Congenital cytomegalovirus infection
Background: CMV is the most common agent that causes congenital virus infection. Only 10 % of infected children have symptomatic infection immediately after birth. Signs of central nervous system damage, neurosensory deafness and delayed psychomotor development may manifest as a result of asimptomatic congenital infection later in childhood. In the article we present basic properties of CMV; we describe clinical picture of the congenital infection and possibilities of diagnose and its treatment. We present five children with symptomatic congenital CMV infection that were hospitalized for the period 1992–2002 at the Neonatal department in the University Children’s Hospital in Ljubljana.
Conclusions: Identification of infected neonates, especially those with asimptomatic congenital CMV infection, is difficult. Latest incidence of infection in Slovenia is unknown. With new investigations the efficiency of antiviral therapy was discovered but exact indications for therapy are not yet known. CMV vaccine, once available, may ultimately be the best control strategy for this important public health problem. Proper educating women in childbearing age about the risks of CMV and how to avoid disease transmission during pregnancy (hand washing, avoiding mouth-to-mouth contact with preschool children, usage of gloves especially when handling dipers or respiratory secretions) are the only control strategies available.
Behrman RE, Kliegman RM, Jenson HB. Nelson textbook of pediatrics. 16th edition. Chapter 248. Philadelphia: W. B. Saunders Company; 2000.
Alford CA, Stagno S, Pass RF, Britt WY. Congenital and perinatal cytomegalovirus infections. Rev Infect Dis 1990; 12: S745–53.
Schlesinger Y, Halle D, Eidelman AI, Reich D, Dayan D, Rudensky B, et al. Urine polymerase chain reaction as a screening tool for detection of congenital cytomegalovirus infection. Arch Dis Child Fetal Neonatal Ed 2003; 88: 71–4.
Noyola DE, Mejia-Elizondo AR, Canseco-Lima JM, Allende-Carrera R, Hernansez-Salinas AE, Ramirez-Zacarias JL. Congenital cytomegalovirus infection in San Luis Potosi, Mexico. Pediatr Infect Dis J 2003; 22: 89–90.
Halwachs-Baumann G, Genser B, Danda M, Engele H, Rosegger H, Folsch B, et al. Screening and diagnosis of congenital cytomegalovirus infection: a 5-year study. Scand Infect Dis 2000; 32: 137–42.
Tsai CH, Tsai FJ, Shih YT, Wu SF, Lin SC, Tseng YH. Detection of congenital cytomegalovirus infection in Chinese newborn infants using polymerase chain reaction. Acta Paediatr 1996; 85: 1241–3.
Murph JR, Souza IE, Dawson JD, Benson P, Pehtram SJ, Pfab D, et al. Epidemiology of congenital cytomegalovirus infection. Maternal risk factors and molecular analysis of cytomegalovirus strains. Am J Epidemiol 1998; 147: 940–7.
Natali A, Valcavi P, Medici MC, Dieci E, Montali S, Chezzi C. Cytomegalovirus infection in an Italian population: Antibody prevalence, virus excretion and maternal transmission. Microbiolog 1997; 20: 123–33.
Bello C, Whittle H. Cytomegalovirus infection in Gambian mothers and their babies. J Clin Pathol 1991; 44: 366–9.
Konjajev Z. Izvirni izsledki o intrauterini okužbi novorojencev s citomegalovirusom [doktorsko delo]. Ljubljana: Medicinska fakulteta; 1973.
Schleiss MR. Cytomegalovirus infection. EMedicine Feb 2005. Dosegljivo na: http://www.emedicine.com/ped/topic544.htm
Rainer D, Matjašič M. Okužba s citomegalovirusom (CMV) pri novorojenčkih in otrocih do drugega leta starosti. Zdrav Vest 1982; 52: 21–5.
Damato EG, Winnen CW. Cytomegalovirus infection: perinatal implications. Obstet Gynecol Neonatal Nurs 2002; 31: 86–92.
Raynor BD. Cytomegalovirus infection in pregnancy. Semin Perinatol 1993; 17: 394–402.
Gaytant MA, Steegers EA, Semmekrot BA, Merkus HM, Galama JM. Congenital cytomegalovirus infection: review of the epidemiology and outcome. Obstet Gynecol Surv 2002; 57: 245–56.
Marolt-Gomišček M, Radšel-Medvešček A. Infekcijske bolezni. Okužbe s citomegalovirusom. 2. izdaja. Ljubljana: Tangram; 2002. p. 376–80.
Malm G, Grondhl EH, Lewensohn-Fuchs I. Congenital cytomegalovirus infection: a retrospective diagnosis in a child with pachygyria. Pediatr Neurol 2000; 22: 407–8.
