Congenital CMV

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

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