Cytomegalovirus (CMV)
• Most common congenital viral infection
• ~40,000 infants per year in the U.S.
• Mild, self limiting illness
• Transmission can occur with primary infection or reactivation of virus
• 40% risk of transmission in primary infection
• Studies suggest increased risk of transmission later in pregnancy
• However, more severe sequalae associated with earlier acquisition
Clinical Manifestations:
• 90% are asymptomatic at birth!
• Up to 15% develop symptoms later, notably sensorineural hearing loss
• Symptomatic infection
• SGA, HSM, petechiae, jaundice, chorioretinitis, periventricular calcifications, neurological deficits
• >80% develop long term complications
• Hearing loss, vision impairment, developmental delay
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| Massive ventricle Enlargement |
Diagnosis:
• Maternal IgG shows only past infection
• Infection common – this is useless
• Viral isolation from urine or saliva in 1st 3weeks of life
• Afterwards may represent post-natal infection
• Viral load and DNA copies can be assessed by PCR
• Less useful for diagnosis, but helps in following viral activity in patient
• Serologies not helpful given high antibody in population
Treatment:
• Ganciclovir is given for the duration of 6wks in symptomatic infants
• Studies show improvement or no progression of hearing loss at 6mos
• No other outcomes evaluated (development, etc.)
• Neutropenia often leads to cessation of therapy
• Treatment currently not recommended in asymptomatic infants due to side effects
• Area of active research to include use of valgancyclovir, treating asx patients, etc.
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