Congenital CMV
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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
Risk Factors
Screening
Natural History, Complications and Prognosis
History and Symptoms
Symptoms in the Mother
Symptoms in the Neonate
- Small size for gestational age
- Small head size
- Inattention to sounds, which may be suggestive of deafness
- Cloudiness of the corneas
- Skin rash at birth
- Yellow discoloration of skin and eyes
- Lethargy
- Poor sucking when feeding
- Floppiness of the baby and low muscle tone
Physical Examination
Laboratory Investigations
Electrocardiogram
Chest X-Ray
CT
MRI
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.[2][6][7][8][9][10][11][12][13][14][15][16][17][18][19]
| Anomaly | Possible Findings |
|---|---|
| Amniotic Fluid | |
| Placenta |
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| General Fetal |
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| Brain |
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| Heart | |
| Gastrointestinal/ Abdominal |
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Other Diagnostic Studies
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
References
- ↑ 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.
- ↑ 2.0 2.1 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.