{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,2]],"date-time":"2026-11-02T17:48:49Z","timestamp":1793641729474,"version":"4.5.1"},"reference-count":143,"publisher":"MDPI AG","issue":"8","license":[{"start":{"date-parts":[[2024,8,7]],"date-time":"2024-08-07T00:00:00Z","timestamp":1722988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>CMV is a ubiquitous DNA virus that establishes infection and results in 40\u2013100% seropositivity. Viral replication occurs following an acquired primary infection (or reinfection) or by the reactivation of life-long latency. In immunocompetent patients, CMV infection is mostly asymptomatic or mild and self-limited. However, an extensive review of the literature published up to April 2024 reveals that despite immunocompetence, CMV can cause a very large variety of clinical syndromes in any part of the gastrointestinal tract (the most common pattern), the central or peripheral nervous system, and the eyes, as well as hematological, pulmonary, cardiac, and cutaneous disease. Not uncommonly, more than one system is involved, and though the disease is often self-limited, treatment with intravenous ganciclovir or oral valganciclovir may be required, and in isolated cases, fatalities may occur. Thus, a potential CMV infection should be considered in the differential of myriad syndromes in non-immunocompromised patients. Associated systemic symptoms (fever, sweats, and weight loss), lymphocytosis, and hepatitis are not uncommon and can be a useful clue. Some populations, such as critically ill patients in intensive care, pregnant women, elderly patients, and those with inflammatory bowel disease, may be more susceptible. Moreover, the potential of past, latent CMV infection (i.e., CMV seropositivity) to be associated with significant cardiovascular morbidity and all-cause mortality years later is intriguing and requires further study. All these data indicate the outstanding importance of developing a vaccine against CMV, which hopefully will become available in the foreseeable future. Meanwhile, a solid diagnosis of active CMV infection can be quickly established (or ruled out) by widely available serology tests and PCR amplification, and clinicians in all disciplines need to be more aware of the diverse guises of CMV infection and remember to consider it in any host, including an immunocompetent one.<\/jats:p>","DOI":"10.3390\/pathogens13080667","type":"journal-article","created":{"date-parts":[[2024,8,8]],"date-time":"2024-08-08T12:13:14Z","timestamp":1723119194000},"page":"667","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":24,"title":["The Wide Spectrum of Presentations of Cytomegalovirus Infection in Immunocompetent Hosts: An Exhaustive Narrative Review"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1413-8858","authenticated-orcid":false,"given":"Ami","family":"Schattner","sequence":"first","affiliation":[{"name":"The Faculty of Medicine, Hebrew University Hadassah Medical School, Ein Kerem, Jerusalem 91120, Israel"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,8,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1016\/j.coviro.2011.06.003","article-title":"Herpesvirus capsid assembly: Insights from structural analysis","volume":"1","author":"Brown","year":"2011","journal-title":"Curr. Opin. Virol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"269","DOI":"10.1038\/331269a0","article-title":"Human cytomegalovirus encodes a glycoprotein homologous to MHC class-I antigens","volume":"331","author":"Beck","year":"1988","journal-title":"Nature"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1038\/386510a0","article-title":"Inhibition of natural killer cells by a cytomegalovirus MHC class I homologue in vivo","volume":"386","author":"Farrell","year":"1997","journal-title":"Nature"},{"key":"ref_4","first-page":"91","article-title":"Modulation of HLA expression in human cytomegalovirus immune evasion","volume":"4","author":"Lin","year":"2007","journal-title":"Cell Mol. Immunol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1285","DOI":"10.1128\/JVI.76.3.1285-1292.2002","article-title":"Potent immunosuppressive activities of cytomegalovirus-encoded interleukin-10","volume":"76","author":"Spencer","year":"2002","journal-title":"J. Virol."},{"key":"ref_6","first-page":"235","article-title":"Fatal attraction: Cytomegalovirus-encoded chemokine homologs","volume":"269","author":"Saederup","year":"2002","journal-title":"Curr. Top. Microbiol. Immunol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"8140","DOI":"10.1128\/JVI.74.17.8140-8150.2000","article-title":"Functional heterogeneity and high frequencies of cytomegalovirus-specific CD8(+) T lymphocytes in healthy seropositive donors","volume":"74","author":"Gillespie","year":"2000","journal-title":"J. Virol."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2433","DOI":"10.1002\/eji.201545495","article-title":"Molecular characterization of HCMV-specific immune responses: Parallels between CD8(+) T cells, CD4(+) T cells, and NK cells","volume":"45","author":"Hertoghs","year":"2015","journal-title":"Eur. J. Immunol."},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Forte, E., Zhang, Z., Thorp, E.B., and Hummel, M. (2020). Cytomegalovirus latency and reactivation: An intricate interplay with the host immune response. Front. Cell Infect. Microbiol., 10.","DOI":"10.3389\/fcimb.2020.00130"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Muller, L., and Di Benedetto, S. (2024). Immunosenescence and cytomegalovirus: Exploring their connection in the context of aging, health, and disease. