Severe fetal anaemia caused by congenital cytomegalovirus infection

2021 ◽  
Vol 14 (10) ◽  
pp. e244585
Author(s):  
Claudia Salazar-Sanchez ◽  
Pedro Llancarí ◽  
Rommy H Novoa ◽  
Walter Ventura
Keyword(s):  
Pregnant Woman ◽  
Fetal Growth ◽  
Umbilical Cord Blood ◽  
Cytomegalovirus Infection ◽  
Peak Systolic Velocity ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus ◽  
Fetal Medicine ◽  
Fetal Infection

A 22-year-old pregnant woman was referred to our fetal medicine unit due to severe fetal growth restriction at 26 weeks of gestation. An extensive detailed ultrasound revealed signs of bilateral periventricular hyperechogenicity, suggesting fetal infection potentially due to cytomegalovirus (CMV). Doppler ultrasound showed a high peak systolic velocity in the middle cerebral artery. Percutaneous umbilical cord blood sampling confirmed fetal CMV infection and severe fetal anaemia. We present this case to highlight the importance of fetal anaemia, which can be fatal regardless of whether it is associated with generalised oedema or hydrops fetalis.

The obstetrician, congenital cytomegalovirus, clinical and diagnostic approaches to the pregnant woman

2015 ◽  
Vol 36 (4) ◽  
pp. 194
Author(s):  
Antonia W Shand
Keyword(s):  
Magnetic Resonance Imaging ◽  
Pregnant Woman ◽  
Fetal Mri ◽  
Maternal Infection ◽  
Resonance Imaging ◽  
Cmv Infection ◽  
Serological Screening ◽  
Congenital Cytomegalovirus ◽  
Fetal Infection ◽  
Diagnostic Approaches

There is low awareness of congenital cytomegalovirus (CMV) in Australia. Routine pregnancy serological screening for CMV is not recommended, but all pregnant women should be given advice about CMV prevention. Obstetricians may be asked to see a pregnant woman when serology suggests CMV infection or when features of fetal infection are present on ultrasound. If maternal CMV infection is confirmed, the timing of infection (pre-pregnancy or gestation of pregnancy), must be determined to predict the fetal risks. In addition, it is important to establish whether maternal infection is primary or reactivation. If there is fetal infection, ultrasound can be used to attempt to establish whether the fetus may have been affected. Serial serology, CMV IgG avidity, maternal viraemia (using serum PCR), amniotic fluid CMV PCR, serial fetal ultrasounds, and possibly fetal MRI (magnetic resonance imaging) are investigations that may be useful to predict neonatal outcomes. Timely and accurate counselling is important to optimise maternal and neonatal management.

scholarly journals Is low birth weight a risk indicator for congenital cytomegalovirus infection?

2009 ◽  
Vol 4 (01) ◽  
pp. 044-047 ◽  
Author(s):  
Zakyieh Al-Hareth ◽  
Fawza Monem ◽  
Nagwa Abdel Megiud
Keyword(s):  
Birth Weight ◽  
Low Birth Weight ◽  
Cord Blood ◽  
Umbilical Cord ◽  
Umbilical Cord Blood ◽  
Head Circumference ◽  
Cytomegalovirus Infection ◽  
Congenital Infection ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus

Background: Congenital cytomegalovirus infection is currently the leading cause of congenital infection in 0.2-2.2% of live births worldwide leading to variable serious sequalae. The aim of the study was to determine if low birth weight is an indicator of CMV congenital infection evidenced by detecting CMV-DNA in umbilical cord blood at the time of delivery. Methodology: CMV-IgG and IgM antibodies and CMV-DNAemia were assessed in umbilical cord blood of two hundreds newborns, one hundred of whom had birth weight ≤ 2700 gram and/or head circumference ≤ 32 cm. Results: CMV-IgM was not detected, while CMV-IgG was positive in 80-90% of the two hundreds tested newborns. CMV-DNA was detected in four out of the 200 newborns. One of them was over the adopted weight limit (> 2700 gram). Conclusions: CMV-IgM and IgG antibodies assessment was not a potential discriminative test to identify congenitally infected newborns. In addition, low birth weight and small head circumference at birth failed to predict congenital CMV infection. CMV-DNA detection in umbilical cord blood at the time of delivery using real-time PCR of all newborns is recommended as decisive, rapid and non-invasive test.

