CYTOMEGALOVIRUS-INFECTION

Recent diagnostic advances in cytomegalovirus (CMV) infection include tests for seroreactivity to individual viral proteins and additional experience with DNA amplification and immunostaining for CMV antigen in leukocytes. In certain well-defined high-risk patient subsets, presence of infectious virus in the blood or bronchoalveolar lavage is sufficiently predictive of invasive CMV disease to warrant immediate therapy. Emphasis on viral quantitation in clinical specimens will increase, because this is a way to assess the urgency of antiviral therapy. Foscarnet has become more available as an alternative to ganciclovir for treatment of disease, but both drugs are toxic and must not be used casually. CMV strains resistant to either or both drugs are of concern. Debate continues on various approaches to preventing CMV disease, such as donor-recipient screening, selection of immunosuppressive regimens, immune globulins, acyclovir, and ganciclovir.