Congenital CMV: Difference between revisions

Revision as of 20:33, 13 July 2020

Epidemiology

Maternal seroconversion in about 2% of pregnancies
- Higher in childcare workers
Risk of transmission to fetus
- 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 Presentation

Mother may have had asymptomatic infection
At birth
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.

@@ Line 1: / Line 1: @@
-== Epidemiology ==
+==Epidemiology==
+*Maternal seroconversion in about 2% of pregnancies
-* Risk of transmission to fetus
+**Higher in childcare workers
-** '''Primary infection''': 30% risk of congenital CMV; higher risk later in pregnancy, but worse outcomes earlier
+*Risk of transmission to fetus
-** Non-primary
+**'''Primary infection''': 30% risk of congenital CMV; higher risk later in pregnancy, but worse outcomes earlier
-*** '''Reinfection''': 5% risk
+**Non-primary
-*** '''Reactivation''': 1% risk
+***'''Reinfection''': 5% risk
+***'''Reactivation''': 1% risk
-== Clinical Presentation ==
+==Clinical Presentation==
-* Mother may have had asymptomatic infection
-* At birth
-** [[Causes::Microcephaly]]
-** [[Causes::Periventricular calcifications]]
-** [[Causes::Chorioretinitis]]
-** [[Causes::Sensorineural hearing loss]]
-** [[Causes::Optic nerve atrophy]]
-** [[Causes::Hepatosplenomegaly]]
-** [[Causes::Cytopenias]]
-* Later
-** [[Causes::Cognitive deficits]] (7%)
-** [[Causes::Sensorineural hearing loss]] (20%)
+*Mother may have had asymptomatic infection
-== Diagnosis ==
+*At birth
+**[[Causes::Microcephaly]]
+**[[Causes::Periventricular calcifications]]
+**[[Causes::Chorioretinitis]]
+**[[Causes::Sensorineural hearing loss]]
+**[[Causes::Optic nerve atrophy]]
+**[[Causes::Hepatosplenomegaly]]
+**[[Causes::Cytopenias]]
+*Later
+**[[Causes::Cognitive deficits]] (7%)
+**[[Causes::Sensorineural hearing loss]] (20%)
+==Diagnosis==
-* In mom, IgM antibodies
-* In baby, urine PCR within 2 weeks of birth
+*In mom, IgM antibodies
-== Management ==
+*In baby, urine PCR within 2 weeks of birth
+==Management==
-* Treatment is indicated for symptomatic babies
-** Brain
-** Hearing
-** Eye
-* IV [[Is treated by::ganciclovir]] or PO [[Is treated by::valganciclovir]], for 6 months
-* Monitor CBC while on therapy
+*Treatment is indicated for symptomatic babies
+**Brain
+**Hearing
+**Eye
+*IV [[Is treated by::ganciclovir]] or PO [[Is treated by::valganciclovir]], for 6 months
+*Monitor CBC while on therapy
 [[Category:Pediatrics]]