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==Risk Factors==
==Risk Factors==
==Screening==
==Screening==
There are no screening recommendations for congenital CMV. <ref name="USPSTF"> U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=congenital+cytomegalovirus. Accessed on Feb 6, 2016 </ref>
There are no screening recommendations for congenital CMV.<ref name="USPSTF"> U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=congenital+cytomegalovirus. Accessed on Feb 6, 2016 </ref>


==Natural History, Complications and Prognosis==
==Natural History, Complications and Prognosis==

Revision as of 21:49, 6 February 2017

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Dima Nimri, M.D. [2]

Overview

Historical Perspective

Classification

Pathophysiology

Causes

The cause of congenital CMV is cytomegalovirus. For more information about the causative agent, click here.

Differentiating Congenital CMV from Other Congenital Infections

The most important congenital infections, which can be transmitted vertically from mother to fetus are the TORCH infections. These infections have overlapping features and hence, must be differentiated from congenital CMV infection:[1]

Congenital Infection Cardiac Findings Skin Findings Ocular Findings Hepatosplenomegaly Hydrocephaly Microcephaly Intracranial Calcifications Hearing deficits
Cytomegalovirus (CMV) ✔ ✔ — ✔ Periventricular calcifications ✔
Toxoplasmosis — ✔ ✔ ✔ Diffuse intracranial calcifications —
Treponema pallidum — ✔ — — — —
Rubella ✔ ✔ ✔ — ✔
Herpes simplex virus (HSV) ✔ ✔ ✔ — ✔
Parvovirus B19 ✔ — — — —

Epidemiology and Demographics

Epidemiology

Incidence

Demographics

Risk Factors

Screening

There are no screening recommendations for congenital CMV.[2]

Natural History, Complications and Prognosis

Natural History

Complications

Common Complications

Common complications in infants with congenital CMV infection include:[3]

Less Common Complications

Less common complications of congenital CMV infection include:[3]

Prognosis

History and Symptoms

Symptoms in the Mother

Mothers with primary or recurrent CMV infection are usually asymptomatic, although those with primary infection are more likely to be symptomatic than those with a recurrent infection. Signs and symptoms of CMV infection in pregnant women include:[4][5][6][7]

Symptoms in the Neonate

Infants with congenital CMV can be asymptomatic at birth. However, one or more of these symptoms may be present:[4][8][9][10][11][12][13][14][15]

Physical Examination

Physical examination findings in infants with congenital CMV infection include:[4][8][9][10][11][12][13][14][15]

Organ System Findings Suggestive of
General Appearance Small for gestational age (SGA)
Skin Skin lesions of several sizes (petechiae and purpura) Thrombocytopenic purpura
Yellow discoloration of the skin and mucous membranes Obstructive jaundice
Eyes Small eyes Microphthalmia
Clouding of the corneas Cataracts
Chorioretinitis
Yellow discoloration of the sclera Obstructive jaundice
Ears Sensorineural hearing loss
Heart Myocarditis
Abdomen Hepatosplenomegaly (HSM)
Neurological Small head circumference Microcephaly
Seizures

Laboratory Investigations

Laboratory findings in infants with congenital CMV infection include:[8][15][16][10][17][3]

Electrocardiogram

Chest X-Ray

CT

The following CT scan findings may be seen in patients with congenital CMV:[3][18][19][20]

CT shows multiple intraparenchymal calcifications with enlarged ventricles and increased extracranial soft tissue in the left parieto-occipital region

MRI

MRI findings are similar to those seen on CT scan.[3][18][19][20][21]

Echocardiography

Ultrasound

Prenatal Ultrasound

Various findings may be seen during a routine prenatal ultrasound in a suspected case of congenital CMV infection. However, none of these findings are specific.[4][22][23][24][25][26][27][28][29][30][31][32][33][34][35]

Anomaly Possible Findings
Amniotic Fluid
Placenta
General Fetal
Brain
Heart
Gastrointestinal/ Abdominal

Other Diagnostic Studies

There are no other diagnostic studies associated with congenital CMV infection.

