Cases Of Congenital Cytomegalovirus Infection Research Articles

A case of congenital cytomegalovirus infection in a child with Prader–Willi syndrome

A possible manifestation of intrauterine infection with herpes viruses can be severe eye damage. Various visual disturbances with negative consequences have been described in Prader–Willi syndrome. The article describes bilateral chorioretinitis in a child with Prader–Willi syndrome, which developed against the background of congenital herpetic infection of CMV etiology.

Assessment of blood viral load in asymptomatic and symptomatic cases of congenital cytomegalovirus infection.

This study aimed to retrospectively evaluate the baseline and follow-up viral loads and viral clearance times in cases followed for asymptomatic and symptomatic congenital cytomegalovirus (cCMV) infection between August 2010 and August 2022. Among 93 cases, they had asymptomatic (n: 55) and symptomatic (n: 38). The median baseline blood viral load detected in the symptomatic cCMV (ScCMV) infection (13 054 IU/mL) was significantly higher than that of asymptomatic cCMV (AcCMV) infection (4636 IU/mL) (p < 0.013). There was no difference in median viral clearance times (75 and 90 days, respectively) in baseline viremic cases in the ScCMV and AcCMV infection groups. There were no differences in median baseline blood viral load (6930 IU/mL and 14 268 IU/mL, respectively) and median viral clearance times (75 and 85 days, respectively) between the 6-week and 6-month antiviral treatment group. No correlation was found between baseline blood viral load, clinical severity, and the number of systems involved. However, in initial viremic cases, the viral load threshold for a symptomatic case was 8856 IU/mL, with 85.7% sensitivity and 54.5% specificity.

Floppy Neonate as a Case of Congenital Cytomegalovirus Infection with Multisystemic Involvement

Cytomegalovirus infection is the most common infection worldwide. Majority of the neonates infected in utero have long-term consequences which can lead to hearing loss, developmental delays and even death. Early diagnosis and treatment are very critical. Most of the cases being asymptomatic poses an additional challenge in early identification of the cases. This is a case of neonate presenting with cryptorchidism, hypotonia due to cCMV. The initial diagnosis made was early onset neonatal septicemia and not cCMV. This case report highlights the importance of including TORCH panel in neonatal screening as well as in antenatal period. Keywords: congenital cytomegalovirus infection, screening, congenital infection, hypotonia

Challenging problems of congenital cytomegalovirus infection therapy: case study

Cytomegalovirus infection is the most common congenital infection, causing development disorders of the fetus’ nervous system. The article describes two clinical cases of congenital cytomegalovirus infection, which highlight the crucial importance of an early administration of direct antiviral drugs (ganciclovir, valgancyclovir) for the generalized manifest forms of infection. The first clinical case study (a girl, most likely infected at the beginning of the second trimester of pregnancy) deals with the development of the classic triad of severe congenital CMV infection (small weight for gestational age, direct hyperbilirubinemia and petechial rash). Given that the intrauterine developmental anomalies specific for CMV were detected in the fetus on the 32nd week of pregnancy during her mother’s comprehensive test examination, the treatment of the infant girl with ganciclovir could have started immediately after her birth. The second clinical case study describes a congenital generalized cytomegalovirus infection in a child with malformations of internal organs and the central nervous system. The described two clinical cases of congenital cytomegalovirus infection highlight the crucial importance of ganciclovir and point to the fact that the isolated use of hyperimmune immunoglobulin does not stop the progression of the disease. The chance of a favorable outcome of the disease is much higher if the clinical diagnosis is established as early as possible after the birth of the child and etiotropic therapy is fully administered.

Fetal Liver Volume Assessment Using Magnetic Resonance Imaging in Fetuses With Cytomegalovirus Infection†.

