ArticlePDF Available

Congenital cytomegalovirus infection (CMV)

Authors:
Michael S Schimmel at Shaare Zedek Medical Center
Michael S Schimmel
Drora Fisher at Shaare Zedek Medical Center
Drora Fisher
Yechiel Schlesinger
Yechiel Schlesinger
Yechiel Schlesinger
  • This person is not on ResearchGate, or hasn't claimed this research yet.
Download full-text PDF
Read full-text
Download citation

Abstract and Figures

Congenital Cytomegalovirus (CMV) infection is the most common intrauterine infection in the developed world. We present a neonate with severe brain imaging abnormalities due to congenital CMV and a brief review of the pertinent literature.
Figures - uploaded by Drora Fisher
Author content
All figure content in this area was uploaded by Drora Fisher
Content may be subject to copyright.
Content uploaded by Drora Fisher
Author content
All content in this area was uploaded by Drora Fisher on Jul 02, 2014
Content may be subject to copyright.
Congenital Cytomegalovirus Infection
Michael S. Schimmel
Drora Fisher
Yechiel Schlesinger
CASE PRESENTATION
A term baby was born to a gravida 3 para 2 mother who did
not receive any prenatal care. The mother did not recall any
illness during pregnancy. At birth, meconium-stained amniotic
fluid was noticed. Apgar scores were 4, 7, and 9 at 1, 5, and
10 minutes, respectively. Physical findings included a birth
weight of 2510 g (3% percentile), head circumference of 28.5
cm ( <3% percentile), hepatosplenomegaly of 5 cm below
costal margin, and petechia over the entire thorax. The baby
was severely hypotonic. Pertinent laboratory findings included a
platelet count of 80,000 on the first day of life, which decreased
to 26,000 on the following day. Due to meconium aspiration
syndrome the baby required mechanical ventilation for 24 hours
followed by oxygen supplement through nasal canula for an
additional 2 weeks. Imaging studies included transfontanel brain
sonography and brain computerized tomography (CT). Para-
sagittal transfontanel sonography at the level of the body of the
right lateral ventricle shows severe dilatation and extensive
hyperechogenicity of the ventricular wall (Figure 1 panel A).
Coronal transfontanel sonogram at the level of the third
ventricle shows the same findings, with faint calcifications in
the thalami (Figure 1 panel B). Axial CT of the brain at the
level of the third ventricle shows calcifications lining the wall of
the lateral ventricle. Calcifications are also seen in the basal
ganglia. Axial CT at the level of the bodies of the lateral
ventricles shows extensive dilatation and calcification surround-
ing the ventricles (Figure 2). Brain stem±evoked responses
audiometry and fundoscopy were both normal.
The baby was discharged home at the age of 3 weeks. On physical
examination at discharge he was still hypotonic and microcephalic;
the rest of his examination was within normal limits.
DENOUEMENT AND DISCUSSION
Congenital Cytomegalovirus Infection (CMV)
On the first day of life total IgM was 56 mg/dl and CMV IgM was
positive. Urine culture and polymerase chain reaction (PCR) were
strongly positive for CMV.
We report a neonate with congenital CMV who presented with
strikingly severe brain abnormalities. Congenital CMV infection is the
Department of Neonatology ( M. S. S. ) , Shaare Zedek Medical Center, Jerusalem, Israel;
Department of Infectious Diseases ( Y. S. ) , Shaare Zedek Medical Center, Jerusalem, Israel;
Department of Radiology ( D. F. ) , Shaare Zedek Medical Center, Jerusalem, Israel.
Address correspondence and reprint requests to Michael S. Schimmel, Department of
Neonatology, Shaare Zedek Medical Center, Jerusalem 91031, Israel.
Figure 1. Panel A: Para-sagittal transfontanel sonography at the level of
the body of the right lateral ventricle shows severe dilatation and extensive
hyperechogenicity of the ventricular wall. Panel B: Axial CT of the brain at
the level of the third ventricle shows calcifications lining the wall of the
lateral ventricle. Calcifications are also seen in the basal ganglia.
Congenital Cytomegalovirus (CMV) infection is the most common
intrauterine infection in the developed world. We present a neonate with
severe brain imaging abnormalities due to congenital CMV and a brief
review of the pertinent literature.