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

References

  1. ↑ Neu N, Duchon J, Zachariah P (2015). "TORCH infections". Clin Perinatol. 42 (1): 77–103, viii. doi:10.1016/j.clp.2014.11.001. PMID 25677998.
  2. ↑ U.S. Preventive Services Task Force https://www.uspreventiveservicestaskforce.org/BrowseRec/Search?s=congenital+cytomegalovirus. Accessed on Feb 6, 2016
  3. ↑ 3.0 3.1 3.2 3.3 3.4 Boppana SB, Fowler KB, Vaid Y, Hedlund G, Stagno S, Britt WJ, Pass RF (1997). "Neuroradiographic findings in the newborn period and long-term outcome in children with symptomatic congenital cytomegalovirus infection". Pediatrics. 99 (3): 409–14. PMID 9041297.
  4. ↑ 4.0 4.1 4.2 4.3 Naing ZW, Scott GM, Shand A, Hamilton ST, van Zuylen WJ, Basha J, Hall B, Craig ME, Rawlinson WD (2016). "Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention". Aust N Z J Obstet Gynaecol. 56 (1): 9–18. doi:10.1111/ajo.12408. PMID 26391432.
  5. ↑ Stagno S, Pass RF, Cloud G, Britt WJ, Henderson RE, Walton PD, Veren DA, Page F, Alford CA (1986). "Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome". JAMA. 256 (14): 1904–8. PMID 3020264.
  6. ↑ Griffiths PD, Baboonian C (1984). "A prospective study of primary cytomegalovirus infection during pregnancy: final report". Br J Obstet Gynaecol. 91 (4): 307–15. PMID 6324849.
  7. ↑ Nigro G, Anceschi MM, Cosmi EV (2003). "Clinical manifestations and abnormal laboratory findings in pregnant women with primary cytomegalovirus infection". BJOG. 110 (6): 572–7. PMID 12798474.
  8. ↑ 8.0 8.1 8.2 Istas AS, Demmler GJ, Dobbins JG, Stewart JA (1995). "Surveillance for congenital cytomegalovirus disease: a report from the National Congenital Cytomegalovirus Disease Registry". Clin. Infect. Dis. 20 (3): 665–70. PMID 7756493.
  9. ↑ 9.0 9.1 Boppana SB, Ross SA, Fowler KB (2013). "Congenital cytomegalovirus infection: clinical outcome". Clin. Infect. Dis. 57 Suppl 4: S178–81. doi:10.1093/cid/cit629. PMC 4471438. PMID 24257422.
  10. ↑ 10.0 10.1 10.2 Boppana SB, Pass RF, Britt WJ, Stagno S, Alford CA (1992). "Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality". Pediatr. Infect. Dis. J. 11 (2): 93–9. PMID 1311066.
  11. ↑ 11.0 11.1 McMullan BJ, Palasanthiran P, Jones CA, Hall BM, Robertson PW, Howard J, Rawlinson WD (2011). "Congenital cytomegalovirus--time to diagnosis, management and clinical sequelae in Australia: opportunities for earlier identification". Med. J. Aust. 194 (12): 625–9. PMID 21692718.
  12. ↑ 12.0 12.1 Boppana SB, Fowler KB, Britt WJ, Stagno S, Pass RF (1999). "Symptomatic congenital cytomegalovirus infection in infants born to mothers with preexisting immunity to cytomegalovirus". Pediatrics. 104 (1 Pt 1): 55–60. PMID 10390260.
  13. ↑ 13.0 13.1 Morita M, Morishima T, Yamazaki T, Chiba S, Kawana T (1998). "Clinical survey of congenital cytomegalovirus infection in Japan". Acta Paediatr Jpn. 40 (5): 432–6. PMID 9821701.
  14. ↑ 14.0 14.1 WELLER TH, HANSHAW JB (1962). "Virologic and clinical observations on cytomegalic inclusion disease". N. Engl. J. Med. 266: 1233–44. doi:10.1056/NEJM196206142662401. PMID 14040222.
  15. ↑ 15.0 15.1 15.2 Kylat RI, Kelly EN, Ford-Jones EL (2006). "Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection". Eur. J. Pediatr. 165 (11): 773–8. doi:10.1007/s00431-006-0172-6. PMID 16835757.
  16. ↑ Dreher AM, Arora N, Fowler KB, Novak Z, Britt WJ, Boppana SB, Ross SA (2014). "Spectrum of disease and outcome in children with symptomatic congenital cytomegalovirus infection". J. Pediatr. 164 (4): 855–9. doi:10.1016/j.jpeds.2013.12.007. PMC 3982912. PMID 24433826.
  17. ↑ Rivera LB, Boppana SB, Fowler KB, Britt WJ, Stagno S, Pass RF (2002). "Predictors of hearing loss in children with symptomatic congenital cytomegalovirus infection". Pediatrics. 110 (4): 762–7. PMID 12359792.
  18. ↑ 18.0 18.1 Noyola DE, Demmler GJ, Nelson CT, Griesser C, Williamson WD, Atkins JT, Rozelle J, Turcich M, Llorente AM, Sellers-Vinson S, Reynolds A, Bale JF, Gerson P, Yow MD (2001). "Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection". J. Pediatr. 138 (3): 325–31. doi:10.1067/mpd.2001.112061. PMID 11241037.
  19. ↑ 19.0 19.1 Fink KR, Thapa MM, Ishak GE, Pruthi S (2010). "Neuroimaging of pediatric central nervous system cytomegalovirus infection". Radiographics. 30 (7): 1779–96. doi:10.1148/rg.307105043. PMID 21057120.