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25020753"},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Lachmann, R., Loenenbach, A., Waterboer, T., Brenner, N., Pawlita, M., Michel, A., Thamm, M., Poethko-Muller, C., Wichmann, O., and Wiese-Posselt, M. (2018). Cytomegalus (CMV) seroprevalence in the adult population of Germany. PLoS ONE, 13.","DOI":"10.1371\/journal.pone.0200267"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"e29525","DOI":"10.1002\/jmv.29525","article-title":"Estimated cytomegalovirus seroprevalence in the general population of the United States and Canada","volume":"96","author":"Flanders","year":"2024","journal-title":"J. Med. Virol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1491","DOI":"10.1093\/infdis\/jiad182","article-title":"Incidence of cytomegalovirus primary and secondary infection in adolescent girls: Results from a prospective study","volume":"228","author":"Paris","year":"2023","journal-title":"J. Infect. Dis."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"386","DOI":"10.1086\/649903","article-title":"Cytomegalovirus reinfections in healthy seroimmune women","volume":"201","author":"Ross","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1800","DOI":"10.1086\/657412","article-title":"Cytomegalovirus viruria and DNAemia in healthy seropositive women","volume":"202","author":"Arora","year":"2010","journal-title":"J. Infect. Dis."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1038\/s41579-021-00582-z","article-title":"Pathogenesis of human cytomegalovirus in the immunocompromised host","volume":"19","author":"Griffiths","year":"2021","journal-title":"Nat. Rev. Microbiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"3497","DOI":"10.2174\/1381612826666200531152901","article-title":"Cytomegalovirus in solid organ transplant recipients: Clinical updates, challenges and future directions","volume":"26","author":"Razonable","year":"2020","journal-title":"Curr. Pharm. Des."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"330","DOI":"10.1016\/j.ajog.2020.02.018","article-title":"Cytomegalovirus infection during pregnancy: State of the science","volume":"223","author":"Foulon","year":"2020","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Rybak-Krzyszkowska, M., G\u00f3recka, J., Huras, H., Massalska-Wolska, M., Sta\u015bkiewicz, M., Gach, A., Kondracka, A., Staniczek, J., G\u00f3rczewski, W., and Borowski, D. (2023). Cytomegalovirus infection in pregnancy prevention and treatment options: A systematic review and meta-analysis. Viruses, 15.","DOI":"10.3390\/v15112142"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"S727","DOI":"10.1093\/clinids\/12.Supplement_7.S727","article-title":"Newer methods for diagnosis of cytomegalovirus infections","volume":"12","author":"Chou","year":"1990","journal-title":"Rev. Infect. Dis."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"466","DOI":"10.2174\/187152611797636703","article-title":"Diagnosis of cytomegalovirus infection","volume":"11","author":"Ross","year":"2011","journal-title":"Infect. Disord. Drug Targets"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1128\/CVI.00487-14","article-title":"Role of cytomegalovirus (CMV) IgG avidity testing in diagnosing primary CMV infection during pregnancy","volume":"21","author":"Prince","year":"2014","journal-title":"Clin. Vaccine Immunol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"1937","DOI":"10.1128\/jcm.30.8.1937-1941.1992","article-title":"Cytomegalovirus DNA detection in sera from patients with active cytomegalovirus infections","volume":"30","author":"Bryttig","year":"1992","journal-title":"J. Clin. Microbiol."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"E1109","DOI":"10.1503\/cmaj.220042","article-title":"Acute cytomegalovirus infection in a 61-year-old woman","volume":"194","author":"Hongo","year":"2022","journal-title":"CMAJ"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1093\/clinids\/24.1.52","article-title":"Severe cytomegalovirus infection in immunocompetent patients","volume":"24","author":"Eddleston","year":"1997","journal-title":"Clin. Infect. Dis."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1186\/1743-422X-5-47","article-title":"Severe cytomegalovirus infection in apparently immunocompetent patients: A systematic review","volume":"5","author":"Rafailidis","year":"2008","journal-title":"Virol. J."},{"key":"ref_27","first-page":"227","article-title":"Clinical and laboratory findings of cytomegalovirus infection in 115 hospitalized non-immunocompromised adults","volume":"152","author":"Bonnet","year":"2001","journal-title":"Ann. Med. Interne"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1603","DOI":"10.1086\/379711","article-title":"Cytomegalovirus infection in immunocompetent patients","volume":"37","author":"Wreghitt","year":"2003","journal-title":"Clin. Infect. Dis."},{"key":"ref_29","first-page":"83","article-title":"Clinical features of cytomegalovirus disease in immunocompetent subjects: A 1990\u20132000 survey","volume":"18","author":"Cacopardo","year":"2003","journal-title":"Ann. Ital. Med. Int."