Perinatal Cytomegalovirus Infection

Abstract

Purpose of review There have been recent advances in the field of congenital CMV infection (cCMV) related to antiviral treatment of pregnant women and infants, the implementation of newborn CMV screening programs, and the frequency and diagnosis of complications among infected children. In addition, postnatal CMV infection (pCMV) is increasingly recognized as a potential cause of long-term sequelae in addition to acute complications among preterm infants, raising important questions related to treatment, and prevention. Recent findings High-dose valacyclovir appears to be safe and effective for the prevention of cCMV among women with first-trimester primary CMV infection. New studies reveal high rates of vestibular dysfunction and neuropsychiatric manifestations among children with cCMV. Some studies report associations between pCMV and long-term consequences, including neurodevelopmental delay and bronchopulmonary dysplasia, among very low birth weight infants, in addition to high risk of sepsis and death acutely, which has motivated efforts to eliminate the virus from breast milk by different methods. Summary More long-term complications of cCMV are increasingly recognized among children previously thought to be asymptomatic. Although a preventive CMV vaccine may be achievable, strategies to reduce the burden of cCMV disease include maternal education about risk-reduction behaviors, antiviral treatment of pregnant women with primary infection, and newborn screening to allow timely, appropriate care. Similarly, although it remains unclear if pCMV causes long-term problems, there is growing interest in identifying and preventing disease from CMV infections among preterm infants.

Não é não só uma virose

“…Nos neonatos gravemente acometidos pela doença a mortalidade pode representar cerca de 30%, esse fato ocorre devido a insuficiência hepática, sangramento, coagulação intravascular disseminada e infecção bacteriana secundária (DEMMLER-HARRISON, 2023a;.…”

“…Lactentes a termo: Quando apresentam sintomas são usualmente breves e incluem febre, sintomas gastrointestinais e hepáticos que comumente apresentam uma boa evolução em torno de dois a três meses (CARMONA; KAKKAR; GANTT, 2022).…”

“…Infecção congênita: O teste mais apropriado é o isolamento do vírus ou detecção de DNA viral na urina, ainda que possa ser isolado da saliva e de outros fluidos. O isolamento viral deve ser feito nas duas primeiras semanas de vida, para que se possa afirmar que a infecção é congênita já que, a excreção viral pode durar meses ou anos (CHIOPRIS et al, 2020).…”

Pooling Saliva Sample as an Effective Strategy for the Systematic CMV Screening of Newborns—A Multicentric Prospective Study

“…Longterm sequelae of this infection affect a larger number of children than other known clinical conditions, such as Down syndrome, fetal alcohol syndrome and spina bifida. [1][2][3] Currently, maternal screening during pregnancy is not recommended, although there is some hope that antenatal treatment may be approved soon. 4 However, it is important to emphasize that prenatal screening only targets primary infections, which means that a large proportion of cases of congenital infection will go undetected, even with the universal prenatal screening program.…”

“…Long-term sequelae of this infection affect a larger number of children than other known clinical conditions, such as Down syndrome, fetal alcohol syndrome and spina bifida. 1–3…”