Congenital CMV
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Congenital CMV
Epidemiology
- 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
- At birth
- Microcephaly
- Periventricular calcifications
- Chorioretinitis
- Sensorineural hearing loss
- Optic nerve atrophy
- Hepatosplenomegaly
- Cytopenia
- 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
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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.
