Clinical and Experimental Pediatrics

The Korean Pediatric Society (대한소아청소년과학회)
권호 표지
DOI QR코드

DOI QR Code

Congenital and perinatal cytomegalovirus infection

  • Kim, Chun Soo (Departments of Pediatrics, Keimyung University School of Medicine)
  • Published : 2010.01.15
Download PDF
⟨ Previous Next ⟩

Abstract

Cytomegalovirus (CMV) is currently the most common agent of congenital infection and the leading infectious cause of brain damage and hearing loss in children. Symptomatic congenital CMV infections usually result from maternal primary infection during early pregnancy. One half of symptomatic infants have cytomegalic inclusion disease (CID), which is characterized by involvement of multiple organs, in particular, the reticuloendothelial and central nervous system (CNS). Moreover, such involvement may or may not include ocular and auditory damage. Approximately 90% of infants with congenital infection are asymptomatic at birth. Preterm infants with perinatal CMV infection can have symptomatic diseases such as pneumonia, hepatitis, and thrombocytopenia. Microcephaly and abnormal neuroradiologic imaging are associated with a poor prognosis. Hearing loss may occur in both symptomatic and asymptomatic infants with congenital infection and may progress through childhood. Congenital infection is defined by the isolation of CMV from infants within the first 3 weeks of life. Ganciclovir therapy can be considered for infants with symptomatic congenital CMV infection involving the CNS. Pregnant women of seronegative state should be counseled on the importance of good hand washing and other control measures to prevent CMV infection. Heat treatment of infected breast milk at $72{^{\circ}C}$ for 5 seconds can eliminate CMV completely.

