Perinatal cytomegalovirus infection: commonly occurring but rarely diagnosed

Abstract

ResumoObjetivo: Avaliar a freqüência da infecção perinatal por citomegalovirus (CMV) em lactentes e descrever a sua apresentação clínica.Casuística e métodos: Foram estudados, prospectivamente, 34 recém-nascidos até o quarto mês de vida. Colheram-se amostras de urina ao nascimento, com 15 dias e mensalmente, bem como amostras de sangue ao nascimento e no terceiro mês de vida. O diagnós-tico laboratorial de citomegalovirose foi realizado pela detecção dos CMV na urina por isolamento viral em cultura de células e por detecção do DNA viral através da reação de amplificação gênica catalisada pela polimerase (PCR). Em todas as crianças foi excluído o diagnóstico de citomegalovirose congênita.Resultados: A incidência da infecção perinatal foi de 38,2% (13/34) e apenas três dessas crianças apresentaram manifestações clínicas. Observou-se um caso com quadro respiratório e diarréia, e outros dois pacientes apresentaram esplenomegalia.Conclusões: Observou-se uma elevada taxa de incidência de infecção perinatal por CMV. Das crianças infectadas, 23% apresentaram sintomas. Esses resultados estimulam a que se faça a pesquisa dos CMV como parte da investigação etiológica de pneumonites e esplenomegalia em lactentes jovens. J. pediatr. (Rio J.). 1999; 75(2): 126-130: citomegalovírus, CMV, infecção perinatal. AbstractObjective: To determine the incidence rate of perinatal cytomegalovirus (CMV) infection and to describe the clinical presentation of this infection in non-transfused term infants attended at a general hospital, in Ribeirão Preto, SP, Brazil.Population and Methods: Thirty four infants free of CMV infection at birth were followed up during the first 4 months of life. Diagnosis of perinatal CMV infection was established by isolating the virus in tissue culture or by polymerase chain reaction DNA amplification (PCR) in urine samples.Results: A 38.2% (13/34) incidence rate of perinatal CMV infection was detected, and only 3 of the infected infants were symptomatic (respiratory tract symptoms in one infant and splenomegaly in two). Conclusions:The results indicate a high incidence rate of perinatal CMV infection in the studied infants. Clinical symptoms were present in 23% of these patients, stimulating the investigation of this agent as a cause of pneumonitis and splenomegaly. Introdução A infecção perinatal por citomegalovírus (CMV) resulta da exposição da criança à secreção cervical durante o trabalho de parto ou ao leite materno nas primeiras semanas de vida, podendo resultar, ainda, da transmissão iatrogênica, especialmente em recém-nascidos prematuros que requerem múltiplas transfusões sanguíneas [1][2][3] . A grande maioria dessas infecções são assintomáticas, porém existem relatos de casos com doença perinatal por CMV 4,5 . J. pediatr. (Rio J.O período de incubação da citomegalovirose perinatal varia de 30 a 120 dias, sendo de 4 a 12 semanas na infecção

Prevalence of Cytomegalovirus Infection in Hospitalized Infants

“…Their rate in the present study is close to 25% and is less than the rate of 38.6% for the perinatal cytomegalovirus infection in a Brazilian hospital. 12 A prevalence rate of 72% in the second six months is comparable with the results from a previous study conducted in Bulgaria 13 , while the data from other countries range from 38.2% in Australia 7 to 93.3% in Turkey 8 . The overall rate of clinically apparent CMV infection in hospitalized infants up to one year of age was between 11.0 ± 2.5% and 17.2 ± 2.9% (18 of 163 or 28 of 163 children) depending on whether or not the 18 infants with symptomatic infection are accompanied by the 10 infants with a concomitant infections.…”

“…Unlike other studies available in the literature 9,10,[12][13][14][15][16] , this study is the only one that uses a reliable screening method throughout the fi rst year of life. The serological studies of Vassileva in Sofi a in 1978 13 and Pancharoen in Thailand in 1998 11 also include the age from 0 to 12 months, but they do not assess the CMV IgG concentration or make comparison with the maternal CMV IgG, which is the reason why they do not provide reliable data for the prevalence rate in the fi rst 6 months.…”

“…These data differ from the population data, and very often are scarce, obsolete and considerably inconsistent -CMV is found in 3.0% to 9.8% of all hospitalized infants 9,10 and in 38.2% to 80.9% of the children in the fi rst three months after birth. 11,12 There are very little actual data about the prevalence, symptoms and risk factors for the infection in hospitalized infants.…”

Prevalence and risk factors of cytomegalovirus infection among HIV-infected and HIV-exposed uninfected infants in Nigeria

“…These values were lower than the prevalence of 93% among HIV-infected and the 90% among the HEU Kenyan infants at three months of age found in another study [15]. Also, the CMV prevalence of 41.4% in this study was higher than the respective 23.8% and 38.6% reported among Bulgarian [29] and Brazilian [30] hospitalized children of similar ages. In addition, the prevalence of acute CMV infection in this study was higher than the 15%-20% among HEU children [16] but lower than the 30%-40% among the HIV-infected children in the United States cohorts at six months of age [13].…”

Early high CMV seroprevalence in pregnant women from a population with a high rate of congenital infection

“…We have previously detected CMV viruria in 38 . 2 % of non-congenitally infected infants from this population aged 3-6 months [17]. After the second year of life, non-maternal sources of infection may enhance viral transmission.…”