Congenital CMV: Difference between revisions
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***'''Reinfection''': 5% risk |
***'''Reinfection''': 5% risk |
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***'''Reactivation''': 1% risk |
***'''Reactivation''': 1% risk |
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*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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{| class="wikitable" |
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! rowspan="2" |Maternal Serostatus |
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! rowspan="2" |Trimester |
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! rowspan="2" |Transmission to Fetus |
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! colspan="3" |Severity of Neurological Disease |
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! rowspan="2" |Overall Probability |
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(of any neurological disease) |
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|- |
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!Severe |
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!Mild/Transient |
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!None |
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|- |
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| rowspan="3" |Primary |
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|first |
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|30% |
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|5% |
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|30% |
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|65% |
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|10% |
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|- |
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|second |
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|40% |
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|0% |
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|15% |
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|85% |
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|6% |
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|- |
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|third |
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|70% |
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|0% |
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|0% |
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|100% |
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|0% |
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|- |
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|Reinfection |
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|overall |
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|5% |
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| colspan="3" | |
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|<1% |
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|- |
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|Reactivation |
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|overall |
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|1% |
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| colspan="3" | |
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|<1% |
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|} |
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* Overall, 20% of infected babies will have permanent neurological sequelae |
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** 50% of those symptomatic at birth and 15% of those asymptomatic |
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==Clinical Manifestations== |
==Clinical Manifestations== |
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Revision as of 01:02, 20 September 2020
Background
- Infection with cytomegalovirus acquired in utero
- See also CMV in pregnancy
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
- Risk of transmission to fetus following primary infection increases with gestational age, but risk of neurological sequelae decreases substantially1
| Maternal Serostatus | Trimester | Transmission to Fetus | Severity of Neurological Disease | Overall Probability
(of any neurological disease) | ||
|---|---|---|---|---|---|---|
| Severe | Mild/Transient | None | ||||
| Primary | first | 30% | 5% | 30% | 65% | 10% |
| second | 40% | 0% | 15% | 85% | 6% | |
| third | 70% | 0% | 0% | 100% | 0% | |
| Reinfection | overall | 5% | <1% | |||
| Reactivation | overall | 1% | <1% | |||
- Overall, 20% of infected babies will have permanent neurological sequelae
- 50% of those symptomatic at birth and 15% of those asymptomatic
Clinical Manifestations
- Mother may have had asymptomatic infection
- At birth (10%)
- Microcephaly (35-50%)
- Periventricular calcifications
- Seizure (5-10%)
- Chorioretinitis (10-15%)
- Sensorineural hearing loss (35%)
- Optic nerve atrophy
- Petechiae (50-75%)
- Neonatal jaundice (40-70%)
- Hepatosplenomegaly (40-60%)
- Small size for gestational age (40-50%)
- Lethargy and hypotonia (30%)
- Poor suck (20%)
- Cytopenias
- Hemolytic anemia (5-10%)
- Pneumonia (5-10%)
- Later
- Cognitive deficits (7%)
- Sensorineural hearing loss (20%)
Diagnosis
- In mom, IgM antibodies
- In baby, urine PCR within 2 weeks of birth
Management
- Treatment is indicated for symptomatic babies
- Brain
- Hearing
- Eye
- IV ganciclovir or PO valganciclovir, for 6 months
- Monitor CBC while on therapy
References
- ^ Gisela Enders, Anja Daiminger, Ursula Bäder, Simone Exler, Martin Enders. Intrauterine transmission and clinical outcome of 248 pregnancies with primary cytomegalovirus infection in relation to gestational age. Journal of Clinical Virology. 2011;52(3):244-246. doi:10.1016/j.jcv.2011.07.005.
- ^ William D Rawlinson, Suresh B Boppana, Karen B Fowler, David W Kimberlin, Tiziana Lazzarotto, Sophie Alain, Kate Daly, Sara Doutré, Laura Gibson, Michelle L Giles, Janelle Greenlee, Stuart T Hamilton, Gail J Harrison, Lisa Hui, Cheryl A Jones, Pamela Palasanthiran, Mark R Schleiss, Antonia W Shand, Wendy J van Zuylen. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. The Lancet Infectious Diseases. 2017;17(6):e177-e188. doi:10.1016/s1473-3099(17)30143-3.
