Usually CMV results in a rapid onset with fever, nonproductive cough and dyspnea. Hypoxia can occur in severe illness. The mortality rate is very high even with antiviral therapy. CMV hepatitis is more common after primary infection, usually arising after transplantation from a seropositive donor. Patients develop fever, hyperbilirubinemia, and elevated liver enzymes.
Severe hepatitis can lead to liver failure and another transplantation.
Among kidney transplant patients CMV syndrome is common and consists of fever, leukopenia, atypical lymphocytosis, hepatosplenomegaly, myalgia and arthralgia. Prophylactic treatment with antiviral drugs prevents this syndrome. Although the incubation period for a horizontally transmitted infection is unknown, it is usually 3 to 12 weeks after blood transfusions and 4 weeks to 4 months after transplantation. During pregnancy a primary infection may present like mild mononucleosis syndrome or be asymptomatic. Recurrent infections do not cause symptoms.