ObjectiveTo assess fetal liver volume (FLV) by magnetic resonance imaging (MRI) in cytomegalovirus (CMV)-infected fetuses compared to a group of healthy fetuses.MethodMost infected cases were diagnosed by the evidence of ultrasound abnormalities during routine scans and in some after maternal CMV screening. CMV-infected fetuses were considered severely or mildly affected according to prenatal brain lesions identified by ultrasound (US)/MRI. We assessed FLV, the FLV to abdominal circumference (AC) ratio (FLV/AC-ratio), and the FLV to fetal body volume (FBV) ratio (FLV/FBV-ratio). As controls, we included 33 healthy fetuses. Hepatomegaly was evaluated post-mortem in 11 cases of congenital CMV infection. Parametric trend and intraclass correlation analyses were performed.ResultsThere were no significant differences in FLV between infected (n = 32) and healthy fetuses. On correcting the FLV for AC and FBV, we observed a significantly higher FLV in CMV-infected fetuses. There were no significant differences in the FLV, or the FLV/AC or FLV/FBV-ratios according to the severity of brain abnormalities. There was excellent concordance between the fetal liver weight estimated by MRI and liver weight obtained post-mortem. Hepatomegaly was not detected in any CMV-infected fetus.ConclusionIn CMV-infected fetuses, FLV corrected for AC and FBV was higher compared to healthy controls, indicating relative hepatomegaly. These parameters could potentially be used as surrogate markers of liver enlargement.

Results of a Protocol for Targeted Testing of Congenital Cytomegalovirus Infection in Babies who Fail the Newborn Hearing Screen

<strong>Background and objectives:</strong> Cytomegalovirus (CMV) is a major cause of sensorineural hearing loss in children [1]. Universal screening is controversial due to the low risk of CMV-related hearing loss [2]. The prevalence of CMV related hearing loss is 0.5 in 1000 children and is thought to be responsible for 15% to 20% of moderate-to-severe hearing loss in children [3, 4]. Since 2018, New York state law requires targeted CMV testing for newborns who “refer” on the Newborn Hearing Screen (NBHS) prior to discharge from the hospital at birth [5]. This is a report of a CMV testing protocol implemented at a community hospital for newborns who “refer” on the NBHS. <strong>Methods:</strong> Clinical records of all neonates born at BronxCare Health System (BCHS) who did not pass the NBHS between March 2019 and September 2020 were retrospectively reviewed. All newborns are screened using Auditory Brainstem Response (ABR) and those who do not pass are referred for audiology evaluation. Newborns who failed NBHS were tested for CMV prior to hospital discharge using Salivary Real-time Polymerase Chain Reaction (PCR) (Quest Diagnostics). Positive results were confirmed with serum PCR. We analyzed NBHS, audiology evaluation and CMV testing results. <strong>Results:</strong> A total of 3555 newborns had NBHS performed; 44 did not pass and were referred for audiology evaluation within 2 weeks of hospital discharge. Of these 44, CMV testing was done for 37 (84%) while 7 (16%) were not tested for CMV. Of those tested, salivary PCR detected CMV in two patients: the first had negative confirmatory serum PCR test; the second was confirmed positive and treated with ganciclovir. This patient, who is confirmed positive, had inconclusive results on follow-up audiology evaluation and was referred for Early Intervention services. Of the original cohort of 44 patients who were referred to audiology; thirty-three (75%) passed audiology evaluation and eleven did not. Of these eleven, two cases were followed successfully and have confirmed hearing loss, while 9 were lost to subsequent audiology follow-up. Of the two hearing loss cases; one was the confirmed CMV positive baby who started treatment with valganciclovir, while the other was CMV negative. Of the nine newborns who were lost to audiology follow up, 8 were tested negative for CMV while one baby was not tested for CMV. <strong>Conclusion:</strong> At BCHS, the prevalence of CMV related hearing loss is 0.28/1000 as compared to the reported prevalence of 0.5/1000. Eighteen months of targeted CMV testing in newborns who did not pass the NBHS found only one confirmed case of congenital CMV infection. This suggests that targeted CMV screening based on NBHS results misses some cases of congenital CMV infection. Of the eligible newborns who failed NBHS; seven were not tested for CMV. The testing protocol will need further refinement to avoid missing patients in the future.

