Prenatal Management of Congenital Human Cytomegalovirus Infection in Seropositive Pregnant Patients Treated with Azathioprine

Paolo Ivo Cavoretto,Antonella Poloniato,Massimo Candiani,Milena Furione,Graziano Barera,Cristina Baldoli,Arsenio Spinillo,Chiara Fornara,Patrizia Rovere Querini,Daniele Lilleri,Alessia Arossa,Gerarda Gaeta

doi:10.3390/diagnostics10080542

Abstract

Human cytomegalovirus (HCMV) is the leading infectious agent causing congenital disabilities. The risk of HCMV transmission to the fetus in pregnant women receiving immunosuppressive agents is unknown. We describe two cases of pregnant women with evidence of pre-conception HCMV protective immunity receiving azathioprine for ulcerative colitis or systemic lupus erythematosus. Both women reactivated the HCMV and transmitted the infection to the fetuses. One newborn showed unilateral hearing deficits and brain abnormalities while the other was asymptomatic. The mother of the symptomatic newborn had low levels of total and HCMV-specific blood CD4+ T cells. Women receiving immunosuppressive agents deserve information about the risk of HCMV congenital infection and should be monitored for HCMV infection during pregnancy. Their newborns should be screened for HCMV congenital infection.

Highlights

IntroductionHuman cytomegalovirus (HCMV) is the leading infectious agent causing congenital disabilities
Human cytomegalovirus (HCMV) is the leading infectious agent causing congenital disabilities.About 0.6% of newborns are congenitally infected with HCMV, and about 20% of these are symptomatic at birth or develop long-term sequelae, in particular, hearing loss [1,2]
HCMV causes the most common congenital infections, and about 20% of infants infected in utero

Summary

Introduction

Human cytomegalovirus (HCMV) is the leading infectious agent causing congenital disabilities. About 0.6% of newborns are congenitally infected with HCMV, and about 20% of these are symptomatic at birth or develop long-term sequelae, in particular, hearing loss [1,2]. Maternal immunity has a role in preventing HCMV transmission to the fetus [3]; pre-conception immunity does not provide complete protection [4]. Pregnant women receiving immunosuppressive treatment may have an increased risk of HCMV reactivation and transmission to the fetus. HCMV infection and its consequences in pregnant women treated with immunosuppressive agents is not known, and few reports exist on congenital HCMV infection in this setting [5,6,7,8]. We describe two cases of congenital infection in pregnant women receiving azathioprine for ulcerative colitis (UC).

Case Presentation

Neonatal MRI for Case 22 after after 20

Findings

Discussion

Conclusions