Congenital cytomegalovirus cmv infection is common worldwide. Potential therapeutic approaches against brain diseases. Cytomegalovirus cmv is the most frequent cause of congenital infection worldwide, with an estimated incidence in developed countries of 0. Congenital cytomegalovirus cmv infection is the most common cause of intrauterine infection. Infants congenitally infected with cmv may benefit from antiviral therapy, especially if. Hearing loss in children with asymptomatic congenital. Prevention and treatment of cancerrelated infections. Cytomegalovirus cmv is a common virus in the herpesvirus family. Human cytomegalovirus cmv is 1 of 8 human herpesviruses. However, two groups of people are at high risk of neurological or other severe symptoms that may lead to longterm effects. A pregnant woman can pass cmv to her fetus following primary infection, reinfection with a different cmv strain, or reactivation of a previous infection.
Most infants will have no permanent health consequences, but a small. Cytomegalovirus disease can be prevented by prophylaxis the administration of antiviral drugs to all or to a subgroup of patients who are at higher risk of viral. Testing should be done within two to three weeks of birth. It affects the central nervous system and causes microcephaly, hydrocephalus, mental retardation, hearing disorder, chorioretinitis and rarely finger anomalies. Delayedonset and progression of snhl among children with asymptomatic congenital cytomegalovirus infection continued to occur throughout adolescence. Fever, dry cough, and shortness of breath, are the most common symptoms. Some babies with congenital cmv infection show signs. Cmv serology in the newborn is a poor way of identifying congenital cmv infection. Congenital and perinatal cytomegalovirus infection cmv. Lower socioeconomic groups tend to have a higher prevalence.
Vertical transmission occurs in around 30% of cases, but the fetus is not always affected. Babies born with congenital cytomegalovirus cmv cdc. People with weakened immunise systems and babies that are infected before birth can experience a more severe illness. Cmv, neurologic answers are found in the johns hopkins hiv guide powered by unbound medicine. Most people dont know they have cmv because it rarely causes problems in healthy people. Immunity induced by primary human cytomegalovirus infection protects against secondary infection among women of childbearing age. Overall, 2% of casepatients developed snhl that was severe. Examination reveals crackles in the lungs and low oxygenation. Cytomegalovirus cmv is a common virus that is usually harmless. Cytomegalovirus cmv transmission, treatment, prognosis. Cytomegalovirus cmv is a common opportunistic infection among hivinfected individuals, a major source of serious complications among organtransplant recipients, and a leading cause of hearing loss, vision loss, and mental retardation among congenitally infected children. Ten defining the standard of care hsv cmv 1970 1980 1990 2000 2010 vidarabine rx of hse vidarabine rx of neonatal hsv vidarabine rx of chickenpox acv rx of hse acv rx of neonatal hsv pcr for hsv cns disease. Cmv is a member of the virus family herpesviridae and is the most common intrauterine infection. Most people come into contact with cmv in their lifetime.
In susceptible people, such as those with suppressed immunity or unborn babies, cmv can be a dangerous infection. Treatment guideline for infants with congenital cmv disease ccmv this guideline is for the use of consultant paediatricians, in consultation with paediatric infection management team, for treating infants within the first 1 month of life with confirmed cmv disease. Although most cmvinfected newborns lack signs of cmv infection, approximately 10% have signs that can consist of low birth weight, jaundice, hepatosplenomegaly, skin rash, microcephaly, and chorioretinitis. In healthy people, it causes a mild flulike illness that lasts a few days or weeks. What are the signs and symptoms of cytomegalovirus pneumonia. This document does not cover cmv diagnosis in immunocompromised individuals. Cmv persists in latent form after a primary infection, and reactivation may occur years later, particularly under conditions of immunosuppression. However, the risk of developing snhl after age 5 years among casepatients was not different than in uninfected children.
At birth, most infants with congenital cmv are asymptomatic. Infection in healthy children and adults is usually mild or without any symptoms. Management of the patient with congenital cmv infection. These specimens must be collected for testing within two to three weeks after the baby is born in order to confirm a diagnosis of congenital cmv infection. Cmv is a common viral infection, especially among young children. Around one in five babies born with congenital cmv infection will have longterm health problems.
Congenital cmv occurs when the infection is passed across the placenta from a pregnant woman to her developing baby. Cmv is the most common congenital infection in the u. Congenital cmv infection and newborn hearing screen 99,775 newborns screened for both hearing impairment and cmv chimes. Congenital cytomegalovirus cmv infection is the leading cause of nonhereditary sensorineural hearing loss and can cause other longterm neurodevelopmental disabilities, including cerebral palsy, intellectual disability, vision impairment, and seizures. Intrauterine infection with cytomegalovirus cmv, a betaherpesvirus, remains the most frequent congenital virus infection in many regions of the world. Cytomegalovirus cmv infection is a disease caused by a type of herpes virus. Of infected infants, approximately 10% are symptomatic at birth, and. Clinically apparent disease in the neonate is much more likely to occur after a primary maternal exposure, particularly in. Congenital cytomegalovirus infection and finger anomaly.
Because the overwhelming infection occurs early on in gestation, the fetus does not mount a significant immune response and, in fact, develops immune. Infection may be acquired transplacentally or during birth. The eight species in this genus include the type species, human betaherpesvirus 5 hcmv, human cytomegalovirus, hhv5, which is the species that infects humans. Incidence of cytomegalovirus infection among the general. Pathogenesis of cytomegalovirus infections, pathogenesis. Audit of screening of sga babies for torch infection standard practice was to investigate all infants cmv infection can be diagnosed by testing a newborn babys saliva, urine preferred specimens, or blood. Guidelines on cmv congenital infection article pdf available in journal of perinatal medicine 375.
