Abstract

With a worldwide prevalence of between 0.3 and 1 %, congenital cytomegalovirus (CMV) infection is the main cause of congenital infection. Long term neurological or audiological sequelae are seen in 20 to 25 % of infected new-borns. Congenital CMV may follow maternal primary infection or maternal non-primary infection, with comparable morbidity. The diagnosis of maternal primary infection can be done at 12 to 13 weeks gestation by serology using a 2 steps algorithm. IgG and IgM are first tested and in cases with positive IgG and IgM, IgG avidity is tested. There are no tools validated to achieve the diagnosis of maternal non-primary infection. It is therefore not advisable to prescribe a CMV serology to a already known as seropositive. Diagnosis of fetal infection relies on CMV PCR in amniotic fluid. The prognosis of an infected fetus is based upon imaging and fetal laboratory markers. At birth, diagnosis relies on CMV PCR in saliva or urine collected in the first 3 weeks. False positive particularly in saliva sample are possible, a confirmation in a second sample is mandatory. Retrospective diagnosis on dried blot spots of Guthrie cards is possible with varied sensitivity depending on the assays used. No antenatal treatment is completely validated. Valganciclovir treatment in neonates with CNS involvement has a proved albeit modest efficacy with improvement or stabilization of hearing.

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