Neurological sequelae in patients with congenital cytomegalovirus

IntroductionThe infection due to cytomegalovirus is the most common congenital infection in developed countries, and one of the main causes of psychomotor impairment and neurosensory hearing loss of infectious origin.The present study has its objectives to describe the clinical-analytical and neuroimaging of patients with secondary neurological sequelae secondary to the congenital cytomegalovirus infection and then compare them with the group of patients with a congenital cytomegalovirus infection that did not have neurological symptoms during their follow-up. Material and methodsA retrospective, observational, cohort study was conducted that included all the cases of congenital cytomegalovirus infection from 2003 until 2018 and the short-medium term neurological sequelae were evaluated. Prenatal, perinatal, and postnatal data of patients with neurological sequelae were compared against those that did not present with any. ResultsA total of 60 patients with congenital cytomegalovirus infection were recorded during the study period, with 65% having neurological involvement during their follow-up period (62.2% with psychomotor impairment, 61.5% with microcephaly, 46.2% loss of hearing, 27.8% motor disorders, 20.5% epilepsy, and 5.6% with chorioretinitis). In the patient group that had sequelae, the presence of clinical symptoms during the neonatal period, as well as changes in the neuroimaging study, were the most common, with both being statistically significant compared to the asymptomatic group. The patients with neurological involvement also had a higher score on the Noyola et alneuroimaging scale. ConclusionsThe symptoms at birth, and certain findings in the neuroimaging, like the changes in the white matter or neuronal migration disorders, could predict neurocognitive sequelae in patients with congenital cytomegalovirus infection.

Recurrent maternal CMV infection associated with symptomatic congenital infection: results from a questionnaire study in Portugal

ObjectiveHuman cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection...

A case of congenital cytomegalovirus infection

Cytomegalovirus is a virus responsible of the majority of intrauterine infections. It may cause hearing loss, microcephaly, cerebral gyral malformations and white matter abnormalities in the fetus. In this paper, a case with congenital cytomegalovirus infection is presented and the current approach is reviewed.

Congenital Cytomegalovirus Infection Presenting as Pneumonia with Respiratory Distress and Thrombocytopenia

Human Cytomegalovirus (CMV) is a member of Herpes viridae family, that affects most of the human population at some stage of live and is the most common congenital infection causing sensorineural hearing loss and neurodevelopmental delay in newborn. CMV infection may be acquired in a newborn congenitally or after delivery, but except for the congenital infection, other mode of infection rarely result in significant symptoms or sequel in them. Clinical findings of congenital CMV infection include IUGR, hydrops, generalized petechiae, purpura, thrombocytopenia, jaundice, hepatosplenomegaly, pneumonitis, microcephaly, periventricular calcifications, seizures, chorioretinitis, sensorineural hearing loss, bone abnormalities, abnormal dentition, and hypocalcified enamel. Here we present a case of congenital CMV infection who presented with Pneumonia with Respiratory distress and thrombocytopenia. A single, live, term, female child delivered at home developed low grade fever, cough and increased oral secretion at 28 day of life and was initially diagnosed as Pneumonia with respiratory distress with thrombocytopenia. Mother and child, both were investigated for TORCH infection which came out to be positive for CMV infection (child’s serum CMV Ab IgM 94 U/ml). Her CMV Viral Load Real Time PCR tested positive with 56380 copies/ml.

Stillbirth and intrauterine fetal death: role of routine histological organ sampling to determine cause of death.

Guidelines for the investigation of intrauterine death and sudden unexpected death in infancy (SUDI) recommend, based on expert opinion, autopsy procedures and tissue sampling strategies for histological analysis. Although stillbirth is much more common than SUDI, there have been no large-scale studies published which evaluate the usefulness of histological evaluation of specific organs in stillbirth for determining cause of death. Our aim was to evaluate the use of macroscopic and microscopic assessment of internal organs to determine cause of intrauterine death. As part of a larger study evaluating several aspects of autopsy findings in intrauterine death, a dedicated database was used to collate antenatal and postmortem examination details for cases of intrauterine death examined between 2005 and 2013 at two tertiary specialist centers in London, UK. Histological findings for all organs were examined in relation to the final cause of death, as determined by objective criteria. Among 1064 intrauterine deaths, the majority (> 80%) of cases had internal organs that were normal on both macroscopic and microscopic examination. There was no case in which histological cardiac examination provided the cause of death when the macroscopic appearance of the heart was normal. Microscopic examination of lung tissue revealed 13 (1%) cases with histological abnormalities that provided the cause of death when the macroscopic appearance was normal, but there was only one (0.1%) case in which the diagnosis would not have been apparent on placental examination: a case of congenital cytomegalovirus infection. There was no case in which microscopic examination of macroscopically normal liver, kidneys, adrenals, spleen, thymus, intestines, pancreas, brain or thyroid provided the cause of death. In this large series of autopsies in cases of intrauterine death, only around 1% of cases demonstrated histological abnormalities which provided the cause of death when the internal organs appeared normal macroscopically. There was no case in which routine histological examination of most tissues provided diagnostically useful information that was not apparent from other examinations, such as placental pathology. There is little benefit, purely in terms of determining cause of death, in obtaining tissue from most macroscopically normal organs for routine histological examination. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

