CMV in pregnancy - Revision history

Aidan: /* Diagnosis */

2021-11-05T12:37:40Z

Diagnosis

← Older revision		Revision as of 12:37, 5 November 2021
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	*Serology with IgM and IgG		*Serology with IgM and IgG
	**IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months		**IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months
	**IgM has false positives, including from rheumatoid factor, [[EBV]] infection, [[lupus]]		**IgM has false positives, including from [[rheumatoid factor]], [[EBV]] infection, [[lupus]]

	{\| class="wikitable"		{\| class="wikitable"

Aidan at 13:23, 20 September 2020

2020-09-20T13:23:03Z

@@ Line 123: / Line 123: @@
 *Counsel mother on risk of fetal infection and subsequent development of congenital CMV
 *If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose
 [[Category:Infectious diseases]]

Aidan: /* Epidemiology */

2020-09-20T13:06:58Z

Epidemiology

← Older revision		Revision as of 13:06, 20 September 2020
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	***'''Reinfection''': 5% risk		***'''Reinfection''': 5% risk
	***'''Reactivation''': 1% risk		***'''Reactivation''': 1% risk
			*However, due to the much higher number of non-primary infections and reactivations, 75% of congenital CMV occurs in mothers who had non-primary infection
	*Risk of transmission to fetus following primary infection increases with gestational age, but risk of neurological sequelae decreases substantially[[CiteRef::enders2011in]]		*Risk of transmission to fetus following primary infection increases with gestational age, but risk of neurological sequelae decreases substantially[[CiteRef::enders2011in]]

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	!None		!None
	\|-		\|-
	\| rowspan="3" \|Primary		\| rowspan="5" \|Primary
			\|periconception
			\|5%
			\|
			\|
			\|
			\|
			\|-
	\|first		\|first
	\|30%		\|30%
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	\|100%		\|100%
	\|0%		\|0%
			\|-
			\|overall
			\|40%
			\| colspan="2" \|13%
			\|78%
			\|
	\|-		\|-
	\|Reinfection		\|Reinfection
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	\|}		\|}

	* Overall, 20% of infected babies will have permanent neurological sequelae		*Overall, 20% of infected babies will have permanent neurological sequelae[[CiteRef::dollard2007ne]]
	** 50% of those symptomatic at birth and 15% of those asymptomatic		**50% of those symptomatic at birth and 15% of those asymptomatic

	==Diagnosis==		==Diagnosis==
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	==Management==		==Management==

			*No clear benefit to use of CMV-targetted antivirals ([[ganciclovir]] or [[valganciclovir]]), and possible risk of gonadal dysgenesis and hematologic toxicity
			*CMV hyperimmune globulin is promising but not yet in widespread use
	*Counsel mother on risk of fetal infection and subsequent development of congenital CMV		*Counsel mother on risk of fetal infection and subsequent development of congenital CMV
	*If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose		*If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose

Aidan: /* Epidemiology */

2020-09-20T01:03:07Z

Epidemiology

← Older revision		Revision as of 01:03, 20 September 2020
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	\|overall		\|overall
	\|5%		\|5%
			\| colspan="3" \|
	\|
	\|
	\|
	\|<1%		\|<1%
	\|-		\|-
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	\|overall		\|overall
	\|1%		\|1%
			\| colspan="3" \|
	\|
	\|
	\|
	\|<1%		\|<1%
	\|}		\|}

			* Overall, 20% of infected babies will have permanent neurological sequelae
			** 50% of those symptomatic at birth and 15% of those asymptomatic

	==Diagnosis==		==Diagnosis==

Aidan at 17:50, 15 August 2020

2020-08-15T17:50:02Z

← Older revision		Revision as of 17:50, 15 August 2020
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	{\| class="wikitable"		{\| class="wikitable"
			! rowspan="2" \|Maternal Serostatus
	! rowspan="2" \|Trimester		! rowspan="2" \|Trimester
	! rowspan="2" \|Transmission to Fetus		! rowspan="2" \|Transmission to Fetus
	! colspan="3" \|Severity of Neurological Disease		! colspan="3" \|Severity of Neurological Disease
			! rowspan="2" \|Overall Probability
			(of any neurological disease)
	\|-		\|-
	!Severe		!Severe
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	!None		!None
	\|-		\|-
			\| rowspan="3" \|Primary
	\|First
			\|first
	\|30%		\|30%
	\|5%		\|5%
	\|30%		\|30%
	\|65%		\|65%
			\|10%
	\|-		\|-
			\|second
	\|Second
	\|40%		\|40%
	\|0%		\|0%
	\|15%		\|15%
	\|85%		\|85%
			\|6%
	\|-		\|-
			\|third
	\|Third
	\|70%		\|70%
	\|0%		\|0%
	\|0%		\|0%
	\|100%		\|100%
			\|0%
			\|-
			\|Reinfection
			\|overall
			\|5%
			\|
			\|
			\|
			\|<1%
			\|-
			\|Reactivation
			\|overall
			\|1%
			\|
			\|
			\|
			\|<1%
	\|}		\|}

Aidan: /* Epidemiology */ added risk by trimester

2020-08-15T17:45:12Z

Epidemiology: added risk by trimester

← Older revision		Revision as of 17:45, 15 August 2020
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	== Background ==		==Background==

