Cytomegalovirus (CMV) Infection in Infants: Two  Case Reports and Review of Literature

Cytomegalovirus (CMV) is a virus under the Herpesviridae family. We describe two case reports on different manifestations of infants with CMV infection presented with neonatal jaundice, small for gestational age (SGA) and congenital cataract. Congenital CMV (cCMV) was diagnosed in a neonate presented with jaundice and SGA. cCMV cannot be excluded in another case as no CMV PCR done within 3 weeks of life. Only one cCMV infection was treated with 6 weeks of ganciclovir anti-viral therapy, which presented with neonatal jaundice, SGA with a very high CMV viral load. All cases were under multidisciplinary follow[1]up, including pediatric for developmental assessments, audiologist for hearing assessment, and ophthalmology for vision assessment. These case reports describe the importance of thorough clinical examination and early screening of CMV infection in infants to rule out cCMV as CMV is the commonest congenital treatable viral infection in Malaysia. Early treatment and intervention can be planned for child wellbeing.

Download Full-text

Cytomegalovirus in pregnancy and the neonate

F1000Research ◽

10.12688/f1000research.10276.1 ◽

2017 ◽

Vol 6 ◽

pp. 138 ◽

Cited By ~ 18

Author(s):

Vincent C. Emery ◽

Tiziana Lazzarotto

Keyword(s):

Vaccine Development ◽

Cmv Infection ◽

Chain Reaction ◽

Congenital Cytomegalovirus ◽

Symptomatic Disease ◽

Diagnosis And Prognosis ◽

Viral Therapy ◽

Avidity Test ◽

Polymerase Chain ◽

Anti Viral Therapy

Congenital cytomegalovirus (CMV) remains a leading cause of disability in children. Understanding the pathogenesis of infection from the mother via the placenta to the neonate is crucial if we are to produce new interventions and provide supportive mechanisms to improve the outcome of congenitally infected children. In recent years, some major goals have been achieved, including the diagnosis of primary maternal CMV infection in pregnant women by using the anti-CMV IgG avidity test and the diagnosis and prognosis of foetal CMV infection by using polymerase chain reaction real-time tests to detect and quantify the virus in amniotic fluid. This review summarises recent advances in our understanding and highlights where challenges remain, especially in vaccine development and anti-viral therapy of the pregnant woman and the neonate. Currently, no therapeutic options during pregnancy are available except those undergoing clinical trials, whereas valganciclovir treatment is recommended for congenitally infected neonates with moderately to severely symptomatic disease.

Download Full-text

QuantiFERON®-CMV for Immune-Monitoring in Patients Undergoing Allogeneic Hematopoietic Stem Cell Transplantation

Blood ◽

10.1182/blood.v112.11.4369.4369 ◽

2008 ◽

Vol 112 (11) ◽

pp. 4369-4369

Author(s):

Enrico Morello ◽

Elisabetta Pagani ◽

Vladia Monsurrò ◽

Irene Cavattoni ◽

Silvia Coin ◽

...

Keyword(s):

At Risk ◽

Whole Blood ◽

Cmv Infection ◽

Mortality And Morbidity ◽

Viral Therapy ◽

Ifn Γ ◽

Cmv Disease ◽

Anti Viral Therapy ◽

Related Mortality

Abstract Background: CMV infection represents a major complication of allo-SCT affecting transplant related mortality and morbidity. Anti-viral therapy is toxic and prolonged treatment could affect graft function. Monitoring specific immune response against CMV could optimize the timing for anti-viral therapy administration in order to avoid related toxicity and to reduce CMV related mortality and morbidity. A recent ELISA based test (QuantiFERON®-CMV) could measure specific (anti-HCMV) and aspecific production of IFN-γ in whole blood. Aims: to test the reliability of QuantiFERON®-CMV in a cross sectional study in order to identify patients at risk of CMV disease after alloHSCT. Methods: QuantiFERON®-CMV is an in vitro diagnostic test using a peptide cocktail simulating human cytomegalovirus proteins (CMV) to stimulate cells in heparinised whole blood. Detection of interferon-γ (IFN-γ) by ELISA is used to identify in vitro responses to these peptide antigens that are associated with CMV infection. The IFN-γ response in the CMV Ag tube is considered positive if > 0.2 UI/mL as defined by the manufacturer. The mitogen-stimulated plasma sample was used as an IFN-γ positive control (PC) for each specimen tested. CMV reactivation and disease were defined according EBMT recommendations. Results: Among 92 tests no correlation between pp65 antigenemia and IFN-γ production was proved (p=0,346). However, among the 41 tests showing lower levels of anti-HCMV IFN-γ production (<0.2 IU/mL) 8 tests belonging 4 patients were associated with CMV disease, whereas among the 51 tests showing higher levels of anti-HCMV IFN-γ production (>=0.2 IU/mL) none were associated with CMV disease (p=0.001), RR 2.5 (CI95% 1.951–3.321). Conclusions: QuantiFERON®-CMV doesn’t seem to represent a significant reliable test for risk of viremia after alloHSCT, but patients with prolonged lower levels of anti-HCMV IFN-γ production (<0.2 IU/mL) are at risk of CMV disease. Prospective studies are required in order to identify the correlation between viremia and the need for treatment.

Download Full-text

Retrospective review of 27 European cases of fatal elephant endotheliotropic herpesvirus-haemorrhagic disease reveals evidence of disseminated intravascular coagulation

Scientific Reports ◽

10.1038/s41598-021-93478-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

K. L. Perrin ◽

A. T. Kristensen ◽

M. F. Bertelsen ◽

D. Denk

Keyword(s):

Disseminated Intravascular Coagulation ◽

Case Reports ◽

Systematic Assessment ◽

Intravascular Coagulation ◽

Viral Therapy ◽

In Captivity ◽

Haemorrhagic Disease ◽

Pathology Review ◽

Anti Viral Therapy ◽

Viral Cytopathic Effect

AbstractElephant endotheliotropic herpesvirus haemorrhagic disease (EEHV-HD) is widely acknowledged as the most common cause of mortality in young Asian elephants (Elephas maximus) in captivity. The objective of the current study was to perform a blinded, retrospective pathology review of European EEHV-HD fatalities, constituting the largest systematic assessment of EEHV-HD pathology to date. Findings between viral genotypes were compared with the aim to investigate if disseminated intravascular coagulation (DIC) could be substantiated as a significant complicating factor, thereby increasing the understanding of disease pathophysiology. Immunohistochemical staining confirmed endothelial cell (EC) damage and the presence of EC intranuclear inclusion bodies, demonstrating a direct viral cytopathic effect. Microthrombi were observed in 63% of cases in several organs, including lungs, which, together with widespread haemorrhage and thrombocytopenia reported in EEHV-HD case reports, supports the presence of overt DIC as a serious haemostatic complication of active EEHV infection. Death was attributed to widespread vascular damage with multi-organ dysfunction, including severe acute myocardial haemorrhage and subsequent cardiac failure. Systemic inflammation observed in the absence of bacterial infection may be caused by cytokine release syndrome. Findings reinforce the necessity to investigate cytokine responses and haemostatic status during symptomatic and asymptomatic EEHV viraemia, to potentially support the use of anti-inflammatory treatment in conjunction with anti-viral therapy and cardiovascular support.

Download Full-text