  20. ↑ 20.0 20.1 Alarcon A, Martinez-Biarge M, Cabañas F, Hernanz A, Quero J, Garcia-Alix A (2013). "Clinical, biochemical, and neuroimaging findings predict long-term neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection". J. Pediatr. 163 (3): 828–34.e1. doi:10.1016/j.jpeds.2013.03.014. PMID 23587436.
  21. ↑ Capretti MG, Lanari M, Tani G, Ancora G, Sciutti R, Marsico C, Lazzarotto T, Gabrielli L, Guerra B, Corvaglia L, Faldella G (2014). "Role of cerebral ultrasound and magnetic resonance imaging in newborns with congenital cytomegalovirus infection". Brain Dev. 36 (3): 203–11. doi:10.1016/j.braindev.2013.04.001. PMID 23647916.
  22. ↑ Enders G, Bäder U, Lindemann L, Schalasta G, Daiminger A (2001). "Prenatal diagnosis of congenital cytomegalovirus infection in 189 pregnancies with known outcome". Prenat. Diagn. 21 (5): 362–77. doi:10.1002/pd.59. PMID 11360277.
  23. ↑ Twickler DM, Perlman J, Maberry MC (1993). "Congenital cytomegalovirus infection presenting as cerebral ventriculomegaly on antenatal sonography". Am J Perinatol. 10 (5): 404–6. doi:10.1055/s-2007-994773. PMID 8240605.
  24. ↑ Abdel-Fattah SA, Bhat A, Illanes S, Bartha JL, Carrington D (2005). "TORCH test for fetal medicine indications: only CMV is necessary in the United Kingdom". Prenat. Diagn. 25 (11): 1028–31. doi:10.1002/pd.1242. PMID 16231309.
  25. ↑ Guerra B, Simonazzi G, Puccetti C, Lanari M, Farina A, Lazzarotto T, Rizzo N (2008). "Ultrasound prediction of symptomatic congenital cytomegalovirus infection". Am. J. Obstet. Gynecol. 198 (4): 380.e1–7. doi:10.1016/j.ajog.2007.09.052. PMID 18191802.
  26. ↑ Benoist G, Salomon LJ, Jacquemard F, Daffos F, Ville Y (2008). "The prognostic value of ultrasound abnormalities and biological parameters in blood of fetuses infected with cytomegalovirus". BJOG. 115 (7): 823–9. doi:10.1111/j.1471-0528.2008.01714.x. PMID 18485159.
  27. ↑ Picone O, Teissier N, Cordier AG, Vauloup-Fellous C, Adle-Biassette H, Martinovic J, Senat MV, Ayoubi JM, Benachi A (2014). "Detailed in utero ultrasound description of 30 cases of congenital cytomegalovirus infection". Prenat. Diagn. 34 (6): 518–24. doi:10.1002/pd.4340. PMID 24532345.
  28. ↑ Azam AZ, Vial Y, Fawer CL, Zufferey J, Hohlfeld P (2001). "Prenatal diagnosis of congenital cytomegalovirus infection". Obstet Gynecol. 97 (3): 443–8. PMID 11239654.
  29. ↑ Liesnard C, Donner C, Brancart F, Gosselin F, Delforge ML, Rodesch F (2000). "Prenatal diagnosis of congenital cytomegalovirus infection: prospective study of 237 pregnancies at risk". Obstet Gynecol. 95 (6 Pt 1): 881–8. PMID 10831985.
  30. ↑ La Torre R, Nigro G, Mazzocco M, Best AM, Adler SP (2006). "Placental enlargement in women with primary maternal cytomegalovirus infection is associated with fetal and neonatal disease". Clin. Infect. Dis. 43 (8): 994–1000. doi:10.1086/507634. PMID 16983610.
  31. ↑ Simonazzi G, Guerra B, Bonasoni P, Pilu G, Lazzarotto T, Santini D, Rizzo N (2010). "Fetal cerebral periventricular halo at midgestation: an ultrasound finding suggestive of fetal cytomegalovirus infection". Am. J. Obstet. Gynecol. 202 (6): 599.e1–5. doi:10.1016/j.ajog.2009.12.021. PMID 20227051.
  32. ↑ Malinger G, Lev D, Zahalka N, Ben Aroia Z, Watemberg N, Kidron D, Sira LB, Lerman-Sagie T (2003). "Fetal cytomegalovirus infection of the brain: the spectrum of sonographic findings". AJNR Am J Neuroradiol. 24 (1): 28–32. PMID 12533323.
  33. ↑ Sampath V, Narendran V, Donovan EF, Stanek J, Schleiss MR (2005). "Nonimmune hydrops fetalis and fulminant fatal disease due to congenital cytomegalovirus infection in a premature infant". J Perinatol. 25 (9): 608–11. doi:10.1038/sj.jp.7211357. PMID 16123790.
  34. ↑ Dogan Y, Yuksel A, Kalelioglu IH, Has R, Tatli B, Yildirim A (2011). "Intracranial ultrasound abnormalities and fetal cytomegalovirus infection: report of 8 cases and review of the literature". Fetal. Diagn. Ther. 30 (2): 141–9. doi:10.1159/000330636. PMID 21952353.
  35. ↑ Pereira L, Petitt M, Fong A, Tsuge M, Tabata T, Fang-Hoover J, Maidji E, Zydek M, Zhou Y, Inoue N, Loghavi S, Pepkowitz S, Kauvar LM, Ogunyemi D (2014). "Intrauterine growth restriction caused by underlying congenital cytomegalovirus infection". J. Infect. Dis. 209 (10): 1573–84. doi:10.1093/infdis/jiu019. PMC 3997585. PMID 24403553.

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