Journal of Perinatology 2001; 21:209± 210.
Clinical Perinatal/Neonatal
Casebook
&&&&&&&&&&&&&&
209
Journal of Perinatology 2001; 21:209 ± 210
# 2001 Nature Publishing Group All rights reserved. 0743-8346/01 $17
www.nature.com/jp
most common intrauterine infection in the developed world. About
40% of babies born to mothers with primary CMV during pregnancy
will be infected at birth, approximately 10% of whom will be
symptomatic. In the symptomatic CMV-infected newborn the most
common clinical manifestations are petechia (76%), hepatosple-
nomegaly (60%), sensorineural hearing loss (58%), microcephaly
(53%), ventriculomegaly and intracranial calcification (30% to
50%).
1
Of the symptomatic babies, 80% will develop severe
neurologic sequelae whereas 10% to 15% of the asymptomatic babies
will have an impaired outcome,
2
most notably hearing loss.
In this baby, the striking brain-imaging manifestations were due
to a CMV infection.
Severe neurocalcifications at birth may follow various etiologies
including vascular anomalies, severe birth asphyxia,
3
and most
commonly, intrauterine infections. The leading infections causing
brain calcifications are CMV, toxoplasmosis, and less frequently,
rubella.
4,5
Imaging findings in CMV include ventricular dilatation and brain
calcifications, predominantly in the periventricular region. In
toxoplasmosis there is also ventricular dilatation, but the calcification
are scattered throughout the brain and are more prominent in the
basal ganglia than in the periventricular region. Congenital rubella is
rare and its calcifications are frequent in the basal ganglia and in the
cortex but usually not in the periventricular region.
4,5
Treatment of symptomatic congenital CMV infection with
gancyclovir have anecdotally been reported by many authors,
5
and is
now being evaluated through an ongoing placebo-controlled study
performed by the NIAID.
7
Initial results are encouraging,
6,7
but firm
recommendations regarding this experimental treatment cannot be
made at this point. In the present case, the parents chose not to treat
the infant.
References
1. Brown HL, Abernathy MP. Cytomegalovirus infection. Semin Perinatol
1998;22:260± 266.
2. Stagno S. Cytomegalovirus. In: Remington JS, Klein JO, editors. Infectious
Diseases of the Fetus and Newborn Infant. 4th ed. Philadelphia, PA: WB
Saunders; 1995. p. 320.
3. Boppana S, Pass RF, Britt WS, et al. Symptomatic congenital cytomegalovirus
infection: neonatal morbidity and mortality. Pediatr Infect Dis J 1992;11:93 ±99.
4. Govaert P, de Vries L. An atlas of neonatal brain sonography. Clin Dev Med
1997;319± 321.
5. Barkovich JA. Infections of the nervous system, congenital infections. In:
Pediatric Neuroimaging. 3rd ed. Philadelphia, PA: Lippincott Williams &
Wilkins; 2000. pp. 715± 724.
6. Nigro G, Scholtz, Bartmann U. Ganciclovir therapy for symptomatic congenital
cytomegalovirus infection in infants: a two -regimen experience. J Pediatr
1994;124:318± 322.
7. Whitley RJ, Cloud G, Gruber W, et al. Ganciclovir treatment of symptomatic
congenital Cytomegalovirus infection: results of a phase II study, National
Institute of Allergy and Infectious Diseases Collaborative Antiviral Study. J
Infect Dis 1997;175:1080± 6.
Figure 2. Panel A: Coronal transfontanel sonogram at the level of the
third ventricle shows the same findings, with faint calcifications in the
thalmi. Panel B: Axial CT at the level of the bodies of the lateral ventricles
shows extensive dilatation and calcification surrounding the ventricles.
Schimmel et al. Congenital Cytomegalovirus Infection
210
Journal of Perinatology 2001; 21:209 ± 210
... Ganciclovir (Cymevene ® ) werd in de literatuur gebruikt bij kinderen met een symptomatische congenitale CMV-infectie met vermoede of bewezen aantasting van het centrale zenuwstelsel waarbij men een verbetering of het verdwijnen vaststelde van de klinische symptomen en de afwijkende laboratoriumresultaten naast een duidelijke (tijdelijke) daling of zelfs afwezigheid van virusuitscheiding (3,11,12). Ganciclovir remt het viraal DNA-polymerase af en dringt goed door in het centrale zenuwweefsel. Het National Institute of Allergy and Infectious Diseases (NIAID) voert een fase-III-studie uit waarin voor het eerst patiënten gerandomiseerd worden (11). ...
