Neonatal screening for congenital cytomegalovirus infections.

Department of Neonatology, Academisch Ziekenhuis, Free University of Brussels, Belgium.
Journal of Perinatal Medicine (Impact Factor: 1.43). 02/1999; 27(2):116-21. DOI: 10.1515/JPM.1999.015
Source: PubMed

ABSTRACT We evaluated a screening program for the detection of congenital cytomegalovirus in 3075 unselected pregnant women. From each live-born child urine for CMV culture was collected within 7 days after birth. Each fetus expelled after a spontaneous second trimester abortion and each stillborn infant were also evaluated for a possible congenital CMV infection. For each congenital infection stored maternal sera were analysed to determine whether maternal infection was primary or recurrent. Fifteen out of the 3075 pregnancies studied resulted in a congenitally infected infant (0.49%). Nine maternal CMV infections were primary infections; five were recurrent infections, and in one case the type of infection could not be determined. Three congenital infections resulted in severe sequelae, leading to the termination of pregnancy in two instances and to neonatal death in one case. One of these severe fetal infections was due to a recurrent maternal infection. Follow-up of the other 12 neonates demonstrated hearing disorders in two children. One was born after a primary maternal infection and one after a recurrent maternal infection. We conclude that congenital CMV infections occurs in 0.49% of all pregnancies in the population studied. Twenty percent of the congenitally infected infants present severe sequelae at birth or during pregnancy, and an additional 17% have audiological deficits at 1 year of age. Severe sequelae may occur after both primary and recurrent maternal CMV infection.

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    ABSTRACT: Neurologic morbidity associated with congenital cytomegalovirus (CMV) infection is a major public health concern. The pathogenesis of cerebral lesions remains unclear. We report the neuropathologic substrates, the immune response, and the cellular targets of CMV in 16 infected human fetal brains aged 23 to 28.5 gestational weeks. Nine cases were microcephalic, 10 had extensive cortical lesions, 8 had hippocampal abnormalities, and 5 cases showed infection of the olfactory bulb. The density of CMV-immunolabeled cells correlated with the presence of microcephaly and the extent of brain abnormalities. Innate and adaptive immune responses were present but did not react against all CMV-infected cells. Cytomegalovirus infected all cell types but showed higher tropism for stem cells/radial glial cells. The results indicate that 2 main factors influence the neuropathologic outcome at this stage: the density of CMV-positive cells and the tropism of CMV for stem/progenitor cells. This suggests that the large spectrum of CMV-induced brain abnormalities is caused not only by tissue destruction but also by the particular vulnerability of stem cells during early brain development. Florid infection of the hippocampus and the olfactory bulb may expose these patients to the risk of neurocognitive and sensorineural handicap even in cases of infection at late stages of gestation.
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    ABSTRACT: CMV infection is among the most frequent pregnancy infections, with an average of 1%. Above all, differential diagnosis has to be made between primary infection and reactivation. Among new approaches, a very useful one consists in the measurement of IgG avidity. In case of a high fetal risk, the diagnosis of congenital infection is ascertained by the characterization of CMV in the amniotic fluid using culture and/or PCR.
    Immuno-analyse & Biologie Specialisee - IMMUNO-ANAL BIOL SPEC. 01/2003; 18(4):212-217.
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    ABSTRACT: Congenital cytomegalovirus infection is the most common viral infection affecting 0.64% of the Brussels population. The virus can be transmitted to the foetus during both primary and recurrent infection. Although most congenitally infected infants are asymptomatic at birth, up to 15% develop late adverse sequelae usually in the form of hearing deficits and subtle neurodevelopmental and behavioural problems.Supporters of a screening policy argue that severe sequelae could be prevented by prenatal screening. However, there is currently no reliable prognostic marker in the antenatal period. Moreover, there is no prenatal safe and effective treatment.Based on the current knowledge routine, serologic screening for CMV infection during pregnancy cannot be recommended.
    International Congress Series 01/2005; 1279:115-117.