Two cases of congenital cytomegalovirus infection

Two cases of congenital cytomegalovirus infection

Detailed in utero ultrasound description of 30 cases of congenital cytomegalovirus infection

The aim of this research was to describe precisely prenatal ultrasound (US) features in congenital cytomegalovirus (CMV) infection. We retrospectively evaluated the US descriptions of cases of congenital CMV infection between 2004 and 2013. In 69 congenital CMV infections, related US abnormalities were reported in 30 cases (43.5%). There were both extracerebral and cerebral abnormalities in 16 cases, purely abnormal brain features in ten, and purely extracerebral features in two. About 19/30 cases presented extracerebral features of 11 different sorts of abnormalities, mainly hyperechogenic bowel (ten cases) and intrauterine growth retardation (nine cases). About 24/30 cases presented cerebral features of 13 different sorts, mainly brain calcifications (12 cases) and occipital horn cavity (11 cases). The main US findings in our series are not specific to CMV infection. However, a frequent finding attracted our attention: the anechogenic cavity located on the extremity of the occipital horn, a region which contains numerous proliferating and differentiating germinal cells. By improving knowledge of US findings linked to CMV infection, US sensitivity may be improved. Understanding why CMV leads to lesions of the occipital horn may help clarify the pathophysiology of congenital infection.

Cytomegalovirus (CMV) glycoprotein H-based serological analysis in Japanese healthy pregnant women, and in neonates with congenital CMV infection and their mothers

BackgroundCongenital cytomegalovirus (CMV) infection is caused by maternal primary infection as well as CMV reinfection or reactivation during pregnancy, although differences in the clinical impact between these modes of infection remain to be clarified. ObjectivesTo investigate the latest prevalence and risk of multiple CMV infection in healthy pregnant women, as well as the types of maternal CMV infection associated with congenital CMV infection. Study designSeroprevalence against CMV and IgG subclasses were determined in 344 serum samples from healthy pregnant women in Japan. CMV genotype and serotype were also determined in 18 pairs of mothers and neonates with congenital CMV infection identified in our CMV screening program. ResultsThirty-two percent of the pregnant women were seronegative, while 66% of CMV seropositive women had IgG3 antibodies against one epitope on glycoprotein H (gH) as the major subclass, and 52% had IgG1 antibodies against one epitope on glycoprotein B (gB). Only a single genotype determined by CMV gH neutralizing epitope was found in the urine from the 18 neonates with congenital CMV infection, even though one case possessed antibodies against multiple CMV strains. In that case, the antibodies against the strain not detected in the urine from the infant disappeared within one month after birth, whereas the antibodies against the infecting CMV strain continued to be detected at 12 months after birth. ConclusionsTwo (11%) of 18 cases of congenital CMV infection occurred via maternal CMV reinfection. Maternal humoral immunity did not prevent congenital CMV infection with another gH subtype.