Congenital Cytomegalovirus Infection: Diagnostic and Prognostic Significance of the Detection of Specific Immunoglobulin M Antibodies in Cord Serum

PEDIATRICS ◽  
1982 ◽  
Vol 69 (5) ◽  
pp. 544-549
Author(s):  
Paul D. Griffiths ◽  
Sergio Stagno ◽  
Robert F. Pass ◽  
Richard J. Smith ◽  
Charles A. Alford
Keyword(s):  
Cytomegalovirus Infection ◽  
Prognostic Significance ◽  
Immunoglobulin M ◽  
Maternal Infection ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus ◽  
Congenital Infections ◽  
Congenital Cmv Infection ◽  
Specific Immunoglobulin

Specific immunoglobulin M antibodies were detected by radioimmunoassay (RIA-IgM) in cord sera from 83/93 (89%) babies congenitally infected with cytomegalovirus (CMV) but in 0/104 cord sera from uninfected control subjects. The type of maternal infection did not affect the ability of the assay to identify congenital infections, but increased RIA-IgM titers were found more frequently in cord sera from babies infected following primary CMV infections (9/18; 50%) than following recurrent CMV infections (1/12; 8%) (P < .05). The magnitude of the fetal immune response was related to disease inasmuch as 14/40 (35%) babies with increased RIA-IgM titers were symptomatic at birth compared with 1/43 (2%) with lower titers (P < .001). When combined with the results of testing for rheumatoid factor and total IgM, the RIA-IgM assay defined subgroups of babies with generally poor (7/15; 47% symptomatic at any stage) or generally good (0/21 symptomatic) prognoses. Prospective studies currently identifying cases of congenital CMV infection may wish to use these three serologic techniques as the results obtained appear to have prognostic significance for those babies who are initially asymptomatic.

Congenital cytomegalovirus infection after maternal persistent immunoglobulin-M antibodies against cytomegalovirus prior to conception

2013 ◽  
Vol 2 (1-2) ◽  
Author(s):  
Yoshiyuki Nakajima ◽  
Naoki Masaoka ◽  
Tatsuo Yamamoto
Keyword(s):  
Cytomegalovirus Infection ◽  
Congenital Infection ◽  
Maternal Serum ◽  
Immunoglobulin M ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus ◽  
Congenital Cmv Infection ◽  
Infant Girl ◽  
Congenital Cmv

AbstractWe describe a case of congenital cytomegalovirus (CMV) infection transmitted by an immunocompetent woman infected before conception with continuous hyper CMV-immunoglobulin M (IgM). A 33-year-old woman whose CMV-IgM levels were stable more than 8 months before conception was referred at 35 gestational weeks due to fetal unilateral cerebral ventriculomegaly. The maternal serum CMV-IgG was 61.7 U/mL, and the CMV-IgM was 3.89 U/mL. An infant girl weighing 2297 g was delivered transvaginally. The neonate was found to have congenital CMV infection. After delivery, the high maternal CMV-IgM level has continued for more than 2 years. In conclusion, although continuous hyper CMV-IgM is rare, the infants of infected women may develop congenital infection. It is our hope that the information provided in the present case will further aid clinicians in counseling patients who find themselves in this situation.

Congenital cytomegalovirus with extracerebral manifestations: ultrasound signs and prognosis — what is important?

2019 ◽  
Author(s):  
Tsikhanenka , A. Chukanov , Yu. Buchel
Keyword(s):  
Cytomegalovirus Infection ◽  
Splenic Artery ◽  
Peak Systolic Velocity ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus ◽  
Abdominal Organs

We present ultrasound data of a congenital cytomegalovirus infection with extracerebral manifestations (mainly lesions of the abdominal organs and an increase in peak systolic velocity in the splenic artery), which can be considered as adverse prognostic signs.

scholarly journals 829. Identification of Congenital Cytomegalovirus Infection Using Real-World Healthcare Data