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"851","DOI":"10.1111\/j.1469-0691.2009.03022.x","article-title":"Venous thrombosis in immunocompetent patients with acute cytomegalovirus infection: A complication that may be underestimated","volume":"16","author":"Abgueguen","year":"2010","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"987","DOI":"10.3109\/00365548.2012.697637","article-title":"Severe primary cytomegalovirus infection in the immunocompetent adult patient: A case series","volume":"44","author":"Orasch","year":"2012","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_32","first-page":"123","article-title":"Primary cytomegalovirus infection in immunocompetent adults in the United States\u2014A case series","volume":"10","author":"Nolan","year":"2017","journal-title":"ID Cases"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"468","DOI":"10.1111\/j.1469-0691.2004.00880.x","article-title":"Cytomegalovirus mononucleosis as a cause of prolonged fever and prominent weight loss in immunocompetent adults","volume":"10","author":"Muniain","year":"2004","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_34","doi-asserted-by":"crossref","unstructured":"Yeh, P.-J., Wu, R.-C., Chiu, C.-T., Lai, M.-W., Chen, C.-M., Pan, Y.-B., Su, M.-Y., Kuo, C.-J., Lin, W.-R., and Le, P.-H. (2022). Cytomegalovirus diseases of the gastrointestinal tract. Viruses, 14.","DOI":"10.3390\/v14020352"},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"Yeh, P.J., Wu, R.C., Chen, C.L., Chiu, C.-T., Lai, M.-W., Chen, C.-C., Chiu, C.-H., Pan, Y.-B., Lin, W.-R., and Le, P.-H. (2024). Cytomegalovirus diseases of the gastrointestinal tract in immunocompetent patients: A narrative review. Viruses, 16.","DOI":"10.3390\/v16030346"},{"key":"ref_36","doi-asserted-by":"crossref","unstructured":"Chaemsupaphan, T., Limsrivilai, J., Thongdee, C., Sudcharoen, A., Pongpaibul, A., Pausawasdi, N., and Charatcharoenwitthaya, P. (2020). Patient characteristics, clinical manifestations, prognosis, and risk factors associated with gastrointestinal cytomegalovirus infection in immunocompetent patients. BMC Gastroenterol., 20.","DOI":"10.1186\/s12876-020-1174-y"},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Yoon, J., Lee, J., Kim, D.C., Lee, J.W., Hong, S.W., Hwang, H.W., Hwang, S.W., Park, S.H., Yang, D.-H., and Ye, B.D. (2023). Endoscopic features and clinical outcomes of cytomegalovirus enterocolitis in immunocompetent patients. Sci. Rep., 11.","DOI":"10.1038\/s41598-021-85845-8"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1121.e1","DOI":"10.1016\/j.cmi.2015.05.016","article-title":"Symptomatic cytomegalovirus gastrointestinal infection with positive quantitative real-time PCR findings in apparently immunocompetent patients: A case series","volume":"21","author":"Bernard","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"276","DOI":"10.1159\/000007827","article-title":"Cytomegalovirus-induced transient protein-losing hypertrophic gastropathy in an immunocompetent adult","volume":"62","author":"Suter","year":"2000","journal-title":"Digestion"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"6156581","DOI":"10.1155\/2019\/6156581","article-title":"A practical review of cytomegalovirus in gastroenterology and hepatology","volume":"2019","author":"Fakhreddine","year":"2019","journal-title":"Gastroenterol. Res. Pract."},{"key":"ref_41","first-page":"bcr2017223297","article-title":"Cytomegalovirus ulcerative oesophagitis in a young healthy immunocompetent patient","volume":"2018","author":"Camacho","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"bcr2014206991","DOI":"10.1136\/bcr-2014-206991","article-title":"Gastritis as a manifestation of primary CMV infection in an immunocompetent host","volume":"2015","author":"Crespo","year":"2015","journal-title":"BMJ Case Rep."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"5084","DOI":"10.3748\/wjg.v12.i31.5084","article-title":"Cytomegalovirus ileitis in an immunocompetent elderly adult","volume":"12","author":"Ryu","year":"2006","journal-title":"World J. Gastroenterol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"236","DOI":"10.1002\/ibd.20299","article-title":"High prevalence of an active cytomegalovirus infection in the appendix of immunocompetent patients with acute appendicitis","volume":"14","author":"Dzabic","year":"2008","journal-title":"Inflamm. Bowel Dis."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"559","DOI":"10.1080\/00365549850161098","article-title":"Cytomegalovirus colitis in the immunocompetent host: An overview","volume":"30","author":"Klauber","year":"1998","journal-title":"Scand. J. Infect. Dis."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"66","DOI":"10.1007\/s00595-006-3335-1","article-title":"Severe proctitis, perforation, and fatal rectal bleeding secondary to cytomegalovirus in an immunocompetent patient: Report of a case","volume":"37","author":"Alam","year":"2007","journal-title":"Surg. Today"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"2030","DOI":"10.3748\/wjg.v22.i6.2030","article-title":"Cytomegalovirus and ulcerative colitis: Place of antiviral therapy","volume":"14","author":"Pillet","year":"2016","journal-title":"World J. Gastroenterol."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"486","DOI":"10.1136\/pgmj.74.874.486","article-title":"Cytomegalovirus infection associated with ulcerative colitis in immunocompetent individuals","volume":"784","author":"Rachima","year":"1998","journal-title":"Postgrad. Med. J."