... Ganciclovir remt het viraal DNA-polymerase af en dringt goed door in het centrale zenuwweefsel. Het National Institute of Allergy and Infectious Diseases (NIAID) voert een fase-III-studie uit waarin voor het eerst patiënten gerandomiseerd worden (11). Aangezien de morbiditeit en de mortaliteit bij een congenitale CMV-infectie met schade aan het centrale zenuwstelsel dermate ernstig is dat de voordelen van de therapie zeker opwegen tegen de nadelen, meent men dat dergelijke patiënten het meest gebaat zijn met een behandeling. ...
Perinatale Cytomegalovirus infectie
Article
Full-text available
  • May 2003
Cytomegalovirus (CMV) infection is one of the most common perinatal infections. A primary maternal infection is usually asymptomatic and will lead to a congenital infection in about 30% of the cases. If recurrent CMV infection develops during pregnancy, the risk of a congenital infection is very low. When seroconversion during pregnancy is proven, the isolation and identification of the virus in the amniotic fluid by PCR (Polymerase Chain Reaction) may yield more information about the likelihood of a congenital infection of the fetus. There should be at least a time lapse of 6 weeks between the maternal infection and the prenatal diagnosis. Fetal blood sampling could procure additional information but is not routinely used. Screening for CMV infection during pregnancy remains controversial. It seems more effective to identify high-risk groups and to prevent transmission of CMV by an effective hygiene. Treatment of congenital CMV infection is only described in symptomatic babies. Further studies, however, are needed to determine the duration and doses of the therapy.
View
... 9 Other clinical manifestations include sensorineural hearing loss, oligohydramnios and polyhydramnios, prematurity, nonimmune hydrops, fetal ascites, hypotonia, poor feeding, lethargy, thermal instability, cerebral ventriculomegaly, "blueberry muffin" spots and, less frequently, hepatitis, pneumonia, osteitis, and intracranial hemorrhage. 10,11 Approximately two-thirds of infants born with symptomatic congenital CMV infection shows intracranial calcifications. Infants with symptomatic CMV infection may be at increased risk for the presence of congenital malformations such as inguinal hernia in males, high-arched palate, hydrocephalus, clasp thumb deformity, and clubfoot. ...
Cytomegalic inclusion disease of the new born- A short review
Article
Full-text available
  • Jul 2018
CMV infection is common in all populations but rarely associated with symptomatic illness in immunocompetent individuals. Immunocompromised patients are more commonly affected and it is a major cause of multi-organ dysfunction. The severity of disease depends upon degree of immunosuppression. Infection with CMV is extremely common but disease is a rare occurrence. The large majority of infections are clinically in apparent as with other Herpes virus infections, leading to prolonged latency, with occasional reactivation. Intrauterine or postnatal infections may lead to the development of clinical disease. Cytomegalic inclusion disease is seen almost exclusively in infants born to mothers developing primary CMV infection during pregnancy. Cytomegalic inclusion disease of the newborn or fetal death are common sequelae of Intrauterine CMV infections. This is associated with hepatosplenomegaly, jaundice, thrombocytopenic purpura and hemolytic anemia. The cytomegalic inclusion disease is probably the most important cause of microcephaly. Other manifestations are chorioretinitis and cerebral calcification. Survivors may show mental retardation. The diagnosis of CMV relies on demonstration of the agent (virus, viral proteins and nucleic acids) either in body fluids, and/or tissue or on serological responses in a patient with clinical findings consistent with CMV infection. Antivirals for systemic treatment of congenital and perinatal CMV infection are ganciclovir and valganciclovir. High-risk group such as patients undergoing allogenic bone marrow organ transplantation, acquired or innate immunodeficiency syndromes and premature infants are ideal candidates for prophylaxis against CMV infection. Administration of CMV immunoglobulins and screening of blood and organ donors for virus and its products are considered in prevention
View
... 9 Other clinical manifestations include sensorineural hearing loss, oligohydramnios and polyhydramnios, prematurity, nonimmune hydrops, fetal ascites, hypotonia, poor feeding, lethargy, thermal instability, cerebral ventriculomegaly, "blueberry muffin" spots and, less frequently, hepatitis, pneumonia, osteitis, and intracranial hemorrhage. 10,11 Approximately two-thirds of infants born with symptomatic congenital CMV infection shows intracranial calcifications. Infants with symptomatic CMV infection may be at increased risk for the presence of congenital malformations such as inguinal hernia in males, high-arched palate, hydrocephalus, clasp thumb deformity, and clubfoot. ...