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S456-S456
Author(s):  
Clara Weil ◽  
Morgan Marks ◽  
Wei Wang ◽  
Gabriel Chodick ◽  
Efraim Bilavsky ◽  
...  
Keyword(s):  
Healthcare System ◽  
Cytomegalovirus Infection ◽  
Laboratory Data ◽  
Case Definition ◽  
Case Review ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus Infection ◽  
Healthcare Database ◽  
Permanent Disability ◽  
Congenital Cytomegalovirus

Abstract Background Infants with congenital cytomegalovirus infection (cCMVi) may present with symptoms such as sensorineural hearing loss (SNHL) during the neonatal period and/or develop permanent disability. This study aims to identify infants with cCMVi using information available in an electronic healthcare database in Israel. Methods We performed a retrospective study in Maccabi Healthcare Services (MHS, 2.4-million-member healthcare system) among infants with ≥30 days’ continuous enrolment since birth and linked maternal data of women aged 18-44 years in 2013-2017. Data were obtained on diagnosis codes (‘Dx’; ICD-9-CM) of CMV and SNHL and dispensed valgancivlovir treatment (‘Tx’) within 90 days after birth. To help inform the timing of the CMV infection (congenital vs. postnatal) data on maternal CMV testing history were also obtained among infants whose earliest CMV Dx was at age 22-90 days. Results The study included 171,952 infants linked to 128,264 mothers (167,879 pregnancies). A total of 461 infants (0.3%) had a CMV Dx within 90 days, 81.3% of which (n=375) were diagnosed within 21 days. Among all infants with a CMV Dx within 90 days, 105 also had dispensed Tx (n=101) and/or SNHL Dx (n=16). Among infants diagnosed at age 22-90 days without evidence of prior Tx or SNHL (n=69), 12 had a record of primary maternal CMV infection in pregnancy, 8 had mothers who were CMV seronegative at the start of pregnancy without follow-up test results, and 49 did not have any maternal laboratory data available. A medical record review is being conducted to validate each cCMV case definition in the MHS database. Conclusion In large Israeli healthcare system, 0.3% of infants had a CMV Dx in their electronic health records suggestive of potential cCMVi. Case review is ongoing to validate these codes and help inform analyses on the clinical and economic burden of cCMVi in this population where awareness of CMV is high but newborn screening is not universal. Disclosures Morgan Marks, PhD, ScM, Merck and Co. Inc. (Employee, Shareholder) Wei Wang, PhD, Merck (Employee) Anushua Sinha, MD, MPH, Merck & Co. (Employee)Merck & Co. (Shareholder)Merck & Co. (Consultant)

scholarly journals Modern diagnostic and treatment approaches of congenital cytomegalovirus infection: a clinical case

2020 ◽  
pp. 48-54
Author(s):  
O.H. Shadrin ◽  
◽  
A.P. Volokha ◽  
N.H. Chumachenko ◽  
V.M. Fysun ◽  
...  
Keyword(s):  
Cytomegalovirus Infection ◽  
Clinical Case ◽  
Clinical Manifestations ◽  
Severe Infection ◽  
Organ Damage ◽  
Antiviral Drugs ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus ◽  
Congenital Cmv Infection

Cytomegalovirus infection (CMV) is one of the most common causes of fetal infection. Recently fetal infections cause from 11% to 45% of perinatal losses, according to various authors, and are considered to be one of the most likely causes of congenital malformations, which lead to infants disability and reduce quality of life. CMV-infection clinical picture is very diverse, disguised as other diseases. There may be clinical manifestations of both generalized infection and single organ damage, because the virus has tropism to various organs and tissues. Timely diagnosis and treatment are the key to successful therapy of even severe manifestations of congenital CMV-infection in infants. Antiviral drugs usage can be sufficiently justified in patients with severe infection and can prevent complications. A clinical case of a manifest form of cytomegalovirus infection with severe hepatitis in an infant is presented and the therapeutic efficacy and safety of the ganciclovir and valganciclovir antiviral drugs are shown. The study is performed in accordance with principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the article. Informed consent of parents was obtained for the research. The authors declare no conflict of interest. Key words: infants, congenital cytomegalovirus infection, ganciclovir, valganciclovir, clinical case.

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