},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"462","DOI":"10.1016\/S0140-6736(98)10077-6","article-title":"Medline solution","volume":"353","author":"Schattner","year":"1999","journal-title":"Lancet"},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"e24914","DOI":"10.1097\/MD.0000000000024914","article-title":"Cytomegalovirus enterocolitis with subsequent diagnosis of coexisting new-onset inflammatory bowel disease: Two case reports and review of the literature","volume":"100","author":"Luangsirithanya","year":"2021","journal-title":"Medicine"},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1182\/blood-2018-06-856500","article-title":"Anemia of inflammation","volume":"133","author":"Weiss","year":"2019","journal-title":"Blood"},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"bcr2013201939","DOI":"10.1136\/bcr-2013-201939","article-title":"Acute cytomegalovirus hepatitis in an immunocompetent host","volume":"2013","author":"Sy","year":"2013","journal-title":"BMJ Case Rep."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"e925495","DOI":"10.12659\/AJCR.925495","article-title":"Acute cytomegalovirus (CMV) hepatitis in an immunocompetent adult","volume":"21","author":"Zahid","year":"2020","journal-title":"Am. J. Case Rep."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.3748\/wjg.15.1427","article-title":"Acute pancreatitis: Etiology and common pathogenesis","volume":"15","author":"Wang","year":"2009","journal-title":"World J. Gastroenterol."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"153","DOI":"10.14740\/gr858w","article-title":"Review of infectious etiology of acute pancreatitis","volume":"10","author":"Rawla","year":"2017","journal-title":"Gastroenterol. Res."},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"2162","DOI":"10.1007\/s10620-020-06531-9","article-title":"Viral-attributed acute pancreatitis: A systematic review","volume":"66","author":"Imam","year":"2021","journal-title":"Dig. Dis. Sci."},{"key":"ref_57","first-page":"122","article-title":"Acute pancreatitis caused by cytomegalovirus-associated duodenal papillitis","volume":"31","author":"Sakakibara","year":"2018","journal-title":"Ann. Gastroenterol."},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"987","DOI":"10.1007\/s00535-005-1683-z","article-title":"Cytomegalovirus cholangitis and pancreatitis in an immunocompetent patient","volume":"40","author":"Oku","year":"2005","journal-title":"J. Gastroenterol."},{"key":"ref_59","first-page":"e00932","article-title":"Cytomegalovirus pancreatitis in an immunocompetent patient","volume":"22","author":"Saeed","year":"2020","journal-title":"ID Cases"},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"S5","DOI":"10.1016\/S1386-6532(02)00028-8","article-title":"Use of PCR for the diagnosis of herpesvirus infections of the central nervous system","volume":"25","author":"DeBiasi","year":"2002","journal-title":"J. Clin. Virol."},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1016\/j.jcv.2005.11.005","article-title":"Atypical symptoms in patients with herpesvirus DNA detected by PCR in cerebrospinal fluid","volume":"35","author":"Schvoerer","year":"2006","journal-title":"J. Clin. Virol."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1016\/j.ijid.2016.01.012","article-title":"Viral infections of the central nervous system in elderly patients: A retrospective study","volume":"44","author":"Parisi","year":"2016","journal-title":"Int. J. Infect. Dis."},{"key":"ref_63","first-page":"333","article-title":"Diagnosis of neurological herpesvirus infections: Real time PCR in cerebral spinal fluid analysis","volume":"32","author":"Gaeta","year":"2009","journal-title":"New Microbiol."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"3636","DOI":"10.1128\/JCM.36.12.3636-3640.1998","article-title":"Human cytomegalovirus (HCMV) encephalitis in an immunocompetent young person and diagnostic reliability of HCMV DNA PCR using cerebrospinal fluid of nonimmunosuppressed patients","volume":"36","author":"Schielke","year":"1998","journal-title":"J. Clin. Microbiol."},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"bcr2018224740","DOI":"10.1136\/bcr-2018-224740","article-title":"CMV encephalitis in an immune-competent patient","volume":"2018","author":"Micallef","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_66","first-page":"CS107","article-title":"Cytomegalovirus meningitis in an immunocompetent patient","volume":"13","author":"Rafailidis","year":"2007","journal-title":"Med. Sci. Monit."},{"key":"ref_67","doi-asserted-by":"crossref","unstructured":"Daida, K., Ishiguro, Y., Eguchi, H., Machida, Y., Hattori, N., and Miwa, H. (2016). Cytomegalovirus-associated encephalomyelitis in an immunocompetent adult: A two-stage attack of direct viral and delayed immune-mediated invasions. Case report. BMC Neurol., 16.","DOI":"10.1186\/s12883-016-0761-6"},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Karunarathne, S., Govindapala, D., Udayakumara, Y., and Fernando, H. (2012). Cytomegalovirus associated transverse myelitis in an immunocompetent host with DNA detection in cerebrospinal fluid; a case report. BMC Res. Notes, 5.","DOI":"10.1186\/1756-0500-5-364"},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"405","DOI":"10.1007\/s13365-018-0717-2","article-title":"High-dose corticosteroids for acute cytomegalovirus-associated transverse myelitis in the immunocompetent patient: A case report and systematic review","volume":"25","author":"Budhram","year":"2019","journal-title":"J. Neurovirol."