View
... Other clinical manifestations include sensorineural hearing loss (SNHL, present in about 30% of symptomatic infants at birth) 33 , oligohydramnios, polyhydramnios, prematurity, intrauterine growth retardation, non-immune hydrops, fetal ascites, hypotonia, poor feeding, lethargy, thermal instability, cerebral ventriculomegaly, microcephaly, intracranial calcifications (central nervous system (CNS) involvement is present in approximately two-thirds of infants with symptomatic CCMV infection) 34 , "blueberry muffin" spots, and chorioretinitis 35,36 and, less frequently, hepatitis, pneumonia, osteitis, and intracranial hemorrhage 37 . ...
Congenital cytomegalovirus infection: Current strategies and future perspectives
Article
Full-text available
  • Jul 2012
  • EUR REV MED PHARMACO
Cytomegalovirus is the most common cause of congenital infections in humans and it produces considerable morbidity in newborns. The present study reviews current concepts on epidemiology, clinical manifestations, diagnosis, treatment, future strategies and prognosis of children with congenital cytomegalovirus infection. Congenital cytomegalovirus infection can be symptomatic or not at birth, but about 10-20% of them all will exhibit neurological damage when followed up. Sensorineural hearing loss is the most frequent long-term consequence and is not manifest invariably at birth or in the neonatal period but in many cases becomes clinically apparent in later childhood. There are growing evidences that newborns with symptomatic congenital cytomegalovirus infection would benefit from treatment with either ganciclovir or valganciclovir, the most widely studied drugs in this setting. It is not yet clear if children with asymptomatic or pauci-symptomatic infection at birth would benefit from treatment. Studies evaluating treatment and long-term follow-up of infants with both symptomatic and asymptomatic infection are necessary, in order to definitely evaluate the short and long-term effectiveness and safety of both ganciclovir and valganciclovir and to identify risk factors associated to the development of long-term sequelae. In this way it will be possible to select those children that might benefit for treatment.
View
... C ytomegalovirus (CMV) is the most frequent cause of congenital infections in humans. (1) Most congenital CMV infections are asymptomatic during the neonatal period. However congenital CMV infection is still the leading viral cause of congenital malformations in the developed world. ...
Clinical experience with ganciclovir and anti-cytomegalovirus immunoglobulin treatment for a severe case of congenital cytomegalovirus infection
Article
Full-text available
  • Mar 2003
We report on a female neonate with severe onset of congenital cytomegalovirus (CMV) infection. She was noted to have cerebral ventriculomegaly on antenatal ultrasound, and presented with petechia after birth. Laboratory tests revealed severe thrombocytopenia (platelet count, 11,000/mm3) and hypoglycemia (serum glucose level, 5 mg/dl). Hepatosplenomegaly with elevated hepatic enzymes, retinitis, conjugated hyperbilirubinemia, and diffuse brainstem anomaly were also found in subsequent examinations. The diagnosis was confirmed by positive CMV-IgM from serum and the isolation of CMV from a urine sample. The patient received intravenous ganciclovir and human anti-CMV immunoglobulin during admission. She was discharged at the age of 61 days and followed-up monthly at our clinics. Symptoms and signs subsided except for mild cerebral ventriculomegaly at her last visit. We demonstrate a successful treatment with the combined use of ganciclovir and anti-CMV immunoglobulin.
