An update on congenital Cytomegalovirus Infection : review (original) (raw)
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Follow-up of infants with congenital cytomegalovirus and normal fetal imaging
Archives of Disease in Childhood - Fetal and Neonatal Edition, 2016
To evaluate the outcome of infants with congenital cytomegalovirus (CMV) infection and normal fetal imaging. Retrospective cohort study. Tertiary paediatric medical centre. 98 infants born to mothers with primary CMV infection in the first and second trimesters (diagnosed by positive amniotic fluid findings) and normal fetal imaging. Initial evaluation included confirmatory urine culture, complete blood count, liver and kidney function tests, funduscopy, brain ultrasound and hearing test. Follow-up included periodic neurological and developmental evaluation, hearing tests until age 5 and Bayley-III Developmental Scale (in some patients). The presence and rate of sequelae of congenital CMV. 52 (53.1%) infants received early antiviral treatment for central nervous system symptoms or signs, mainly lenticulostriatal vasculopathy on postnatal ultrasonography (88.5%). Sensorineural hearing loss was found on first examination in 16 infants (25 ears), of whom 10 also had cranial ultrasound findings; another five with late-onset hearing loss were also treated. The median follow-up time was 32 (12-83) months. Most infants with moderate and severe hearing loss were infected in the first trimester (10 vs 2, p=0.053). At the last assessment, eight children (10 ears) still had hearing loss, including two with bilateral loss who underwent a cochlear implant. The mean Bayley-III score was 102.6±10.3 (range 85-127). All 98 children attended regular educational institutions. Congenital CMV infection acquired from primary maternal infection with normal fetal imaging is associated with a high rate of subtle signs and symptoms after birth. Overall, intermediate-term outcome is good with a low rate of sequelae.
BMC infectious diseases, 2017
Scarce data exist about screening, diagnosis and prognosis of non-primary Cytomegalovirus (CMV) during pregnancy. We aimed to examine antenatal diagnosis of maternal non-primary CMV infection and to identify risk factors for congenial CMV disease. Retrospective cohort of 107 neonates with congenital symptomatic CMV infection, following either primary (n = 95) or non-primary (n = 12) maternal CMV infection. We compared the groups for the manifestations and severity of congenial CMV disease, as well as for possible factors associated with the risk of developing CMV related infant morbidity. Disease severity is not similar in affected newborns, with a higher incidence of abnormal brain sonographic findings, following primary versus non-primary maternal CMV infection (76.8% vs. 8.3%, p < .001). Symptomatic congenital CMV disease following a non-primary infection is more frequent if gestational hypertensive disorders and/or gestational diabetes mellitus have ensued during pregnancy (3...
Prenatal diagnosis of congenital cytomegalovirus infection: Two decades later
American Journal of Obstetrics and Gynecology, 1990
Cytomegalovirus is the most common cause of congenital infection in the United States, yet there has been little progress in the prenatal diagnosis of this intrauterine infection. We present evidence that viral culture of amniotic fluid may be a useful adjunct procedure, when performed as part of the antenatal evaluation of suspected fetal cytomegalovirus infection. (AM J OBSTET GVNECOL 1990;163:447-50.) Cytomegalovirus (CMV) is the most common cause of congenital infection, affecting 30,000 to 40,000 liveborn infants annually in the United States.1.2 However, prenatal diagnosis of fetal CMV infection has received little attention over the last 20 years and was not mentioned in a recent editorial strongly urging renewed efforts to eliminate the problem.' In this Clinical Opinion, we briefly survey the epidemiologic characteristics of congenital CMV infection. Then we review published methods of prenatal diagnosis and provide evidence for our opinion that viral cultures of amniotic fluid may be a useful procedure. Finally, we suggest that antenatal diagnosis can play an important role in suggested programs that seek to prevent congenital infection and to treat those cases that do occur.
New advances in the diagnosis of congenital cytomegalovirus infection
Journal of Clinical Virology, 2008
Although the diagnosis of congenital CMV infection is still complex, important goals have been achieved in recent years, among which are: the availability of more reliable IgM tests for screening pregnant women whose pre-pregnancy serological status for CMV is unknown, tests to determine the avidity index of anti-CMV IgG, allowing the diagnosis of a primary CMV infection and innovative and traditional virological tests to detect the virus in amniotic fluid. When a woman is found to be IgM-positive, further diagnostic evaluation focused on determining whether this is due to a primary infection should be carried out. Maternal primary infections that were difficult to determine until a few years ago unless documented by seroconversions can now be readily diagnosed from the presence of low/moderate avidity anti-CMV antibody which persists for approximately 18-20 weeks after primary infection. In mothers at risk of transmitting the virus prenatal diagnosis can be performed between 21 and 22 weeks of gestation, and the amniotic fluid represents the pathological material of choice to determine intrauterine virus transmission. At birth or in the first 2/3 weeks of life, it is essential to use appropriate tests for diagnosis of CMV congenital infection.