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"500","DOI":"10.1111\/j.1365-2796.2007.01794.x","article-title":"Neuromyelitis optica following CMV primo-infection","volume":"261","author":"Tran","year":"2007","journal-title":"J. Intern. Med."},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"787","DOI":"10.1007\/s13365-021-01006-7","article-title":"Extensive longitudinal myelitis due to cytomegalovirus infection","volume":"27","author":"Aissi","year":"2021","journal-title":"J. Neurovirol."},{"key":"ref_72","doi-asserted-by":"crossref","first-page":"bcr2017222158","DOI":"10.1136\/bcr-2017-222158","article-title":"SLE presenting as demyelinative autoimmune visual loss","volume":"2018","author":"Schattner","year":"2018","journal-title":"BMJ Case Rep."},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"e16346","DOI":"10.1111\/ene.16346","article-title":"Guillain-Barr\u00e9 syndrome: History, pathogenesis, treatment, and future directions","volume":"16","author":"Hughes","year":"2024","journal-title":"Eur. J. Neurol."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"837","DOI":"10.1093\/cid\/cir074","article-title":"Guillain-Barr\u00e9 syndrome following primary cytomegalovirus infection: A prospective cohort study","volume":"52","author":"Orlikowski","year":"2011","journal-title":"Clin. Infect. Dis."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"1110","DOI":"10.1212\/WNL.51.4.1110","article-title":"The spectrum of antecedent infections in Guillain-Barr\u00e9 syndrome: A case-control study","volume":"51","author":"Jacobs","year":"1998","journal-title":"Neurology"},{"key":"ref_76","doi-asserted-by":"crossref","first-page":"e16365","DOI":"10.1111\/ene.16365","article-title":"Guillain-Barr\u00e9 syndrome: A comprehensive review","volume":"31","author":"Bellanti","year":"2024","journal-title":"Eur. J. Neurol."},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1186\/1743-422X-8-95","article-title":"An immunocompetent adult patient with hepatitis and Guillain-Barr\u00e9 syndrome after cytomegalovirus infection","volume":"8","author":"Ma","year":"2011","journal-title":"Virol. J."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1016\/j.jcjo.2012.12.002","article-title":"Cytomegalovirus retinitis in the absence of AIDS","volume":"48","author":"Gupta","year":"2013","journal-title":"Can. J. Ophthalmol."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"107","DOI":"10.1080\/09273948.2017.1394471","article-title":"Clinical features of CMV-associated anterior uveitis","volume":"26","author":"Chan","year":"2018","journal-title":"Ocul. Immunol. Inflamm."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"53","DOI":"10.1111\/aos.13877","article-title":"Uveitis causes according to the immune status of the patient","volume":"97","author":"Rothova","year":"2019","journal-title":"Acta Ophthalmol."},{"key":"ref_81","doi-asserted-by":"crossref","first-page":"834","DOI":"10.1016\/j.ajo.2007.12.015","article-title":"Clinical features of cytomegalovirus anterior uveitis in immunocompetent patients","volume":"145","author":"Chee","year":"2008","journal-title":"Am. J. Ophthalmol."},{"key":"ref_82","first-page":"1774","article-title":"Acquired cytomegalovirus infections in immunocompetent adults: 116 cases","volume":"27","author":"Faucher","year":"1998","journal-title":"Presse Med."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"13","DOI":"10.1016\/S0248-8663(05)82124-1","article-title":"Clinical, biological and developmental aspects of cytomegalovirus infection in immunocompetent patients","volume":"15","author":"Ragnaud","year":"1994","journal-title":"Rev. Med. Interne"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1097\/00005792-198603000-00005","article-title":"Clinical and laboratory evaluation of cytomegalovirus-induced mononucleosis in previously healthy individuals. Report of 82 cases","volume":"65","author":"Horwitz","year":"1980","journal-title":"Medicine"},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Raadsen, M., Du Toit, J., Langerak, T., van Bussel, B., van Gorp, E., and Goeijenbier, M. (2021). Thrombocytopenia in virus infections. J. Clin. Med., 10.","DOI":"10.3390\/jcm10040877"},{"key":"ref_86","first-page":"e21959","article-title":"Fever of Unknown Origin: The Workup and Diagnosis of Pel-Ebstein Fever","volume":"14","author":"Khanna","year":"2022","journal-title":"Cureus"},{"key":"ref_87","doi-asserted-by":"crossref","first-page":"e3","DOI":"10.1016\/j.amjmed.2009.12.030","article-title":"Pel-Ebstein cyclic fever: Not just lymphoma","volume":"123","author":"Schattner","year":"2010","journal-title":"Am. J. Med."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"863","DOI":"10.1111\/bjh.17017","article-title":"Characteristics and outcome of adults with cytomegalovirus-induced thrombocytopenia: A case series and literature review","volume":"191","author":"Shragai","year":"2020","journal-title":"Br. J. Haematol."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1007\/s10096-018-3185-y","article-title":"Risk factors of venous thrombo-embolism during cytomegalovirus infection in immunocompetent individuals. A systematic review","volume":"37","author":"Ceccarelli","year":"2018","journal-title":"Eur. J. Clin. Microbiol. Infect. Dis."