Congenital Cytomegalovirus Infection - Lessons from a Clinical Case

Background: Cytomegalovirus (CMV) is a worldwide spread herpes virus that establishes a latent infection after the primary infection. It becomes a major problem in immunocompromised patients and in cases of primary or reactivated infection during pregnancy. CMV is the most common congenital infection and is the leading infectious cause of sensoneural deafness and cerebral mental retardation. Aim: Тo raise the attention to the discordance in our knowledge of cCMV infection and the implementation of the knowledge in practice. Materials and methods: CMV-DNA was extracted from saliva and plasma samples according to the protocol of DNA-Sorb-A, Sacace, Biotechnologies, Italy. Polymerase chain reaction (PCR) was performed using a commercial kit based on the Taq-man principle: Quantitative RT-PCR for CMV-DNA detection (Sacace, Biotechnologies, Italy). The linear range of the CMV Real-TM Quant PCR test is 500-10000000 copies/ml, and the reported sensitivity is 400 copies/ml. Results: The infant was born with clinical manifestations involving development of hepatosplenomegaly, chorioretinitis, anemia, microcephaly and simultaneous dilatation of the brain ventricles. CMV infection was confirmed using modern PCR studies. Conclusions: This case highlights the need for specific virological/PCR tests to be performed for all children with the least suspected congenital infection, especially when there is an option of a specific treatment.

Download Full-text

Congenital Cytomegalovirus Infection: Evaluation and Management

Journal of Enam Medical College ◽

10.3329/jemc.v9i2.41414 ◽

2019 ◽

Vol 9 (2) ◽

pp. 116-126

Author(s):

Md Benzamin ◽

Md Mizanur Rahman ◽

Md Rukunuzzaman ◽

ASM Bazlul Karim

Keyword(s):

Cytomegalovirus Infection ◽

Clinical Manifestations ◽

Congenital Infection ◽

Asymptomatic Infection ◽

Reproductive Age ◽

Cmv Infection ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus ◽

Life Threatening ◽

Disseminated Disease

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. J Enam Med Col 2019; 9(2): 116-126

Download Full-text

Congenital Cytomegalovirus Infection: A Cause of Renal Dysplasia?

Pediatric and Developmental Pathology ◽

10.2350/06-06-0099.1 ◽

2007 ◽

Vol 10 (4) ◽

pp. 300-304 ◽

Cited By ~ 5

Author(s):

Maren Chan ◽

Jonathan L. Hecht ◽

Theonia Boyd ◽

Seymour Rosen

Keyword(s):

Viral Infections ◽

Tissue Injury ◽

Clinical Manifestations ◽

Renal Dysplasia ◽

Cmv Infection ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus ◽

Wide Range ◽

The Central Nervous System ◽

Multicystic Dysplasia

Cytomegalovirus (CMV) infection is one of the most frequently encountered viral infections of the fetus and induces a wide range of histologic and clinical manifestations. Congenital abnormalities are typically restricted to the central nervous system despite evidence of CMV inclusions occurring in most epithelial cells. Although tissue injury and even glomerulonephritis have been observed in congenital CMV infections, renal multicystic dysplasia has not been reported. Herein, we describe a case of unilateral renal dysplasia in a 19-week fetus with concurrent CMV infection. We believe the present case to be the first description of a virus apparently inducing renal multicystic dysplasia.

Download Full-text

Congenital Cytomegalovirus Infection Masquerading as Antenatal Ventriculomegaly With Intraventricular Hemorrhage in a Term Neonate

The Neurohospitalist ◽

10.1177/1941874419846044 ◽

2019 ◽

Vol 10 (1) ◽

pp. 55-57

Author(s):

Deepanjan Bhattacharya ◽

B. N. Anil Kumar ◽

Inusha Panigrahi ◽

Anupriya Kaur

Keyword(s):

Intraventricular Hemorrhage ◽

Term Neonate ◽

Preterm Neonates ◽

Cmv Infection ◽

Congenital Cytomegalovirus Infection ◽

Positive Polymerase Chain Reaction ◽

Congenital Cytomegalovirus ◽

Left Lateral Ventricle ◽

Polymerase Chain ◽

Occipital Horn

Intraventricular hemorrhage is an uncommon manifestation of congenital cytomegalovirus (CMV) infection and has been described in preterm neonates. We discuss a term neonate, who was referred because of intracranial hemorrhage and hydrocephalous detected in the antenatal ultrasound. She had cholestatic jaundice, hepatitis, and thrombocytopenia, with positive polymerase chain reaction for CMV. Neuroimaging revealed reduced sulcation, mildly enlarged ventricles, and multiple periventricular cysts, along with residual hemorrhage in occipital horn of left lateral ventricle. She was started on ganciclovir, following which there was improvement in platelet count, jaundice, as well as transaminase levels.

