Asymptomatic Primary Cytomegalovirus Infection: Virologic and Immunologic Features

We followed 45 seronegative adolescents for acquisition of cytomegalovirus (CMV); 6 (5 female, 1 male) seroconverted after a median of 7.5 months. All were free of signs and symptoms. CMV was isolated from 32 (59.2%) of 54 urines, 2-80 weeks after infection; viruria was less frequent after 6 months. CMV was isolated from saliva of 3 subjects, vaginal swabs of 2 of 5, and 1 white blood cell (WBC) sample. CMV DNA was detected by polymerase chain reaction in WBCs and plasma from all subjects tested. The proportion of WBC samples with CMV DNAemia was 75%-80% within 16 weeks of infection, declining to 0%-25% after 48 weeks. The rate of plasma DNAemia was 25%-40% at 8-16 weeks, declining with time. IgG antibody to CMV, glycoprotein B (gB), and neutralizing antibody were present after 6-8 weeks. Lymphocyte proliferative responses to CMV and to gB were low, compared with those of controls. CMV shedding was of shorter duration than expected. Although antibody response was prompt and vigorous, CMV DNA could be detected in blood for months.