Infection à cytomégalovirus pendant la grossesse : enjeux et prise en charge

Abstract

Cytomegalovirus is the main cause of neurosensorial deficit due to a congenital infection. Fetal infection may follow a maternal primary infection or a maternal secondary infection. The diagnosis of maternal primary infection remains tricky because the interpretation of IgG avidity test may be difficult. The diagnosis of maternal secondary infections is impossible with usual routine assays. The virological diagnosis of fetal infection is very reliable with a sensitivity over 90% and a specificity next to 100%. In the context of a proven intrauterine infection, the negative predictive value of ultrasound coupled with fetal brain RMI is over 85%. No antenatal treatment is yet validated, two treatments (hyperimmune therapy and antival therapy) are under evaluation. Six months treatment course with valganciclovir improves audiologic and neurodevelopmental outcomes of symptomatic neonates.