Keywords

References

  1. Stagno S, Britt W. Cytomegalovirus infections. In : Remington JS, Klein JO, Wilson CB, Baker CJ, editors. Infectious diseases of the fetus and newborn infant. 6th ed. Philadelphia : Saunders, 2006:739-81
  2. Stagno S. Cytomegalovirus. In : Kliegman RM, Behrman RE, Jenson HB, Stanton BF, editors. Nelson textbook of pediatrics. 18th ed. Philadelphia : Saunders, 2007:1377-9
  3. Trincado DE, Rawlinson WD. Congenital and perinatal infections with cytomegalovirus. J Paediatr Child Health 2001;37:187-92 https://doi.org/10.1046/j.1440-1754.2001.00645.x
  4. Malm G, Engman ML. Congenital cytomegalovirus infections. Semin Fetal Neonatal Med 2007;12:154-9 https://doi.org/10.1016/j.siny.2007.01.012
  5. Undin MH, Gonik B. Perinatal infections. In : Martin RJ, Fanaroff AA, Walsh MC, editors. Neonatal-perinatal medicine. 8th ed. St Louis : Mosby, 2006:840-82
  6. Volpe JJ. Neurology of the newborn. 5th ed. Philadelphia :Saunders, 2008:851-915
  7. Nassetta L, Kimberlin D, Whitley R. Treatment of congenital cytomegalovirus infection: implications for future therapeutic strategies. J Antimicrob Chemother 2009;63:862-7 https://doi.org/10.1093/jac/dkp083
  8. Isaacs D, Moxon ER. Hand book of Neonatal infection: A practical guide. 1st ed. London : WB Saunders Co, 2000; 378-88
  9. Baley JE, Toltzis P. Perinatal viral infections. In : Martin RJ, Fanaroff AA, Walsh MC, editors. Neonatal-perinatal medicine. 8th ed. St Louis : Mosby, 2006:429-53
  10. Pass RF, Fowler KB, Boppana SB, Britt WJ, Stagno S. Congenital cytomegalovirus infection following first trimester maternal infection: symptoms at birth and outcome. J Clin Virol 2006;35:216-20 https://doi.org/10.1016/j.jcv.2005.09.015
  11. Fowler KB, Stagno S, Pass RF, Britt WJ, Boll TJ, Alford CA. The outcome of congenital cytomegalovirus infection in relation to maternal antibody status. N Engl J Med 1992;326:663-7 https://doi.org/10.1056/NEJM199203053261003
  12. AAP committee on infectious diseases. cytomegalovirus infection. In: Pickering LK, Baker CJ, Kimberlin DW, Long SS, editors. Red book. 28th ed. IL:American academy of pediatrics, 2009:275-80
  13. Demmler-Harrison GJ. Cytomegalovirus. In : Feigin RD, Cherry JD, Demmler-Harrison GJ, Kaplan SL, editors. Textbook of pediatric infectious diseases. 6th ed. Philadelphia : Saunders, 2009:2022-43
  14. Kim JH, Chung EJ, Park HK, Moon SJ, Choi SM, Oh SH. Postnatal cytomegalovirus infection in an extremely premature infant transmitted via breast milk: A case report. Korean J Pediatr 2009;52:1053-8 https://doi.org/10.3345/kjp.2009.52.9.1053
  15. Stehel EK, Sánchez PJ. Cytomegalovirus Infection in the Fetus and Neonate. NeoReviews 2005;6:e38-e45 https://doi.org/10.1542/neo.6-1-e38
  16. Revello MG, Gerna G. Pathogenesis and prenatal diagnosis of human cytomegalovirus infection. J Clin Virol 2004;29:71-83 https://doi.org/10.1016/j.jcv.2003.09.012
  17. Kumar ML, Nankervis GA, Cooper AR, Gold E. Postnatally acquired cytomegalovirus infections in infants of CMV-excreting mothers. J Pediatr 1984;104:669-73 https://doi.org/10.1016/S0022-3476(84)80941-5
  18. Hamprecht K, Maschmann J, Vochem M, Dietz K, Speer CP, Jahn G. Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding. Lancet 2001:357:513-8 https://doi.org/10.1016/S0140-6736(00)04043-5
  19. Boppana SB, Fowler KB, Britt WJ, Stagno S, Pass RF. Symptomatic congenital cytomegalovirus infection in infants born to mothers with preexisting immunity to cytomegalovirus. Pediatrics 1999;104:55-60 https://doi.org/10.1542/peds.104.1.55
  20. Boppana SB, Rivera LB, Fowler KB, Mach M, Britt WJ. Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity. N Engl J Med 2001;344:1366-71 https://doi.org/10.1056/NEJM200105033441804
  21. Hamprecht K, Maschmann J, Jahn G, Poets CF, Goelz R. Cytomegalovirus transmission to preterm infants during lactation. J Clin Virol 2008;41:198-205 https://doi.org/10.1016/j.jcv.2007.12.005
  22. Yeager AS, Grumet FC, Hafleigh EB, Arvin AM, Bradley JS, Prober CG. Prevention of transfusion-acquired cytomegalovirus infections in newborn infants. J Pediatr 1981;98:281-7 https://doi.org/10.1016/S0022-3476(81)80662-2
  23. Sawyer MH, Edwards DK, Spector SA. Cytomegalovirus infection and bronchopulmonary dysplasia in premature infants. Am J Dis Child 1987;141:303-5
  24. Fowler KB, Boppana SB. Congenital cytomegalovirus (CMV) infection and hearing deficit. J Clin Virol 2006;35:226-31 https://doi.org/10.1016/j.jcv.2005.09.016
  25. Fowler KB, McCollister FP, Dahle AJ, Boppana S, Britt WJ, Pass RF. Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection. J Pediatr 1997;130:624-30 https://doi.org/10.1016/S0022-3476(97)70248-8
  26. Cheeran MC, Lokensgard JR, Schleiss MR. Neuropathogenesis of congenital cytomegalovirus infection: disease mechanisms and prospects for intervention. Clin Microbiol Rev 2009;22:99-126 https://doi.org/10.1128/CMR.00023-08
  27. Demmler GJ, Buffone GJ, Schimbor CM, May RA. Detection of cytomegalovirus in urine from newborns by using polymerase chain reaction DNA amplification. J Infect Dis 1988;158:1177-84
  28. Kim DW, Kwack H, Jang SH, Kang IS, Lee HJ, Choi JW, et al. Cytomegalovirus infection in children: The significance of CMV specific IgM antibody test and virus isolation in the urine. J Korean Pediatr Soc 1992;35:890-901
  29. Revello MG, Zavattoni M, Baldanti F, Sarasini A, Paolucci S, Gerna G. Diagnostic and prognostic value of human cytomegalovirus load and IgM antibody in blood of congenitally infected newborns. J Clin Virol 1999;14:57-66 https://doi.org/10.1016/S1386-6532(99)00016-5
  30. Kimberlin DW, Lin CY, Sanchez PJ, Demmler GJ, Dankner W, Shelton M, et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr 2003;143:16-25 https://doi.org/10.1016/S0022-3476(03)00192-6
  31. Kimberlin DW, Acosta EP, Sánchez PJ, Sood S, Agrawal V, Homans J, et al. Pharmacokinetic and pharmacodynamic assessment of oral valganciclovir in the treatment of symptomatic congenital cytomegalovirus disease. J Infect Dis 2008;197:836-45 https://doi.org/10.1086/528376
  32. Schleiss MR. Congenital Cytomegalovirus Infection: Update on Management Strategies. Curr Treat Options Neurol 2008;10:186-192 https://doi.org/10.1007/s11940-008-0020-2
  33. Noyola DE, Demmler GJ, Nelson CT, Griesser C, Williamson WD, Atkins JT, et al. Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 2001;138:325-31 https://doi.org/10.1067/mpd.2001.112061
  34. Ramsay ME, Miller E, Peckham CS. Outcome of confirmed symptomatic congenital cytomegalovirus infection. Arch Dis Child 1991;66:1068-9 https://doi.org/10.1136/adc.66.9.1068
  35. Rivera LB, Boppana SB, Fowler KB, Britt WJ, Stagno S, Pass RF. Predictors of hearing loss in children with symptomatic congenital cytomegalovirus infection. Pediatrics 2002;110:762-7 https://doi.org/10.1542/peds.110.4.762
  36. Lee KY. Seroepidemiology of cytomegalovirus in Taejon, Korea. J Korean Pediatr Soc 1998;41:754-9
  37. Adler SP, Finney JW, Manganello AM, Best AM. Prevention of child-to-mother transmission of cytomegalovirus among pregnant women. J Pediatr 2004;145:485-91 https://doi.org/10.1016/j.jpeds.2004.05.041
  38. Fowler KB, Dahle AJ, Boppana SB, Pass RF. Newborn hearing screening: will children with hearing loss caused by congenital cytomegalovirus infection be missed? J Pediatr 1999;135:60-4 https://doi.org/10.1016/S0022-3476(99)70328-8
  39. Demmler GJ. Screening for congenital cytomegalovirus infection: a tapestry of controversies. J Pediatr 2005;146:162-4 https://doi.org/10.1016/j.jpeds.2004.11.020
  40. Yasuda A, Kimura H, Hayakawa M, Ohshiro M, Kato Y, Matsuura O, et al. Evaluation of cytomegalovirus infections transmitted via breast milk in preterm infants with a real-time polymerase chain reaction assay. Pediatrics 2003;111:1333-6 https://doi.org/10.1542/peds.111.6.1333
  41. Jim WT, Shu CH, Chiu NC, Kao HA, Hung HY, Chang JH, et al. Transmission of cytomegalovirus from mothers to preterm infants by breast milk. Pediatr Infect Dis J 2004;23:848-51 https://doi.org/10.1097/01.inf.0000137571.35541.55

