Congenital and postnatal cytomegalovirus infections

Czech version

Authors: D. Smíšková ¹; P. Hubáček ²
Authors‘ workplace: Klinika infekčních nemocí, 2. LF UK a FN Bulovka, Praha ¹; Ústav lékařské mikrobiologie, 2. LF UK a FN Motol, Praha ²
Published in: Čes-slov Neonat 2022; 28 (2): 112-116.
Category: Reviews

Overview

Congenital cytomegalovirus infection is the most common congenital infection worldwide (0.2−6 % of live births, 0.2−0.6 % in countries with a higher economic standard). It is the most common cause of non-genetic sensorineural hearing loss and has a significant role in neurological developmental disorders. The risks of transmission to the fetus are fundamentally different for primary infection (30−35 %) and for reactivation or reinfection (1.1−1.7 %). About 90 % of newborns are asymptomatic at the time of birth, but 10−15 % develop hearing impairment or neurodevelopmental disorder in the first years of life.

Prenatal clinical manifestations include intrauterine growth retardation, ventriculomegaly, microcephaly or intracranial calcification, whereas low birth weight, microcephaly, hypotonia, petechial exanthema, blueberry muffins, hepatosplenomegaly, thrombocytopenia, neutropenia, hepatopathy, hyperbilirubinemia, hearing impairment or chorioretinitis are seen postnatally.

The diagnosis should be established as soon as possible, the recommended screening test is the examination of saliva or urine (PCR), followed by quantitative viremia and viruria.

The treatment is started in the first 4 weeks of life in newborns with a gestational age of over 32 weeks with CNS involvement and/ or severe involvement of other organs (liver, bone marrow, lungs, eye). The basic virostatic agent is intravenous ganciclovir or oral valganciclovir. The duration of treatment is 6 months, in indicated cases up to 1 year.

The follow-up of children with congenital CMV infection should last until at least 4 years of age, regular evaluation of hearing, neurodevelopmental outcome and vision are necessary.

Keywords:

cytomegalovirus – sensorineural hearing loss – congenital infection – postnatal infection – ganciclovir – valganciclovir

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