Symptomatic Congenital Cytomegalovirus Infection in Children of Seropositive Women

Abstract

Cytomegalovirus (CMV) is the most frequent congenital virus infection worldwide. The risk of congenital CMV (cCMV) transmission is highest in seronegative women who acquire primary CMV infection during pregnancy. A growing body of evidence indicates that secondary CMV infections in pregnant women with preconceptual immunity (either through reactivation of latent virus or re-infection with a new strain of CMV) contribute to a much greater proportion of symptomatic cCMV than was previously thought. Here, we describe a case of symptomatic cCMV infection in the newborn of a woman with proven immunity prior to pregnancy. Diagnosis was confirmed by CMV PCR from amniotic fluid and fetal MR imaging. The newborn presented with typical cCMV symptoms including jaundice, hepatosplenomegaly, cholestasis, petechiae, small head circumference, and sensorineural hearing loss, the most common neurologic sequela. CMV was detected in infant blood and urine by PCR, and intravenous ganciclovir was initiated and continued orally for 6 weeks totally. Apart from persisting right-sided deafness, the child exhibited normal neurological development up through the last follow-up at 4.5 years. To date, the most effective strategy to prevent vertical CMV transmission is hygiene counseling for women of childbearing age, which, in our case, and in concordance with recent literature, applies to seronegative, as well as seropositive, women. Once an expecting mother shows seroconversion or signs of an active CMV infection, there are no established procedures to reduce the risk of transmission, or therapeutic options for the fetus with signs of infection. After birth, symptomatic infants can be treated with ganciclovir to inhibit viral replication and improve hearing ability and neurodevelopmental outcome. A comprehensive review of the literature, including our case study, reveals the most current and significant diagnostic and treatment options available. In conclusion, the triad of maternal hygiene counseling, postnatal hearing screening of all newborns, followed by CMV PCR in symptomatic infants, and antiviral therapy of infants with symptomatic cCMV provides an outline of best practice to reduce the burden of CMV transmission sequelae.

Congenital Human Cytomegalovirus Infection Inducing Sensorineural Hearing Loss

“…However, the most effective strategy to prevent HCMV vertical transmission is health counseling for women of childbearing age, which is also conducive to screening seronegative women. However, once HCMV infection is detected in pregnant women, there is no effective way to reduce the risk of transmission to the fetus, nor the effective treatment (Mack et al, 2017). Therefore, we advocate preventing HCMV infection by behavioral prevention, such as screening and intervention during pregnancy, not sharing food or drink with children, not kissing children's mouths, and frequent hand washing.…”

“…A study has shown that behavioral control can reduce maternal HCMV infection and protect newborns from viral infection (Fowler and Boppana, 2018). It is believed that health education for women of childbearing age, hearing screening for newborns after birth, and subsequent HCMV PCR diagnosis of symptomatic infants and symptomatic infants with antiviral treatment can reduce the incidence of SNHL after HCMV infection (Mack et al, 2017). Because HCMV can damage SGN and causes SNHL, further studies are needed to explore the mechanism of SNHL caused by HCMV and provide scientific evidence for follow-up treatment and seek the gospel for most children with HCMVrelated SNHL.…”

Diagnostic Assessment of Progressive Fluctuating Sensorineural Hearing Loss in Children

“…The hazard for congenital CMV (cCMV) contamination is utmost in females without previous immunity who firstly develop CMV infection while being expectant. Nevertheless, emerging research suggests that secondary CMV contamination during pregnancy with immunity prior to impregnation (either due to vivification of an inactive virus or re-contamination with a new species of CMV) can further induce a much higher rate of active cCMV than what was used to believe [5].…”

Maternal cytomegalovirus immune status and hearing loss outcomes in congenital cytomegalovirus-infected offspring

“…It was previously thought that non-primary maternal CMV infections during pregnancy had both low transmission rates to the fetus and very low rates of symptomatic cCMV infection in the newborn, with a few exceptions found in isolated case reports. However, a growing body of evidence has indicated that maternal pre-conception immunity to CMV, while conferring some protection, is imperfect, and that maternal non-primary CMV infections during pregnancy may result in both asymptomatic and symptomatic cCMV, even with severe manifestations, in a much larger percentage of newborns than previously thought [15][16][17][18][19][20][21][22][23][24][25][26][27][28]. Still other studies have suggested that the age, race/ethnicity, and other demographics of the maternal population may influence the rates of maternal CMV infection (primary vs non-primary), rates of CMV transmission to the fetus and newborn, the presence of symptoms at birth in the newborn, and the outcomes in the children [29,30].…”