Infección congénita por citomegalovirus: presentación de tres casos y revisión de la literatura

La infección perinatal más frecuente es causada por citomegalovirus (CMV), en el feto y el recién nacido esta infección es la principal causa de sordera y compromiso en el desarrollo psicomotor; el tamizaje, diagnóstico y manejo no se han protocolizado en el control prenatal. El pronóstico de estos pacientes dependerá de un manejo adecuado. Se presentan tres casos con el objetivo de revisar el diagnóstico prenatal y el manejo en el neonato.Materiales y métodos: se muestran tres casos de infección congénita por citomegalovirus diagnosticados en el Hospital Universitario Hernando Moncaleano de Neiva-Huila, centro de referencia de la región suroccidental de Colombia. Se realizó una búsqueda electrónica en las bases de datos de PudMed, Embase, Medline, Lilacs, Cochrane.Resultados: se encontraron 31 artículos, dos guías basadas en evidencia, seis revisiones sistemáticas, dos consensos de la Asociación Española de Pediatría, cuatro estudios de casos y controles, cuatro estudios de cohortes, doce revisiones narrativas, un estudio analítico de decisiones y de costos.Conclusión: el tamizaje rutinario para CMV en el control prenatal no está recomendado. Se debe hacer tamizaje en mujeres gestantes de alto riesgo. El método de tamizaje son la inmunoglobulina IgM específica y el test de avidez por IgG, si esta es baja confirma infección reciente. La prueba confirmatoria es la PCR para CMV. En recién nacidos la prueba de tamizaje es la PCR y el patrón de oro es el cultivo viral. En mujeres con infección gestacional se debe aplicar inmunoglobulina específica para protección fetal.

A Rare Case of Congenital Cytomegalovirus Infection in Pregnancy

Mrs. SC, 30-years old in her third pregnancy, had two previous pregnancies 7 and 2 years ago which ended in uncomplicated term vaginal deliveries. She was booked for antenatal care at about 13 weeks. The mother’s blood group was A Rhesus positive. She had triple test for trisomy 21 and neural tube defects at 16 weeks gestation and was found to be low risk for both. At 30 weeks gestation she reported reduced fetal movements. The Cardiotocography (CTG) (Fig. 1) showed diminished variability with a few shallow decelerations suggesting fetal hypoxia. Considering the suboptimal CTG an ultrasound scan was performed which showed significant ventriculomegaly (Fig. 2), pericardial effusion, ascites, splenomegaly and oligohydramnios. The couple was counselled regarding significant risk of handicap. Since the underlying cause was uncertain at that point, she had further investigations for hydrops including maternal serology for viral screening and fetal cordocentesis which subsequently confirmed maternal and fetal Cytomegalovirus (CMV) infection (Table 1). She did not want any active intervention. A couple of days later the mother reported no fetal movements and an ultrasound scan confirmed intrauterine fetal death. A stillborn female baby (Fig. 3) weighing 1,455 g was delivered 2 days later following induction of labour. In the post-mortem report, it was commented that the lung showed numerous enlarged cells with nuclear and cytoplasmic inclusions characteristic of active CMV infection. The macroscopic feature of hepatosplenomegaly was consistent with this finding and that no other internal anatomical abnormalities were found.

Congenital Cytomegalovirus Infection: An Overview

Cytomegalovirus (CMV) remains the most common cause of congenitally-acquired infection in the United States and is a leading infectious cause of sensorineural hearing loss, cognitive delay, and permanent neurologic sequelae. Although most cases of congenital CMV infection are asymptomatic, significant morbidity and mortality exist for symptomatic infants and may also occur in asymptomatic ones. Diagnosis remains relatively straightforward, but treatment options are limited and associated with some toxicity. Efforts at prevention via vaccination, screening, and improved epidemiology deserve high priority to limit the impact of this common infection.

Infección congénita por citomegalovirus. Revisión de nuestra experiencia diagnóstica de 18 años