Johansson PJ, Jonsson M, Alfors K, Ivarsson SA, Svanberg L, Guthenberg C. Retrospective diagnostics of congenital cytomegalovirus infection performed by polymerase chain reaction in blood stored on filter paper. Scand J Infect Dis 1997; 29: 465–8.
Barbi M, Binda S, Caroppo S, Ambrosetti U, Corbetta C, Sergi P. A wider role for congenital cytomegalovirus infection in sensorineural hearing loss. Pediatr Infect Dis J 2003; 22: 39–42.
Van der Knaap MS, Vermeulen G, Barkhof F, Hart AA, Loeber JG, Weel JF. Pattern of white matter abnormalities at MR imaging: use of polymerase chain reaction testing on Guthrie cards to link pattern with congenital cytomegalovirus infection. Radiol 2004; 230: 529–36.
Schleiss MR. Antiviral therapy of congenital cytomegalovirus infection. Semin Pediatr Infect Dis 2005; 16: 50–9.
Schleiss MR, Anderson JL, McGregor A. Cyclic cidofovir (cHPMPC) prevents congenital cytomegalovirus infection in Guinea pig model. Virol J 2006; 3: 9.
Kern ER. Pivotal role of animal models in development of new therapies for cytomegalovirus infections. Antiviral Res 2006; 71: 164–71.
Kimberlin DW, Lin CY, Sanches PJ, Demmler GJ, Shelton M, Jacobs RF, et al. Effect of ganciclovir therapy on hearing in simptomatic congenital cytomegalovirus disease involving central nervous system: a randomized, controlled trial. J Pediatr 2003; 143: 16–25.
Tanaka-Kitajima N, Sugaya N, Futatani T, Kanegane H, Suzuki C, Oshiro M, et al. Ganciclovir therapy for congenital cytomegalovirus infection in six infants. Pediatr Infect Dis J 2005; 24: 782–5.
Meine-Jansen CF, Toet MC, Rademaker CM, Ververs TF, Gerards LJ, van Loon AM. Treatment of symptomatic congenital cytomegalovirus infection with valganciclovir. J Perinat Med 2005; 33: 364–6.
Arvin AM, Fast P, Myers M, Plotkin S, Rabinovich R. Vaccine development to prevent cytomegalovirus disease: Report from National Vaccine Advisory Committee. Clin Infect Dis 2004; 39: 233– 9.
Noyola DE, Demmler GJ, Nelson CT, Griesser C, Williamson WD, Atkins JT, et al. Huston Congenital CMV Longitudinal Study Group. Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 2001; 138: 325–31.
Fowler KB, Dahle AJ, Boppana SB, Pass RF. Newborn hearing screening: will children with hearing loss caused by congenital cytomegalovirus infection be missed? J Pediatr 1999; 135: 60–4.
Barbi M, Binda S, Primache V, Caroppo S, Dido P, Guidotti P, et al. Cytomegalovirus DNA detection in Guthrie cards: a powerful tool for diagnosing congenital infection. J Clin Virol 2000; 17: 159–65.
Binda S, Caroppo S, Dido P, Primache V, Veronesi L, Calvario A, et al. Modification of CMV DNA detection from dried blood spots for diagnosing congenital CMV infection. J Clin Virol 2004; 30: 276–9.
Smets K, De Coen K, Dhooge I, Standaert L, Laroche S, Mahieu L, et al. Selesting neonates with congenital cytomegalovirus infection for ganciclovir therapy. Eur J Pediatr 2006; 165: 885–90.
National Congenital CMV Disease Registry. BCM Jan 2005. Dosegljivo na: http://www.bcm.tmc.edu/pedi/infect/cmv/
The Author transfers to the Publisher (Zdravniški vestnik/Slovenian Medical Journal) all economic copyrights following form Article 22 of the Slovene Copyright and Related Rights Act (ZASP), including the right of reproduction, the right of distribution, the rental right, the right of public performance, the right of public transmission, the right of public communication by means of phonograms and videograms, the right of public presentation, the right of broadcasting, the right of rebroadcasting, the right of secondary broadcasting, the right of communication to the public, the right of transformation, the right of audiovisual adaptation and all other rights of the author according to ZASP.
The aforementioned rights are transferred non-exclusively, for an unlimited number of editions, for the term of the statutory
The Author can make use of his work himself or transfer subjective rights to others only after 3 months from date of first publishing in the journal Zdravniški vestnik/Slovenian Medical Journal.
The Publisher (Zdravniški vestnik/Slovenian Medical Journal) has the right to transfer the rights, acquired parties without explicit consent of the Author.
The Author consents that the Article be published under the Creative Commons BY-NC 4.0 (attribution-non-commercial) or comparable licence.