View
Infectious Diseases
Chapter
  • Jan 2022
Prenatal infections are common and varied. Their pathogenesis and related circumstances must be understood if the pathological lesions are to be interpreted correctly, and although many types of infection cause placental changes, in some types, the infection may be difficult to prove from placental examination alone. Infections may ascend from the endocervical canal, or they may reach the placenta hematogenously through the maternal blood. Rarely are they iatrogenic and acquired by amniocentesis, chorionic villus sampling, amnioscopy, percutaneous umbilical blood sampling (PUBS), or intrauterine fetal transfusion. Rare cases may also develop from direct infection from the endometrium. Many infections cause gross and microscopic changes of the placenta, but others, e.g., most cases of Coxsackie virus infection, leave few characteristic or specifically recognizable traces. This is also the case with parvovirus B19 infection, which often leads to fetal hydrops but has no specific placental alteration other than the classic intranuclear inclusions in nucleated red blood cell precursors and endothelium (Hartwick et al. Teratology 39:295–302, 1989). Rarely both Coxsackie and parvovirus B19 (Samra et al. Obstet Gynecol 73:832–4, 1989) do result in lesions (see discussions below).
View
Infectious Diseases
Chapter
  • Feb 2012
Prenatal infections are important aspects of placental pathology. They are common and varied. Their pathogenesis and related circumstances must be understood if the pathological lesions are to be interpreted correctly. Many types of infection cause placental changes, but in some types, the infection may be difficult to prove from placental examination. Ultrastructural studies are especially lacking in this area and might be helpful, particularly when virus infection is suspected. Infections may ascend from the endocervical canal, or they may reach the placenta hematogenously through the maternal blood. Rarely are they acquired by amniocentesis, chorionic villus sampling, amnioscopy (Horky and Amon 1967), percutaneous umbilical blood sampling (“PUBS”; Wilkins et al. 1989), or intrauterine fetal transfusion (Goodlin 1965; Scott and Henderson 1972). Many infections cause gross and microscopic changes of the placenta, but others, e.g., the Coxsackie virus infection, leave few characteristic or specifically recognizable traces. This is also the case with parvovirus B19 infection, which often leads to fetal hydrops but has no specific placental alteration other than perhaps intranuclear inclusions in nucleated red blood cell precursors and endothelium, as a report by Hartwick et al. (1989) showed. Samra et al. (1989) described villous necrosis and calcification in the placenta from a 20 weeks’ gestation with hydrops due to this infection (see Chap. 16).
View
Cytomegalovirus infections in the pregnant women, fetus, and newborn infant
Article
  • Apr 2003
Citomegalovirus is a viral disease. If it occurs in pregnancy, there could be serious diseases of fetus and newborn infants: fetal death, spontaneous miscarriage, malformations in different levels but also healthy newborn infants. It is very important the pregnancy age, when cytomegalovirus occurs; congenital syndrome risk is 0,6%. The aim is to review the epidemiological studies published so far, with respect to factors that affect the incidence of congenital CMV infection, and factors that may influence its outcome, such as preexisting maternal immunity. The incidence of congenital CMV infection varied, and seemed to correlate with the level of preexisting immunity in the population. Preexisting maternal immunity is reported to strongly reduce transmission, the severity of congenital CMV infection (symptoms at birth and or sequelae later in life) is significantly greater after virus transmission due to a primary infection of the mother as compared with recurrence or reinfection. The data indicate that preexisting immunity of the mother the risk is significantly mitigate the outcome of congenital infection. The purpose of this work has been to describe the natural course of a CMV infection, to list the potential sequelae of a congenital CMV infection, to outline potential strategies to prevent transmission of CMV, and to summarize the diagnostic work up of a patient with a potential CMV infection.
View
Congenital cytomegalovirus infection
Article
  • Apr 2003
  • J NATL MED ASSOC
Cytomegalovirus (CMV) is the most common congenital infection in humans. Congenital CMV infection can follow either a primary or recurrent maternal infection, but the likelihood of fetal infection and the risk of associated damage is higher after a primary infection. Approximately 90% of congenitally infected infants are asymptomatic at birth. Jaundice, petechiae, and hepatosplenomegaly are the most frequently noted clinical triad in symptomatic infants. More frequent and more severe sequelae occur in symptomatic infants, notably psychomotor hearing loss and retardation. Congenital CMV infection can be diagnosed by isolation of the virus from the urine or saliva within the first three weeks of life. Rapid diagnosis can be accomplished by detection of CMV DNA by DNA amplification or hybridization techniques.