},{"key":"ref_90","first-page":"195","article-title":"Thrombosis associated with acute cytomegalovirus infection: A meta-analysis","volume":"22","author":"Justo","year":"2011","journal-title":"Eur. J. Med."},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"231","DOI":"10.1080\/17843286.2016.1177265","article-title":"Venous thromboembolism associated with acute cytomegalovirus infection: Epidemiology and predisposing conditions","volume":"71","author":"Yildiz","year":"2016","journal-title":"Acta Clin. Belg."},{"key":"ref_92","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00277-011-1334-9","article-title":"Cytomegalovirus infection is associated with venous theromboembolism of immunocompetent adults\u2014A case-control study","volume":"91","author":"Schimanski","year":"2012","journal-title":"Ann. Hematol."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"969","DOI":"10.1007\/s00277-013-1715-3","article-title":"Thrombosis following acute cytomegalovirus infection: A community prospective study","volume":"92","author":"Paran","year":"2013","journal-title":"Ann. Hematol."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.thromres.2018.06.015","article-title":"Cytomegalovirus-associated splanchnic vein thrombosis in immunocompetent patients: A systematic review","volume":"168","author":"Bertoni","year":"2018","journal-title":"Thromb. Res."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"104","DOI":"10.1016\/j.amjmed.2019.09.011","article-title":"Cytomegalovirus-associated splenic infarction","volume":"133","author":"Schattner","year":"2020","journal-title":"Am. J. Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"356","DOI":"10.1016\/j.jcv.2012.08.010","article-title":"Cytomegalovirus pneumonia in immunocompetent host: Case report and literature review","volume":"55","author":"Grilli","year":"2012","journal-title":"J. Clin. Virol."},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"271","DOI":"10.2169\/internalmedicine.1638-23","article-title":"Primary cytomegalovirus pneumonia successfully treated with corticosteroid therapy and valganciclovir","volume":"63","author":"Gocho","year":"2024","journal-title":"Intern. Med."},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"1178","DOI":"10.1016\/j.amjmed.2022.05.020","article-title":"Unusual presentations of systemic lupus erythematosus. A narrative review","volume":"135","author":"Schattner","year":"2022","journal-title":"Am. J. Med."},{"key":"ref_99","doi-asserted-by":"crossref","first-page":"bcr1120103489","DOI":"10.1136\/bcr.11.2010.3489","article-title":"Valganciclovir treatment of primary cytomegalovirus pneumonitis in an immunocompetent adult","volume":"2011","author":"Snape","year":"2011","journal-title":"BMJ Case Rep."},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1007\/s00408-012-9431-7","article-title":"Infectious diseases causing diffuse alveolar hemorrhage in immunocompetent patients: A state-of-the-art review","volume":"191","author":"Zanetti","year":"2013","journal-title":"Lung"},{"key":"ref_101","doi-asserted-by":"crossref","first-page":"131","DOI":"10.2169\/internalmedicine.49.2313","article-title":"Cytomegalovirus (CMV) and acute myocarditis in an immunocompetent patient","volume":"49","author":"Roubille","year":"2010","journal-title":"Intern. Med."},{"key":"ref_102","doi-asserted-by":"crossref","first-page":"523","DOI":"10.14503\/THIJ-13-3504","article-title":"Fulminant cytomegalovirus myocarditis in an immunocompetent host: Resolution with oral valganciclovir","volume":"41","author":"Padala","year":"2014","journal-title":"Tex. Heart Inst. J."},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Palmeira, M.M., Ribeiro, H.Y.U., Lira, Y.G., Neto, F.O.M.J., Rodrigues, I.A.d.S., da Paz, L.N.F., and Pinheiro, M.d.C.N. (2016). Heart failure due to cytomegalovirus myocarditis in immunocompetent young adults: A case report. BMC Res. Notes, 9.","DOI":"10.1186\/s13104-016-2181-5"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"683","DOI":"10.1086\/427804","article-title":"Cytomegalovirus infection of the heart is common in patients with fatal myocarditis","volume":"40","author":"Vuorinen","year":"2005","journal-title":"Clin. Infect. Dis."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"1388","DOI":"10.1056\/NEJM200011093431908","article-title":"Myocarditis","volume":"343","author":"Feldman","year":"2000","journal-title":"N. Engl. J. Med."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1016\/0002-9343(93)90262-N","article-title":"Etiology of large pericardial effusions","volume":"95","author":"Corey","year":"1993","journal-title":"Am. J. Med."},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"1942","DOI":"10.1093\/eurheartj\/ehl025","article-title":"Molecular analysis of pericardial fluid: A 7-year experience","volume":"27","author":"Levy","year":"2006","journal-title":"Eur. Heart J."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"350","DOI":"10.1159\/000443375","article-title":"Clinical significance of viral genome persistence in the myocardium of patients with dilated cardiomyopathy","volume":"58","author":"Wojciechowska","year":"2015","journal-title":"Intervirology"},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"237","DOI":"10.1002\/jmv.10200","article-title":"Unusual manifestations of primary cytomegalovirus infection in patients without HIV infection and without organ transplants","volume":"68","author":"Crowley","year":"2002","journal-title":"J. Med. Virol."