Infection by cytomegalovirus (CMV) is the most frequent congenital viral infection. Although it offers a wide range of manifestations, it nevertheless continues to be underdiagnosed if there are no symptoms in the newborn infant, which is what most commonly happens. A definitive retrospective diagnosis can only be reached after the first three weeks by detecting CMV DNA in blood on the filter paper used in the neonatal screening test.The article reviews our experience with congenital CMV from a diagnostic perspective and with the study of CMV DNA in the heel prick test.Of the 10,855 patients included in the neuropaediatric service database, there were 11 cases of congenital CMV. The diagnosis was only probable in four cases and it was definitive in seven of them, the diagnosis being obtained in the neonatal period in four of these patients and retrospectively in three others, by means of the heel prick test. The heel prick test was performed in 10 cases altogether, and was positive in five of them.There can be no doubt that many cases of congenital CMV infection are still not diagnosed. Retrospective study of congenital infection by CMV by detecting DNA in blood from the filter paper used in the neonatal screening test should be considered in the presence of severe symptoms and different clinical pictures such as: delayed intrauterine growth, microcephaly, neurosensory hypoacusis, chorioretinitis, mental retardation, behavioural disorders (especially autistic spectrum disorders), intracranial calcifications, encephaloclastic disorders, leukoencephalopathy, cortical dysplasia and malformations of the temporal lobe or the hippocampus. Given its availability, ready access and low cost, the benefits to be gain from continuing to use the heel prick test should be reconsidered.

Ascites consuming an exudate due to meconium peritonitis as presentation of cytomegalovirus congenital infection

UENPS.161 Ascites consuming an exudate due tomeconium peritonitis as presentation of cytomegalovirus congenital infection George Mitsiakos, Despoina Lavou⁎, Apostolos Athanasiadis, Hlias Chatziioannidis, Aggelos Dimitrakoudis, Emmanouil Roilides, Nikolaos Nikolaidis B' NICU, Aristotle University of Thessaloniki, Thessaloniki, Greece A' Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece 3rdDepartment of Paediatric, Aristotle University of Thessaloniki, Thessaloniki, Greece Background and aim Introduction: Ascites in neonates is observed in many conditions and can be biliary, urinary, chylous or caused by infection [toxoplasma, rubella, syphilis, adenovirus and extremely rarely from cytomegalovirus (CMV)]. Objective: To present a case of congenital CMV infection with ascites in utero, consuming an exudates. Materials and methods Case presentation: The neonate was born by caesarian section after a gestation of 30 weeks. Maternal history revealed an uneventful IVF pregnancy, until ultrasound scanat 17weeks showed thepresenceof fetal ascites as isolated finding and normal anatomy till delivery. Maternal serology for CMV showed positive IgG and negative IgM, prior to pregnancy, at 15th and 22nd weeks of gestation. The neonate was intubated at birth due to respiratory distress and improved rapidly with the aspiration of 150ml of peritoneal fluid, revealing the composition of an exudate. TORCH screening of the neonate showed positive IgG antibodies for CMV, increasing titres of 250 to 975 AU/ml in 15 days. Further investigations included PCR for viral DNA CMVwhich tested positive in all samples given (urine, peripheral blood, peritoneal and cerebrospinal fluid). Quantitative PCR in peripheral blood showed 103,000 copies/ml. The neonate was treated with Gancyclovir for 42 days, generally well tolerated. The neonate was systematically screened for the adverse effects of thrombocytopenia and neutropenia.

Seroprevalencia de la infección por citomegalovirus en puérperas y su impacto neonatal

Cytomegalovirus (CMV) is the most frequent etiologic agent associated with perinatal infections. The incidence of this infection is higher in developing countries. The seroprevalence of CMV infection among pregnant women and its impact on newborns have not been studied in Panama and there are a few publications on this health problem in Latin America. The purpose of this study was to determine the seroprevalence of CMV infection in puerperal women and CMV-related morbidity in the neonates of seropositive mothers. A total of 316 blood samples from puerperal women and 317 urine samples from their newborns were obtained to determine CMV IgG and the polymerase chain reaction CMV test respectively. Risk factors such as parity, socioeconomic status and educational level were analyzed. The seroprevalence of CMV was 84 % and the incidence of congenital CMV infection in the newborns of seropositive women was 0.8 %. Two cases of congenital CMV infection were diagnosed, one of which showed clinical signs at birth, but neither of the newborns showed neurological or audiological sequels in the first 11 months of life. There were no correlations between positive serology and parity, socioeconomic status or educational level in the mothers studied. Although neither of the newborns diagnosed with congenital CMV infection showed clinical signs at the time of this report, we believe that the incidence of 0.8 % found in this study should be kept in mind with a view to evaluating the possibility of including CMV diagnostic tests in neonatal screening and introducing measures to prevent seronegative mothers from becoming infected.