Cited by

  1. The effect of prenatal highly active antiretroviral therapy on the transmission of congenital and perinatal/early postnatal cytomegalovirus among HIV-infected and HIV-exposed infants. vol.55, pp.6, 2010, https://doi.org/10.1093/cid/cis535
  2. Cytomegalovirus Infection in Infantile Hepatitis vol.15, pp.2, 2010, https://doi.org/10.5223/kjpgn.2012.15.2.91
  3. Intractable diarrhoea caused by cytomegalovirus enterocolitis in an immunocompetent term neonate vol.59, pp.6, 2013, https://doi.org/10.1093/tropej/fmt052
  4. Host genetics and susceptibility to congenital and childhood cytomegalovirus infection: a systematic review vol.57, pp.4, 2010, https://doi.org/10.3325/cmj.2016.57.321
  5. 후기 미숙아에서 생후 2개월에 진단된 중증 거대 세포바이러스 감염 vol.23, pp.2, 2010, https://doi.org/10.14776/piv.2016.23.2.137
  6. Hearing impairment in children with congenital cytomegalovirus (CMV) infection based on distortion product otoacoustic emissions (DPOAE) and brain evoked response audiometry stimulus click (BERA Click vol.884, pp.None, 2010, https://doi.org/10.1088/1742-6596/884/1/012081
  7. Cyclophilin A as a target in the treatment of cytomegalovirus infections vol.26, pp.None, 2018, https://doi.org/10.1177/2040206618811413
  8. Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period vol.53, pp.2, 2010, https://doi.org/10.5045/br.2018.53.2.110
  9. Clinical Courses and Outcome of Newly Diagnosed Immune Thrombocytopenia in Infants vol.25, pp.2, 2010, https://doi.org/10.15264/cpho.2018.25.2.97
  10. Changes in Cytomegalovirus Seroprevalence in Korea for 21 Years: a Single Center Study vol.25, pp.3, 2010, https://doi.org/10.14776/piv.2018.25.e8
  11. Case of cytomegalovirus pneumonia presented as pneumothorax in 4-month-old healthy infant vol.9, pp.2, 2010, https://doi.org/10.4168/aard.2021.9.2.104