Download Full-text

Congenital cytomegalovirus infection: occurrence in two socioeconomically distinct populations of a developing country

Revista do Instituto de Medicina Tropical de São Paulo ◽

10.1590/s0036-46651985000200010 ◽

1985 ◽

Vol 27 (2) ◽

pp. 105-108 ◽

Cited By ~ 20

Author(s):

Cláudio S. Pannuti ◽

Lucy S. Vilas-boas ◽

Maria J. O. Angelo ◽

Renato P. S. Carvalho ◽

Conceição M. Segre

Keyword(s):

Umbilical Cord ◽

Virus Isolation ◽

Congenital Infection ◽

Socioeconomic Background ◽

Cmv Infection ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus ◽

Low Socioeconomic ◽

Cord Serum ◽

Population Prevalence

In São Paulo, Brazil, between November 1980 and July 1982, 1614 newborns of middle socioeconomic background and 1156 newborns of low socioeconomic background were examined for the occurrence of congenital cytomegalovirus (CMV) infection by isolation of virus from urine samples or detection of specific anti-CMV IgM in umbilical cord serum tested by immunofluorescence. In the low socioeconomic population prevalence of CMV complement-fixing antibodies in mothers was 84.4%(151/179) and the incidence of congenital infection assessed by virus isolation 0.98% (5/508), as compared with 0.46% (3/648) in the group of newborns tested by detection of specific anti-CMV IgM in umbilical cord-serum. In middle socioeconomic level population prevalence of CMV complement-fixing antibodies in mothers was 66.5% (284/427) and the incidence of CMV congenital infection was 0.39% (2/518) in the group of newborns screened by virus isolation and 0.18% (2/1096) in the group tested by detection of specific anti-CMV IgM. In the present study none of the 12 congenitally infected newborns presented clinical apparent disease at birth.

Download Full-text

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

Case Reports in Perinatal Medicine ◽

10.1515/crpm-2012-0021 ◽

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.

Download Full-text

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

Ukrainian journal of Perinatology and Pediatrics ◽

10.15574/pp.2020.84.48 ◽

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.

Download Full-text

Update on congenital cytomegalovirus infection: Prenatal prevention, newborn diagnosis, and management

Paediatrics & Child Health ◽

10.1093/pch/pxaa083 ◽

2020 ◽

Vol 25 (6) ◽

pp. 395-395 ◽

Cited By ~ 1

Author(s):

Michelle Barton ◽

A Michael Forrester ◽

Jane McDonald

Keyword(s):

Cytomegalovirus Infection ◽

Multidisciplinary Approach ◽

Congenital Infection ◽

Cmv Infection ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus ◽

Common Cause ◽

Hygienic Measures ◽

Reduce Risk ◽

Congenital Cmv

Abstract Cytomegalovirus (CMV) is the leading cause of congenital infection and the most common cause of non-genetic sensorineural hearing loss (SNHL) in childhood. Although most infected infants are asymptomatic at birth, the risk for SNHL and other neurodevelopmental morbidity makes congenital CMV (cCMV) a disease of significance. Adherence to hygienic measures in pregnancy can reduce risk for maternal CMV infection. The prompt identification of infected infants allows early initiation of surveillance and management. A multidisciplinary approach to management is critical to optimize outcomes in affected infants.

Download Full-text

Clinical profile of symptomatic congenital cytomegalovirus infection: cases from a tertiary hospital in north India

Tropical Doctor ◽

10.1177/0049475520923491 ◽

2020 ◽

Vol 50 (3) ◽

pp. 282-284

Author(s):

Deepanjan Bhattacharya ◽

Inusha Panigrahi ◽

Chakshu Chaudhry

Keyword(s):

Intracranial Haemorrhage ◽

Tertiary Hospital ◽

North India ◽

Common Finding ◽

Cmv Infection ◽

Chain Reaction ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus ◽

The Mean ◽

Polymerase Chain

We retrospectively analysed the records of nine infants with polymerase chain reaction proven congenital cytomegalovirus (CMV) infection, of which 66% were born preterm. Microcephaly was a universal finding, followed by hepatosplenomegaly in 89%, while chorioretinitis was seen in only 44% cases. The mean age at diagnosis was 3.5 months. Neuroimaging was abnormal in 78%, with ventriculomegaly being the most common finding followed by T2/FLAIR white matter abnormalities, periventricular cysts and intracranial haemorrhage.

Download Full-text

A New Multiplatform Model for Outpatient Prenatal and Postpartum Care in a Cohort of COVID-19-Affected Obstetric Patients

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18105144 ◽

2021 ◽

Vol 18 (10) ◽

pp. 5144

Author(s):

Mar Muñoz-Chápuli Gutiérrez ◽

Ana Durán-Vila ◽

Javier Ruiz-Labarta ◽

Pilar Payá-Martínez ◽

Pilar Pintado Recarte ◽

...

Keyword(s):

Clinical Manifestations ◽

Specific Treatment ◽

Rt Pcr ◽

Good Adherence ◽

Major Morbidity ◽

Reference Hospital ◽

The Mean ◽

Discharge From Hospital ◽

Over Time

Spain was one of the epicenters of the first wave of the COVID-19 pandemic. We describe in this article the design and results of a new telephone-and-telematic multiplatform model of systematic prenatal and postpartum follow-up for COVID-19-affected women implemented in a tertiary reference hospital in Madrid. We included patients with RT-PCR-confirmed COVID-19 during pregnancy or delivery from 10 March 2020 to 15 December 2020. We had a total of 211 obstetric patients: 148 (70.1%) were tested at the onset of suspicious clinical manifestations and 62 (29.4%) were tested in the context of routine screening. Of all the patients, 60 women (28.4%) were asymptomatic and 97 (46%) presented mild symptoms. Fifty-one women (24.2%) were admitted to our hospital for specific treatment because of moderate or severe symptoms. We had no missed cases and a good adherence. The mean number of calls per patient was 2.3. We performed 55 in-person visits. We analyzed the complexity of our program over time, showing a two-wave-like pattern. One patient was identified as needing hospitalization and we did not record major morbidity. Telemedicine programs are a strong and reproducible tool to reach to pregnant population affected by COVID-19, to assess its symptoms and severity, and to record for pregnancy-related symptoms both in an outpatient regime and after discharge from hospital.

Download Full-text