1920, Goodpasture correctly postulated the viral etiology of these inclusions.
Goodpasture used the term cytomegalia to refer to the enlarged, swollen nature of the infected cells. Human CMV was first isolated in tissue culture in 1956, and the propensity of this organism to infect the salivary gland led to its initial designation as a salivary gland virus.

In 1960, Weller designated the virus cytomegalovirus
; during the 1970s and 1980s, knowledge of the role of CMV as an important pathogen with diverse clinical manifestations increased steadily.
Although enormous progress has recently been made in defining and characterizing the molecular biology, immunology, and antiviral therapeutic targets for CMV, considerable work remains in devising strategies for prevention of CMV infection and in understanding the role of specific viral genes in pathogenesis.

Furthermore, development of a vaccine against this virus is a major public health priority (reviewed in Deterrence/Prevention).

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