Nonprimary Cytomegalovirus Fetal Infection
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, 2016
Cytomegalovirus (CMV) is the most common congenital viral infection, causing hearing, visual and psychomotor impairment. Preexisting maternal CMV immunity substantially reduces, but not eliminates, the risk of fetal infection and affectation. This article is about a case of nonprimary maternal CMV infection during pregnancy, with vertical transmission, resulting in severe fetal affectation. Preconceptional analysis indicated maternal CMV past infection. Pregnancy progressed uneventfully until the 20th week ultrasound (US), which revealed cerebral abnormalities: thin and hyperechogenic cerebral cortex with prominent lateral ventricles, bilateral periventricular hyperechogenicities, cerebellar vermis hypoplasia and absent corpus callosum. The MRI suggested these findings were compatible with congenital infection rather than primary brain malformation. The fetal karyotype was normal. The title of CMV's IgG antibodies almost tripled. Since the first semester, analysis of the polymerase chain reaction (PCR) for CMV DNA in the amniotic fluid was negative. The pregnancy was terminated at 23 weeks. Neuropathological findings at autopsy showed severe brain lesions associated with CMV infection.
Prenatal indicators of congenital cytomegalovirus infection
The Journal of Pediatrics, 2000
Objective: To assess the validity of a diagnostic protocol designed to predict the outcome of newborns of mothers suspected to have primary cytomegalovirus (CMV) infection during the first 4 months of pregnancy.
Outcomes of congenital cytomegalovirus disease following maternal primary and non-primary infection
Journal of Clinical Virology, 2017
Background: Natural history and long term prognosis of congenital cytomegalovirus (CMV) disease according to maternal primary versus non-primary infection are not clearly documented. Objective: To investigate clinical, laboratory and neuroimaging features at onset and long term outcome of congenitally CMV-infected patients born to mothers with non-primary infection compared with a group of patients born to mothers with primary infection. Study design: Consecutive neonates born from 2002 to 2015 were considered eligible for the study. Patients underwent clinical, laboratory and instrumental investigation, and audiologic and neurodevelopmental evaluation at diagnosis and during the follow up. Results: A cohort of 158 congenitally infected children was analysed. Ninety-three were born to mothers with primary CMV infection (Group 1) and 65 to mothers with a non-primary infection (Group 2). Eighty-eight infants had a symptomatic congenital CMV disease: 49 (46.2%) in Group 1 and 39 (60%) in Group 2. Maternal and demographic characteristics of patients of Group 1 and Group 2 were comparable, with the exception of prematurity and a 1-minute Apgar score less than 7, which were more frequent in Group 2 compared to Group 1. Prevalence of neuroimaging findings did not significantly differ between the two groups. An impaired neurodevelopmental outcome was observed in 23.7% of patients of Group 1 and in 24.6% cases of Group 2. Similarly, the frequency of hearing loss did not differ between the two groups (25.8% versus 26.2%, respectively). Conclusions: Neurodevelopmental and hearing sequelae are not affected by the type of maternal CMV infection. Preventing strategies should be developed for both primary and non-primary infections.
Congenital Cytomegalovirus Infection: Evaluation and Management
Congenital cytomegalovirus (CMV) infection is the most common congenital infection worldwide and most individuals are eventually exposed to this agent. In developing countries the seroprevalence in women of reproductive age approximates 100%. Cytomegalovirus (CMV) infection has great importance to obstetriciangynecologists and pediatricians. Despite the heavy disease burden, CMV infection is severely under-diagnosed because the majority (approximately 80%) of affected mothers are asymptomatic. The clinical manifestations of congenital CMV infection vary widely, from asymptomatic infection to potentially life-threatening disseminated disease. Prenatal diagnosis of fetal CMV infection can be made by testing amniotic fluid for cytomegalovirus by amniocentesis. Diagnosis of congenital cytomegalovirus infection in neonates should include real-time PCR of saliva, urine, or both, as soon as possible after birth. Antiviral therapy is not routinely recommended for congenital cytomegalovirus infection. Neonates with life-threatening infection and moderately to severely symptomatic congenital cytomegalovirus disease, CNS involvement is considered for immediate treatment that should be initiated within first month of life.
Congenital cytomegalovirus infection: recent advances in the diagnosis of maternal infection
Human Immunology, 2004
In most European countries, pregnant women are tested for cytomegalovirus (CMV) during the first trimester of pregnancy. Within the last 5 years, European laboratories have made significant progress in solving diagnostic problems linked to infection in pregnancy. With advances in CMV serology, the presence of anti-CMV immunoglobulin (Ig)M detected by a screening test such as enzyme immunoassay, can be confirmed by blot, identifying pregnant women undergoing an active or recent infection. Furthermore, primary infections that were proven if a seroconversion was observed or suspected in the presence of IgM, can now be readily diagnosed by disclosing the presence of anti-CMV low avidity in IgM-positive mothers, greatly reducing the number of women who should be considered at risk of transmitting the virus. Virologic maternal tests are not enough to diagnose a recent primary maternal CMV infection and the detection or quantification of CMV in maternal blood does not seem to be associated with a higher risk for fetal infection. A cohort of 1520 pregnant women considered at risk of transmitting the virus were followed in a longitudinal study at the University of Bologna. Women were identified as part of routine CMV screening in several Italian regions and were IgM-positive for CMV. We documented IgG seroconversion in 83 women and 1437 were IgM-positive by commercial kit. Human Immunology 65, 410Ϫ415 (2004).