Cytomegalovirus: biology, clinical features and methods for diagnosis

Cytomegalovirus (CMV) infections remain a major obstacle to the successful outcome of bone marrow transplantation (BMT). The clinical manifestations of CMV-induced disease are many and varied and may mimic other disease processes commonly seen after BMT. The development of effective strategies for the prevention and treatment of such infections requires an understanding of the life cycle of the virus. In this review we discuss the molecular structure of CMV, the modes of replication and transmission, and the biology of the development of latency and reactivation. The recent availability of potentially effective anti-CMV drugs emphasizes the need for rapid diagnostic techniques which permit the initiation of treatment early in the disease. We review the diagnostic methods in common use and compare the newly developed rapid assays with the standard techniques of viral isolation and serological responses, with particular reference to their use in marrow transplant recipients.