Colonic stricture mimicking Hirschsprung's disease: a localized cytomegalovirus infection

Ekema, George; Pedersini, Pierluigi; Milianti, Susanna; Ubertazzi, Michele; Minoli, Dario Guido; Manciana, Alessandro

doi:10.1016/j.jpedsurg.2005.12.029

Cited by 30 publications

(29 citation statements)

References 17 publications

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“…3 This infant' s intraoperative specimens demonstrated histopathological findings of ulceration, inflammation, granulation tissue, necrosis, and stricture. 8 The pathogenesis of NEC-like syndrome triggered by CMV infection is unclear. CMV enteritis often occurs in immunocompromised adults, including solid organ transplant (SOT) or hematopoietic stem cell transplant (HSCT) patients, but it is uncommon in the neonate and only rarely has been associated with severe enough pathology to require surgical resection.…”

Section: Figurementioning

confidence: 99%

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Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

et al. 2013

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Human cytomegalovirus (CMV) infection may be acquired in very low birth weight and extremely low birth weight (ELBW) infants from breast milk. The clinical relevance of such infections is uncertain. There is no consensus on whether screening breast milk for CMV, freezing/pasteurizing milk before feeding, or performing virological monitoring on at-risk infants is warranted. We describe an ELBW infant who acquired CMV postnatally from breast milk and developed CMV sepsis syndrome and clinical evidence of necrotizing enterocolitis (NEC) at ∼5 weeks of age. The availability of serial dried blood spots from day of life (DOL) 4 to 21, coincidentally obtained for a metabolic study, provided the novel opportunity to retrospectively test for and quantify the magnitude of CMV DNAemia. DNAemia was present for several weeks before the onset of severe CMV disease, first being noted on DOL 18 and increasing in magnitude daily to 4.8 log10 genomes/mL on DOL 21, approximately 8 days before the onset of abdominal distension and 15 days before the onset of CMV sepsis syndrome and NEC. After surgical resection, supportive care, and ganciclovir therapy, the infant recovered. This case underscores the importance of including CMV infection in the differential diagnosis of sepsis and NEC in premature infants. This case also suggests the value of prospective virological monitoring in at-risk low birth weight and ELBW infants. Future studies should examine the potential utility of preemptive monitoring for, and possibly treatment of, CMV DNAemia in premature infants, which may herald the onset of serious disease.

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Section: Figurementioning

confidence: 99%

“…[2][3][4][5][6][7][8][9][10][11][12][13][14][15] There is no consensus to guide surveillance, prevention, and therapy of CMV infections acquired via breast milk in the premature infant. Some experts stress the generally innocuous course of these infections, and argue that special precautions to prevent transmission are unnecessary.…”

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confidence: 99%

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

et al. 2013

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“…All cases of neonatal CMV infection are mentioned in the literature as NEC-like illnesses but none of them clearly identifies whether CMV was the causative pathogen responsible for NEC or whether it occured only as an infection during the course of NEC (5). Most of the patients in the literature were premature babies and most of them showed no other features of the disease, except GI involvement of CMV infection (4,5).…”

Section: Discussionmentioning

confidence: 99%

“…Most of the patients in the literature were premature babies and most of them showed no other features of the disease, except GI involvement of CMV infection (4,5).…”

Section: Discussionmentioning

confidence: 99%

Jejunal stricture in a premature infant: Is cytomegalovirus the causative pathogen or a superinfection?

Aksu

Sarı²,

Karabulut³

et al. 2013

Turk J Gastroenterol

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“…Cytomegalovirus (CMV) is the most common cause of congenital viral infection, affecting 0.2 to 2.3% of all live births in developed countries; [1][2][3][4][5][6][7][8][9][10][11][12] it is also estimated as the leading infectious cause of nongenetic hearing loss, mental retardation 1,2,13-15 and non-genetic congenital malformations. 16 Very low birth weight and extremely low birth weight newborns are at higher risk of symptomatic CMV infection, most commonly secondary, acquired through breast milk.…”

Section: Introductionmentioning

confidence: 99%

Neonatal gastrointestinal involvement and congenital cytomegalovirus

et al. 2016

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Cytomegalovirus (CMV) is the most common cause of congenital viral infection, affecting 0.2 to 2.3% of all live births in developed countries. Very low birth weight and extremely low birth weight newborns are at higher risk of symptomatic CMV infection, most commonly secondary and acquired through breast milk. Gastrointestinal involvement is rare in acquired CMV infections, but it could be an important manifestation of postnatal infection in preterm infants admitted to neonatal intensive care units. Early onset of CMV gastrointestinal signs/symptoms is very rare. In a review of the literature it is described in 5 newborns in the first 24 hours of life, and 6 considering the onset in the first week of life. This review describes also a case report of congenital CMV in an immunocompetent newborn with onset of gastrointestinal signs immediately after birth: a possible association between viral infection and enteric manifestations was considered in the differential diagnosis. A review of the literature of the different case reports found has done, with description and comparison of the different patients and clinical presentations. IntroductionCytomegalovirus (CMV) is the most common cause of congenital viral infection, affecting 0.2 to 2.3% of all live births in developed countries; 1-12 it is also estimated as the leading infectious cause of nongenetic hearing loss, mental retardation 1,2,13-15 and non-genetic congenital malformations. 16 Very low birth weight and extremely low birth weight newborns are at higher risk of symptomatic CMV infection, most commonly secondary, acquired through breast milk. 17 Maternal primary CMV infection or reinfection during pregnancy are the cause of neonatal congenital infection, with a mean risk of transmission of 40% (24-75%), 3,18 lower in the first three months (36%) than in the last three months of gestation (78%). 3,19 Considering all the infected newborns, only 5 to 10% are symptomatic at birth, in particular with neurodevelopmental delay signs and sensorial hearing loss. Among asymptomatic patients, 10% to 15% will show developmental disorders, mainly sensory hearing loss. 1,2,8,10,11,13,14,[20][21][22] Most of congenital infections (85-90%) remain asymptomatic: 3,16,23 among them, 8 to 15% will show developmental disorders or sensorial hearing loss. [1][2][3]13,14 Possible signs and symptoms of congenital CMV infection with onset at birth are the following: 3,16,24 unilateral or bilateral sensorial hearing loss, visual loss, microcephaly, hepatomegaly and/or hepatitis, splenomegaly, thrombocytopenia, jaundice, petechiae, motor defects, mental disability, chorioretinitis, strabismus, optic atrophy, dental defects. Rarely it could present as a severe multi organ dysfunction with polyserositis.Gastrointestinal involvement is considered very rare in congenital and acquired CMV infection. 7,8,10,11,20 On the other hand, CMV gastrointestinal symptoms could be an important manifestation of postnatal infection in patients admitted to neonatal intensive care units 25 or a ...

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Colonic stricture mimicking Hirschsprung's disease: a localized cytomegalovirus infection

Cited by 30 publications

References 17 publications

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

Jejunal stricture in a premature infant: Is cytomegalovirus the causative pathogen or a superinfection?

Neonatal gastrointestinal involvement and congenital cytomegalovirus

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