},{"key":"ref_110","doi-asserted-by":"crossref","unstructured":"Li, X., Huang, Y., Xu, Z., Zhang, R., Liu, X., Li, Y., and Mao, P. (2018). Cytomegalovirus infection and outcome in immunocompetent patients in the intensive care unit: A systematic review and meta-analysis. BMC Infect. Dis., 18.","DOI":"10.1186\/s12879-018-3195-5"},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"R68","DOI":"10.1186\/cc7875","article-title":"Cytomegalovirus infection in critically ill patients: A systematic review","volume":"13","author":"Osawa","year":"2009","journal-title":"Crit. Care"},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"1204","DOI":"10.1093\/cid\/cix120","article-title":"Epidemiology of multiple herpes viremia in previously immunocompetent patients with septic shock","volume":"64","author":"Ong","year":"2017","journal-title":"Clin. Infect. Dis."},{"key":"ref_113","doi-asserted-by":"crossref","unstructured":"Roa, P.L., Perez-Granda, M.J., Munoz, P., Catalan, P., Alonso, R., Sanchez-Perez, E., Novoa, E., and Bouza, E. (2015). A prospective monitoring study of cytomegalovirus infection in non-immunosuppressed critical heart surgery patients. PLoS ONE, 10.","DOI":"10.1371\/journal.pone.0129447"},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1007\/s00134-015-4071-z","article-title":"Cytomegalovirus reactivation and mortality in patients with acute respiratory distress syndrome","volume":"42","author":"Ong","year":"2016","journal-title":"Intensive Care Med."},{"key":"ref_115","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.burns.2010.11.006","article-title":"Cytomegalovirus infection in severe burns patients monitoring by real-time polymerase chain reaction: A prospective study","volume":"37","author":"Bordes","year":"2011","journal-title":"Burns"},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"71","DOI":"10.1016\/j.ijid.2013.11.008","article-title":"Cytomegalovirus colitis in immunocompetent critically ill patients","volume":"20","author":"Siciliano","year":"2014","journal-title":"Int. J. Infect. Dis."},{"key":"ref_117","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.cmi.2014.09.001","article-title":"Presence of human cytomegalovirus DNA in the blood ofpatients with community-acquired pneumonia","volume":"21","author":"Saletinger","year":"2015","journal-title":"Clin. Microbiol. Infect."},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"706","DOI":"10.1007\/s00134-022-06716-y","article-title":"Cytomegalovirus blood reactivation in COVID-19 critically ill patients: Risk factors and impact on mortality","volume":"48","author":"Gatto","year":"2022","journal-title":"Intensive Care Med."},{"key":"ref_119","doi-asserted-by":"crossref","first-page":"45","DOI":"10.37201\/req\/068.2022","article-title":"Cytomegalovirus reactivation in patients diagnosed with severe COVID-19, a point prevalence study in a general hospital","volume":"36","author":"Barrios","year":"2023","journal-title":"Rev. Esp. Quimioter."},{"key":"ref_120","doi-asserted-by":"crossref","first-page":"ofx029","DOI":"10.1093\/ofid\/ofx029","article-title":"Association between cytomegalovirus reactivation and clinical outcomes in immunocompetent critically ill patients: A systematic review and meta-analysis","volume":"4","author":"Lachance","year":"2017","journal-title":"Open Forum Infect. Dis."},{"key":"ref_121","doi-asserted-by":"crossref","first-page":"443","DOI":"10.1042\/CS20100162","article-title":"Prevalence and prognostic implications of active cytomegalovirus infection in patients with acute heart failure","volume":"119","author":"Chilet","year":"2010","journal-title":"Clin. Sci."},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1016\/j.ogc.2023.02.002","article-title":"Cytomegalovirus in pregnancy","volume":"50","author":"Canfield","year":"2023","journal-title":"Obstet. Gynecol. Clin. North. Am."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/j.1600-0897.2010.00836.x","article-title":"The immune system in pregnancy: A unique complexity","volume":"63","author":"Mor","year":"2010","journal-title":"Am. J. Reprod. Immunol."},{"key":"ref_124","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s11357-017-9985-7","article-title":"Recent advances in CMV tropism, latency, and diagnosis during aging","volume":"39","author":"Leng","year":"2017","journal-title":"GeroScience"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/infdis\/160.1.1","article-title":"Immunologic evidence for frequent age-related cytomegalovirus reactivation in seropositive immunocompetent individuals","volume":"160","author":"McVoy","year":"1989","journal-title":"J. Infect. Dis."},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1111\/jgs.16022","article-title":"Investigating and remediating selection bias in geriatrics research: The selection bias toolkit","volume":"67","author":"Banack","year":"2019","journal-title":"J. Am. Geriatr. Soc."},{"key":"ref_127","doi-asserted-by":"crossref","unstructured":"Fowler, K., Mucha, J., Neumann, M., Lewandowski, W., Kaczanowska, M., Grys, M., Schmidt, E., Natenshon, A., Talarico, C., and Buck, P.O. (2022). A systematic literature review of the global seroprevalence of cytomegalovirus: Possible implications for treatment, screening, and vaccine development. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-13971-7"},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"1144","DOI":"10.1093\/aje\/kwq062","article-title":"Cytomegalovirus infection and the risk of mortality and fraility in older women: A prospective observational study","volume":"171","author":"Wang","year":"2010","journal-title":"Am. J. Epidemiol."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"1421","DOI":"10.1093\/cid\/cit083","article-title":"Seropositivity and higher immunoglobulin g antibody levels against cytomegalovirus are associated with mortality in the population-based European prospective investigation of Cancer-Norfolk cohort","volume":"56","author":"Langenberg","year":"2013","journal-title":"Clin. Infect. Dis."},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"281ra43","DOI":"10.1126\/scitranslmed.aaa2293","article-title":"Cytomegalovirus infection improves immune responses to influenza","volume":"7","author":"Furman","year":"2015","journal-title":"Sci. Transl. Med."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"263","DOI":"10.1007\/s00430-019-00605-w","article-title":"Impact of CMV upon immune aging: Facts and fiction","volume":"208","author":"Jergovic","year":"2019","journal-title":"Med. Microbiol. Immunol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"073","DOI":"10.31083\/j.jin2102073","article-title":"Infectious agents and Alzheimer\u2019s disease","volume":"21","author":"Piekut","year":"2022","journal-title":"J. Integr. Neurosci."},{"key":"ref_133","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1093\/aje\/kwaa238","article-title":"Association between immune response to cytomegalovirus and cognition in the Health Retirement Study","volume":"190","author":"Stebbins","year":"2021","journal-title":"Am. J. Epidemiol."},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"2204","DOI":"10.1001\/jama.1990.03440160066039","article-title":"Possible role of cytomegalovirus in atherogenesis","volume":"263","author":"Malnick","year":"1990","journal-title":"JAMA"},{"key":"ref_135","doi-asserted-by":"crossref","unstructured":"Cristescu, C.V., Alain, S., and Ruta, S.M. (2022). The role of CMV infection in primary lesions, development and clinical expression of atherosclerosis. J. Clin. Med., 11.","DOI":"10.3390\/jcm11133832"},{"key":"ref_136","doi-asserted-by":"crossref","first-page":"1897","DOI":"10.1093\/infdis\/jis620","article-title":"Higher immunoglobulin G antibody levels against cytomegalovirus are associated with incident ischemic heart disease in the population-based EPIC-Norfolk cohort","volume":"206","author":"Langenberg","year":"2012","journal-title":"J. Infect. Dis."},{"key":"ref_137","doi-asserted-by":"crossref","first-page":"1179","DOI":"10.1093\/infdis\/jiab364","article-title":"Human cytomegalovirus and risk of Incident cardiovascular disease in United Kingdom Biobank","volume":"225","author":"Hamilton","year":"2022","journal-title":"J. Infect. Dis."},{"key":"ref_138","doi-asserted-by":"crossref","first-page":"e005025","DOI":"10.1161\/JAHA.116.005025","article-title":"Cytomegalovirus infection and relative risk of cardiovascular disease (ischemic heart disease, stroke, and cardiovascular death): A meta-analysis of prospective studies up to 2016","volume":"6","author":"Wang","year":"2017","journal-title":"J. Am. Heart Assoc."},{"key":"ref_139","first-page":"1188","article-title":"Association of cytomegalovirus diseases with newly developed myocardial infarction and congestive heart failure: Data from a national population-based cohort","volume":"18","author":"Lee","year":"2022","journal-title":"Arch. Med. Sci."},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"1394","DOI":"10.1080\/21645515.2015.1037999","article-title":"Cytomegalovirus seropositivity is associated with herpes zoster","volume":"11","author":"Ogunjimi","year":"2015","journal-title":"Hum. Vaccin. Immunother."},{"key":"ref_141","doi-asserted-by":"crossref","unstructured":"Gugliesi, F., Pasquero, C., Griffante, G., Scutera, S., Albano, C., Castillo Pacheco, S.F., Riva, G., Dell\u2019Oste, V., and Biolatti, M. (2021). Human cytomegalovirus and autoimmune diseases: Where are we?. Viruses, 13.","DOI":"10.3390\/v13020260"},{"key":"ref_142","doi-asserted-by":"crossref","unstructured":"Gogesch, P., Penner, I., Krauter, S., B\u00fcscher, N., Grode, L., Aydin, I., and Plachter, B. (2019). Production strategies for pentamer-positive subviral dense bodies as a safe human cytomegalovirus vaccine. Vaccines, 7.","DOI":"10.3390\/vaccines7030104"},{"key":"ref_143","unstructured":"Fierro, C., Brune, D., Shaw, M., Schwartz, H., Knightly, C., Lin, J., Carfi, A., Natenshon, A., Kalidindi, S., and Reuter, C. (J. Infect. Dis., 2014). Safety and immunogenicity of a messenger RNA=based cytomegalovirus vaccine in healthy adults: Results from a phase 1, randomized, clinical trial, J. Infect. Dis., online ahead of print."}],"container-title":["Pathogens"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/8\/667\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T15:31:39Z","timestamp":1760110299000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2076-0817\/13\/8\/667"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,8,7]]},"references-count":143,"journal-issue":{"issue":"8","published-online":{"date-parts":[[2024,8]]}},"alternative-id":["pathogens13080667"],"URL":"https:\/\/doi.org\/10.3390\/pathogens13080667","relation":{},"ISSN":["2076-0817"],"issn-type":[{"value":"2076-0817","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,8,7]]}}}