Cytomegalovirus (CMV) Infection

Cytomegalovirus is a double-stranded DNA virus in the Herpesviridae family. After the initial infection, it can remain latent in the body. When cellular immune control is weakened—particularly after solid-organ transplantation—CMV can reactivate, replicate, and injure tissues directly. Many immunocompetent adults have no symptoms or develop a mononucleosis-like illness with fever, fatigue, lymphadenopathy, and malaise. That relatively mild picture changes in an immunocompromised patient. CMV may cause retinitis, colitis, esophagitis, pneumonitis, hepatitis, cytopenias, or disseminated disease. The distinction between CMV infection and CMV disease guides nursing urgency. CMV DNA in the blood indicates viral replication. CMV disease is suspected when that replication occurs with clinical evidence of tissue injury, such as new visual symptoms, gastrointestinal inflammation, or respiratory decline. A blood result does not identify which organ is being damaged; the patient’s symptoms and focused assessment provide that information. The experienced nurse therefore asks two questions early: How much immune protection does this patient have, and which organ system may be failing? A transplant recipient with a rising viral load and new blurred vision has a very different priority from an...