	* Infection with [[cytomegalovirus]] during pregnancy		*Infection with [[cytomegalovirus]] during pregnancy
	* Infection can be primary infection, non-primary reinfection with another strain, or non-primary reactivation of latent virus		*Infection can be primary infection, non-primary reinfection with another strain, or non-primary reactivation of latent virus
	* Mainly of concern because of the risk of causing [[congenital CMV]]		*Mainly of concern because of the risk of causing [[congenital CMV]]

	=== Epidemiology ===		===Epidemiology===

	* Maternal seroconversion in about 2% of pregnancies		*Maternal seroconversion in about 2% of pregnancies
	** Higher in childcare workers		**Higher in childcare workers
		⚫	*Affects about 1 in 200 live births in US
	* Risk of transmission to fetus
			*Risk of transmission to fetus is highest with maternal primary infection, and much lower for non-primary infection
⚫	** ~~About~~ 1 in 200 live births in US
	** '''Primary infection''': 30% risk of congenital CMV~~; higher risk later in pregnancy, but worse outcomes earlier~~		**'''Primary infection''': 30% risk of congenital CMV
	** Non-primary		**Non-primary:
	*** '''Reinfection''': 5% risk		***'''Reinfection''': 5% risk
	*** '''Reactivation''': 1% risk		***'''Reactivation''': 1% risk
			*Risk of transmission to fetus following primary infection increases with gestational age, but risk of neurological sequelae decreases substantially[[CiteRef::enders2011in]]

			{\| class="wikitable"
⚫	== Diagnosis ==
			! rowspan="2" \|Trimester
			! rowspan="2" \|Transmission to Fetus
			! colspan="3" \|Severity of Neurological Disease
			\|-
			!Severe
			!Mild/Transient
			!None
			\|-
			\|First
			\|30%
			\|5%
			\|30%
			\|65%
			\|-
			\|Second
			\|40%
			\|0%
			\|15%
			\|85%
			\|-
			\|Third
			\|70%
			\|0%
			\|0%
			\|100%
			\|}

		⚫	==Diagnosis==

	* Serology with IgM and IgG		*Serology with IgM and IgG
	** IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months		**IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months
	** IgM has false positives, including from rheumatoid factor, [[EBV]] infection, [[lupus]]		**IgM has false positives, including from rheumatoid factor, [[EBV]] infection, [[lupus]]

	{\| class="wikitable"		{\| class="wikitable"
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	\|}		\|}

	* Fetal infection is confirmed by amniocentesis sent for PCR		*Fetal infection is confirmed by amniocentesis sent for PCR
	** To minimized the risk of a false-negative result, it should be be done after 17 weeks gestation and at least 7 weeks after maternal infection		**To minimized the risk of a false-negative result, it should be be done after 17 weeks gestation and at least 7 weeks after maternal infection

	== Management ==		==Management==

	* Counsel mother on risk of fetal infection and subsequent development of congenital CMV		*Counsel mother on risk of fetal infection and subsequent development of congenital CMV
	* If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose		*If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose

	[[Category:Infectious diseases]]		[[Category:Infectious diseases]]

Aidan: Created page with "== Background == * Infection with cytomegalovirus during pregnancy * Infection can be primary infection, non-primary reinfection with another strain, or non-primary react..."

2020-08-14T15:32:57Z

Created page with "== Background == * Infection with cytomegalovirus during pregnancy * Infection can be primary infection, non-primary reinfection with another strain, or non-primary react..."

New page

== Background ==

* Infection with [[cytomegalovirus]] during pregnancy
* Infection can be primary infection, non-primary reinfection with another strain, or non-primary reactivation of latent virus
* Mainly of concern because of the risk of causing [[congenital CMV]]

=== Epidemiology ===

* Maternal seroconversion in about 2% of pregnancies
** Higher in childcare workers
* Risk of transmission to fetus
** About 1 in 200 live births in US
** '''Primary infection''': 30% risk of congenital CMV; higher risk later in pregnancy, but worse outcomes earlier
** Non-primary
*** '''Reinfection''': 5% risk
*** '''Reactivation''': 1% risk

== Diagnosis ==

* Serology with IgM and IgG
** IgM usually positive for 6 weeks after primary infection, but can remain positive for as long as 12 months
** IgM has false positives, including from rheumatoid factor, [[EBV]] infection, [[lupus]]

{| class="wikitable"
!IgG
!IgM
!Avidity
!Interpretation
|-
| +
|–
|N/A
|past infection, low risk for congenital infection
|-
| +
| +
|high
|past infection, low risk for congenital infection
|-
| +
| +
|low
|primary maternal infection within the past 3 months
|-
|–
|–
|N/A
|either no infection, or repeat in 4 weeks
|}

* Fetal infection is confirmed by amniocentesis sent for PCR
** To minimized the risk of a false-negative result, it should be be done after 17 weeks gestation and at least 7 weeks after maternal infection

== Management ==

* Counsel mother on risk of fetal infection and subsequent development of congenital CMV
* If they would terminate if CMV-positive due to those risks, then proceed with amniocentesis to diagnose

[[Category:Infectious diseases]]
[[Category:Obstetrical medicine]]
[[Category:Obstetrical infections]]