Diagnostic challenges in congenital cytomegalovirus infection in pregnancy: A case report

Abstract

Cytomegalovirus is the most common congenital viral infection. Infection can cause developmental delay, sensorineural deafness and fetal death. Fetal damage is more severe when infection occurs in the first trimester of pregnancy. Prenatal ultrasound findings may be cerebral, such as ventriculomegaly, microcephaly and periventricular leukomalacia, as well as non-cerebral, such as echogenic bowel, ascites and pericardial effusion. We present a case of congenital cytomegalovirus infection in which the only ultrasound sign noted at routine second-trimester scan was low-grade echogenic bowel, a soft marker, which progressed to severe disease in the third trimester, when further investigation was prompted, leading to the diagnosis. Patients need to be counselled regarding the possible perinatal prognosis. Ultrasound markers can often but not always predict severity and, hence, counselling can be a challenge. Conclusion: A meticulous anatomy survey in mid-trimester remains the norm and ultrasound soft markers should prompt comprehensive testing for viral infections in pregnancy.

An Overview of Cytomegalovirus Infection in Pregnancy

“…Following the evaluation of maternal serum antibodies, the infection should be confirmed by CMV detection, either from blood or other body fluids. This is a means to diagnose with certainty an active maternal infection, but the sensitivity decreases within the first month after infection [ 34 ]. Urine, saliva, vaginal secretions, blood, and amniotic fluid cultures can be used to isolate CMV, but blood and urine analyses are performed more often.…”

Multiple Cerebral Abnormalities at Third-trimester Ultrasound Scan in an Uncomplicated Pregnancy

“…CMV is the most common congenital infection, affecting 0.5%–2% of all live births and the main nongenetic cause of congenital sensorineural hearing loss and neurological damage. [ 1 2 ]…”

“…As described in the literature, only about 1%–2% of congenital infection result from nonprimary infection. [ 2 ] Besides, although transmission is higher when maternal infection occurs later in pregnancy, the severity of the disease is more significant in the first trimester. The gestational age at maternal infection is nowadays considered to be a main prognostic factor as long-term sequelae have shown to appear in 51%–57% of cases from 1 st -trimester primary infection.…”

Pathophysiology of Hyperechogenic Bowel in Congenitally Human Cytomegalovirus Infected Fetuses

“…It may be caused by inflammation, meconium peritonitis, ascites or anemia [12]. The association of congenital infections with isolated HB has been reported in 2.2% and the most commonly detected infectious agent is CMV [7,24,25].…”