View
Urine polymerase chain reaction as a screening tool for detection of congenital cytomegalovirus infection
Article
  • Oct 2003
To define the incidence of congenital cytomegalovirus (CMV) infection in a defined population in Israel as diagnosed by urine polymerase chain reaction (PCR), and to assess the utility of this method for screening for congenital CMV infection. A convenient sample of urine specimens from asymptomatic newborns were subjected to CMV PCR. Positive results were validated by urine tube culture and by determination of serum CMV IgM antibodies. Maternal CMV IgG was determined in a representative sample of mothers. Newborns with positive urine specimens underwent full clinical evaluation. Epidemiological characteristics of the mothers were extracted from the medical records. Two medical centres in Israel with different population characteristics. A total of 2000 newborns (1000 in each medical centre). Presence of CMV DNA in the urine. Despite significant epidemiological differences between the populations in the two hospitals, the CMV seroprevalence was similar, 80.5% and 85%. Fourteen of the 2000 newborns screened (0.7%) were PCR positive. Urine culture was positive in nine of 10 specimens; IgM was positive in only two of 13 newborns with positive PCR. Eleven newborns underwent full or partial evaluation, and only one (9%) was symptomatic. The incidence of congenital CMV infection in the study population was 0.7%; over 90% were asymptomatic. Urinary CMV PCR is a reliable, rapid, and convenient method, and thus may serve as a screening tool for the detection of congenital CMV infection.
View
Ganciclovir therapy for symptomatic congenital cytomegalovirus infection in infants: A two-regimen experience
Article
Full-text available
  • Mar 1994
  • J Pediatr
The efficacy of two regimens of ganciclovir therapy was evaluated in 12 infants with symptomatic congenital cytomegalovirus (CMV) infection. Virologic investigations included culture from urine, saliva, and cerebrospinal fluid, detection of CMV DNA by polymerase chain reaction, and detection of CMV class-specific antibodies (IgG, IgA, IgM) by enzyme immunoassays. Six infants were given ganciclovir, 5 mg/kg twice daily for 2 weeks (group 1); the other six infants were given 7.5 mg/kg twice daily for 2 weeks and 10 mg/kg three times weekly for 3 months (group 2). In group 1 the CMV cultures of specimens from three infants became sterile; two of these infants also had negative results on CMV DNA studies; results of culture and CMV DNA study were still positive after ganciclovir therapy in the remaining three infants. Subsequently, normal outcome was observed in only two patients. In group 2, all infants had negative CMV-culture and CMV DNA results; clinical improvement was evident in five infants, one of whom had later development of mild psychomotor retardation. In another infant, severe psychomotor retardation and hearing loss developed after transient improvement developed. These preliminary data indicate that a ganciclovir regimen including a higher dose and more prolonged therapy might be more effective in infants with symptomatic congenital CMV infection.
View
Ganciclovir treatment of symptomatic congenital cytomegalovirus infection: results of a phase II study. National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group
Article
Full-text available
  • May 1997
Congenital cytomegalovirus (CMV) infection occurs in approximately 1% of newborns in the United States. A phase II evaluation was done of ganciclovir for the treatment of symptomatic congenital CMV infection. Daily doses of 8 or 12 mg/kg were administered in divided doses at 12-h intervals for 6 weeks. Clinical and laboratory evaluations sought evidence of toxicity, quantitative virologic responses in urine, plasma drug concentrations, and clinical outcome. A total of 14 and 28 babies received 8 and 12 mg/kg/day, respectively. Five additional babies received ganciclovir on a compassionate plea basis. Significant laboratory abnormalities included thrombocytopenia (< or = 50,000/mm3) in 37 babies and absolute neutropenia (< or = 500 mm3) in 29 babies. Quantitative excretion of CMV in the urine decreased; however, after cessation of therapy, viruria returned to near pretreatment levels. Hearing improvement or stabilization occurred in 5 (16%) of 30 babies at 6 months or later, indicating efficacy.
