HISTORY. Ask about immunosuppressive conditions such as recent traumatic injury that may have required multiple blood transfusions, organ transplantation, or HIV infection. The patient may describe a recent viral infection with symptoms such as sore throat, tiredness, joint and muscle aches, and headache. Some patients will remember an episode that lasted approximately 3 weeks with high fevers as the only symptom. In an immunosuppressed patient, there may be specific organ involvement, such as the lungs (dry cough, difficulty breathing), the GI tract (watery diarrhea, bloody diarrhea, nausea, vomiting, and cramping), and the CNS (blurred vision, headache, neck rigidity, tremors, lethargy, and even seizures and coma).

PHYSICAL EXAMINATION. Infants may show signs of delayed development and may show signs of jaundice, petechial rash, respiratory distress, and hearing loss.

With adults, assess all body systems, but the most severe signs and symptoms occur with CNS or liver involvement. Evaluate patients for signs of fever, pallor, changes in the lymph node tissue, and pharyngitis. Auscultate the patient's lungs to assess for crackles. Note decreased breath sounds, cough, shortness of breath, and symptoms of pneumonia.

Patients may also have mental status changes such as irritability, lethargy, and even seizures and coma. Patients may evidence hyperactive bowel sounds, tenderness to palpation of the stomach, and possible distension. Assess for neck rigidity, pupil changes, motor weakness, positive Babinski reflex, and tremors. Perform an eye exam to identify changes in the eye grounds, initially with small, white, cotton-wool spots with irregular borders on the retina that enlarge to fluffy white exudates and visible hemorrhages, causing vision loss progressing to blindness.

PSYCHOSOCIAL. Assess the patient's or his or her parents' ability to cope. The unborn child's mother and father will need counseling and support to deal with the possible effects of CMV on their unborn infant.

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