Congenital cytomegalovirus infection is the most common congenital infection in neonates in the usa, affecting approximately 0. In the united states during the period 19881994, approximately onequarter of congenital cmv infections were attributable to primary maternal infection n 8772, and threequarters were attributable to nonprimary maternal infection n 29,918. Congenital cytomegalovirus cmv infection refers to a condition where cytomegalovirus is transmitted in the prenatal period. Women infected for the first time during pregnancy are especially likely to transmit cmv to their fetuses. Cytomegalovirus infection in transplant recipients scielo. But if youre pregnant or have a weakened immune system, cmv is cause for concern. For women suspected of having primary cmv infection in pregnancy, diagnosis should be either by igg seroconversion or with positive cmv igm, positive igg, and low igg avidity grade 1b. Once the diagnosis of congenital cmv infection is confirmed, one option is pregnancy termination. In contrast, relatively little attention has been paid to the morbidity and mortality that cmv infection may cause in immunocompetent patients. In the fetus, cmv infection may lead to cytomegalic inclusion disease, characterised by severe neurological abnormalities, intellectual disability, and hearing defects.
View as pdf send by post cytomegalovirus cmv infection is a common virus which infects people of all ages. These diseases are treatable, but need to be recognized early in their course so that antiviral intervention can be effected promptly. About one out of every 200 infants is born with congenital cytomegalovirus cmv infection. The morbidity and mortality associated with cytomegalovirus cmv infection in immunocompromised patients especially in hivinfected patients and transplant recipients, as well as with congenital cmv infection are well known.
It is the leading cause of nonhereditary sensorineural hearing loss snhl and can cause other longterm neurodevelopmental disabilities, including cerebral palsy, intellectual disability, vision impairment, and seizures. Attribution of congenital cytomegalovirus infection to. Nccn clinical practice guidelines in oncology nccn. Congenital cytomegalovirus infection congenital cmv infection.
The intersection of drugs, diagnostics and the natural history of disease new drug applications. It is a member of the betaherpesvirus subfamily, which also includes the roseolaviruses, human herpesvirus type 6, and human herpesvirus type 7. The main method of infection between people is via saliva or urine, though all body fluids have the potential to carry the virus. In cmv lytic infection damages systemic tissues directly, whereas ebv involves an activated and distorted immune system. Sometimes it causes problems in babies if you catch it during pregnancy congenital cmv. Infection with cmv is ubiquitous and generally asymptomatic in. Cytomegalovirus is responsible for the most common congenital present at birth infection in the united states. Congenital cytomegalovirus cmv infection occurs in 0. For babies with signs of congenital cmv infection at birth, antiviral. The burden of disease related to congenital cmv in substantial, as it is the leading nongenetic cause of sensorineural hearing loss and an important cause of neurodevelopmental disabilities in children.
Congenital cmv infection can be diagnosed by testing a newborn babys saliva, urine preferred specimens, or blood. Infants can contract cmv infections from their infected mothers, sometimes before birth when the virus is passed to the fetus through the placenta, or during delivery if the mothers genital tract is infected. Once you have the virus, it stays in your body for the rest of your life. Congenital cmv ccmv can result in significant morbidity, mortality or. Cmv human herpesvirus type 5 is transmitted through blood, body fluids, or transplanted organs. Cytomegalovirus cmv and pregnancy fact sheet fact sheets. Cmv is similar to the herpes virus that causes cold sores and chickenpox. Maternal primary and nonprimary cytomegalovirus cmv infection during. If testing is done more than three weeks after birth, it is not possible to distinguish between congenital cmv infection and an infection acquired after birth.
Incidence estimates of congenital cmv infection range between 0. A second proposed option has been treatment of the mother with antiviral agents such as ganciclovir, foscarnet, and cidofovir. Congenital cmv infection can follow either a primary or recurrent maternal infection, but the likelihood of fetal infection and the risk of associated damage is higher after a primary infection. Cytomegalovirus cmv is a common virus that can infect almost anyone. The pathogenesis of these infections is not completely understood, but certainly multifaceted. Approximately 90% of congenitally infected infants are asymptomatic at birth. Research into intrauterine infection has been hampered by the lack of. Primary cytomegalovirus cmv infection may cause a mononucleosis syndrome clinically indistinguishable from epsteinbarr virus infection. But usually, its people with a weakened immune system, such as those with hivaids, who become ill. Although the presence of igm is very specific for fetal and newborn infection, it is not very sensitive. Prevention of cytomegalovirus cmv reactivation or disease inf4 prevention of hepatitis b virus hbv, hepatitis c virus hcv, and human immunodeficiency virus hiv.
Cytomegalovirus cmv is the most common congenital infection in humans. Cmv is the most important cause of congenital viral infections in australia. Cmv infection is mostly asymptomatic among the general population. Risk factors for congenital cytomegalovirus infection in the offspring of young women. Active surveillance for cases diagnosed by paediatricians wendy vaudry md cm 1, bonita e lee md msc, rhonda j rosychuk phd1,2 1department of pediatrics, faculty of medicine and dentistry, university of alberta. Most people do not know that cmv infection is the most common cause of congenital viral infection in the united states, affecting about one to two out of 100 newborn babies. Cytomegalovirus pneumonia infection is usually present along with many other affected body organs. Neurological consequences of cytomegalovirus infection. Once infected, your body retains the virus for life. Intrauterine infection is thought to follow maternal viraemia and placental infection. Cytomegalovirus cmv is a member of the herpes family. Cytomegalovirus cmv is a ubiquitous herpesvirus spread by close interpersonal contact through saliva, blood, genital secretions, urine, or breast milk that infects up to 90% of the us population by the 8th decade of life and establishes lifelong latency in monocytes and granulocytes. An important risk factor for primary infection during pregnancy is prolonged exposure to young children.
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