View
Ganciclovir Treatment of Symptomatic Congenital Cytomegalovirus Infection: Results of a Phase II Study
Article
  • May 1997
Congenital cytomegalovirus (CMV) infection occurs in ∼1% of newborns in the United States. A phase II evaluation was done of ganciclovir for the treatment of symptomatic congenital CMV infection. Daily doses of 8 or 12 mg/kg were administered in divided doses at 12-h intervals for 6 weeks. Clinical and laboratory evaluations sought evidence of toxicity, quantitative virologic responses in urine, plasma drug concentrations, and clinical outcome. A total of 14 and 28 babies received 8 and 12 mg/kg/day, respectively. Five additional babies received ganciclovir on a compassionate plea basis. Significant laboratory abnormalities included thrombocytopenia (≤50,000/mm3) in 37 babies and absolute neutropenia (≤500 mm3) in 29 babies. Quantitative excretion of CMV in the urine decreased; however, after cessation of therapy, viruria returned to near pretreatment levels. Hearing improvement or stabilization occurred in 5 (16%) of 30 babies at 6 months or later, indicating efficacy.
View
View
Symptomatic congenital cytomegalovirus infection: Neonatal morbidity and mortality
Article
  • Mar 1992
Knowledge of the natural history of symptomatic congenital cytomegalovirus (CMV) infection in the newborn is essential in order to anticipate complications and assess the potential benefit from antiviral therapy. To define the disease course we reviewed data on 106 neonates with symptomatic congenital CMV infection diagnosed and managed by the investigators. Petechiae, jaundice and hepatosplenomegaly were each noted in 70% or more patients. Microcephaly was noted in 54 of 102 (53%) at birth. Elevated alanine aminotransferase, conjugated hyperbilirubinemia and thrombocytopenia were seen in 83, 81 and 77%, respectively. Eighty-six percent had at least two of the manifestations highly suggestive of congenital infection. Platelet count fell to its nadir during the second week of life whereas elevated alanine aminotransferase and direct bilirubin persisted past the first month. In spite of the difficulty in assessing central nervous system function in the newborn, evidence of damage was present in the majority. Seventy-two had microcephaly, poor suck, lethargy/hypotonia or seizures. Abnormal computerized tomographic scan was present in 16 of 20 (80%) and decreased hearing in 20 of 39 (56%). Cerebrospinal fluid protein was greater than 120 mg/dl in 24 of 52 (46%) and this elevation was associated with neurologic abnormalities as well as hearing loss. The mean length of hospital stay was 13 and 22.4 days for term and preterm infants, relatively. Thirteen infants (12%) died during the first 6 weeks of life. Disseminated CMV infection with multiorgan involvement was evident in 7 of 9 at postmortem examination. We conclude that neonates with symptomatic congenital CMV infection have a multi-system disease with significant morbidity and mortality.
View
Cytomegalovirus infection
Article
  • Sep 1998
  • SEMIN PERINATOL
Cytomegalovirus (CMV) infection is the most common perinatal infection and may result in severe injury to the fetus. Forty percent to 50% of infants delivered to mothers with primary CMV will have congenital infections. Of these, 5% to 18% will be overtly symptomatic at birth. The mortality rate in these children is almost 30%; approximately 80% of the survivors have severe neurological morbidity. The majority of congenitally infected infants will be asymptomatic at birth; 10% to 15% of these children subsequently have sequelae such as visual and auditory defects. If recurrent or reactivated CMV infection develops during pregnancy, the risk of serious fetal injury is very low. Similarly, neonatal infection acquired during delivery or from breast feeding also poses minimal risk to the child. Because antimicrobial therapy and immunoprophylaxis for CMV infection are unsatisfactory, pregnant women must be educated about preventive measures.
View
View
An atlas of neonatal brain sonography
  • Jan 1997
  • 321
  • P Govaert
  • L De Vries
Govaert P, de Vries L. An atlas of neonatal brain sonography. Clin Dev Med 1997;319 ± 321.
Ganciclovir therapy for symptomatic congenital cytomegalovirus infection in infants: a two -regimen experience
  • Jan 1994
  • 318-322
  • G Nigro
  • Scholtz
  • U Bartmann
Nigro G, Scholtz, Bartmann U. Ganciclovir therapy for symptomatic congenital cytomegalovirus infection in infants: a two -regimen experience. J Pediatr 1994;124:318 ± 322.
An atlas of neonatal brain sonography Clin Dev Med
  • P Govaert
  • Vries De