What Is Congenital CMV?

Cytomegalovirus is the most common pathogen that causes congenital fatal infections. Sequelae of congenital infections include significant cognitive dysfunction, psychomotor disorders, and deafness. It is the main cause of neurological injuries in children, including hearing impairment and neurodevelopmental abnormalities (NDI). As a member of the herpes virus family, cytomegalovirus is ubiquitous. The prevalence of infection in school-age children in developing countries exceeds 90%. The infection rate of women of reproductive age in European and American countries is about 50% to 85%. The seropositive rate of cytomegalovirus in children in China is 83% to 87%, and it is about 95% in adults. Congenital cytomegalovirus infection is mainly through vertical transmission such as placenta, cervical secretions and blood during childbirth, and breastfeeding after birth. Cytomegalovirus can also be infected through blood transfusion.

Basic Information

English name

cytomegalovirus infection

Visiting department

Pediatrics

Common causes

Cytomegalovirus infection

Common symptoms

Intrauterine growth restriction, hydrocephalus, extensive bleeding points, purpura, microcephaly, periventricular calcification, chorioretinitis, epilepsy, etc.

Contagious

Have

way for spreading

Placenta, blood, breastfeeding, etc.

Causes of congenital cytomegalovirus infection

Cytomegalovirus is the most common pathogen that causes congenital fatal infections. Congenital cytomegalovirus infection is mainly through vertical transmission such as placenta, cervical secretions and blood during childbirth, and breastfeeding after birth. Cytomegalovirus can also be infected through blood transfusion.

Clinical manifestations of congenital cytomegalovirus infection

Most congenital infections have no clinical symptoms, but 10% to 15% are manifested as intrauterine growth restriction, hydrocephalus, extensive bleeding points, purpura, microcephaly, periventricular calcification, chorioretinitis, epilepsy, pneumonia, Bone abnormalities, thrombocytopenia, neutropenia, and hepatosplenomegaly were accompanied by an increase in direct bilirubin and transaminase. Most infected infants have neurological sequelae after birth, including progressive sensorineural hearing loss (SNHL) and neurodevelopmental dysfunction. Children with symptomatic congenital cytomegalovirus infection are associated with a higher risk of congenital malformations, such as inguinal hernia and horseshoe foot. It has been reported that symptomatic congenital human cytomegalovirus (HCMV) infections often die due to decompensated liver function, bleeding, disseminated intravascular coagulation (DIC), or secondary bacterial infections, with a mortality rate of 5% to 10%. . Low birth weight infants (<1500g) and preterm infants (<32 weeks) with congenital HCMV infection can develop worsening respiratory symptoms, neutropenia, or sepsis in the early stages of onset.

Congenital cytomegalovirus infection test

The gold standard for the diagnosis of congenital cytomegalovirus infection is the isolation of cytomegalovirus in the urine and saliva of children within 2 weeks after birth. In addition, detection of cytomegalovirus DNA and cytomegalovirus antigen (PP ₆₅ ) in urine, blood, saliva, and cerebrospinal fluid samples is also a rapid method for the diagnosis of congenital cytomegalovirus infection. Detection of cytomegalovirus-immunoglobulin M (IgM) in serum 2 to 3 weeks after birth also indicates congenital cytomegalovirus infection.

Diagnosis of congenital cytomegalovirus infection

For suspected or confirmed congenital cytomegalovirus infection, craniocerebral ultrasound, CT, and magnetic resonance (MRI) are used to further support the diagnosis; in addition, hearing assessment, brainstem auditory evoked potentials, and visual assessment are also return visits to verify congenital giant cells Important means of virus infection.

Differential diagnosis of congenital cytomegalovirus infection

It is mainly distinguished from other congenital viral infectious diseases, such as petechiae, skeletal defects, and sensorineural hearing loss (SNHL) caused by rubella virus infection; fetal brain damage and long-term sequelae of congenital enterovirus infection; neonatal simple Herpes virus infection develops convulsions; parvovirus B ₁₉ infection can develop hepatomegaly and anemia. Be sure to check for other infectious diseases when corresponding clinical symptoms appear.

Treatment of congenital cytomegalovirus infection

If cytomegalovirus infection is not accompanied by organ damage, in general, no special treatment is needed, but it should be monitored regularly. Ganciclovir is the first FDA-approved drug to treat severe congenital cytomegalovirus infections. Ganciclovir antiviral treatment guidelines include:

1. There are obvious diseases related to cytomegalovirus infection, such as cytomegalovirus hepatitis, interstitial pneumonia, encephalitis and retinochoroiditis, especially children with AIDS.

2. Prophylactic medication after transplantation.

3. Children with congenital cytomegalovirus infection with central nervous system damage (such as sensorineural hearing loss) to prevent hearing damage or deterioration. Children with congenital cytomegalovirus infection with central nervous system symptoms are advised to receive intravenous ganciclovir for 6 weeks within the first month of life. The most common adverse reactions were myelosuppression (two-thirds of the children showed neutropenia), thrombocytopenia, anemia, and liver and kidney toxicity, which were generally reduced or recovered after withdrawal.

Prevention of congenital cytomegalovirus infection

Vaccines are the most promising solution to congenital cytomegalovirus infections. Effective vaccines can prevent neurological sequelae and other disabilities, benefit children for life, and save social medical costs. Clinical trials are currently underway, so pregnant women should minimize the risk of exposure to congenital cytomegalovirus. For milk infected with congenital cytomegalovirus, it is recommended to freeze it in a refrigerator at -20 degrees Celsius for more than 24 hours, which can significantly reduce the infectivity of congenital cytomegalovirus, and then pasteurize it at 62.5 degrees Celsius for about 30 seconds. Can eliminate virus infectivity.