Congenital cytomegalovirus infection: background for manifestation; clinical case; difficulties of treatment

Abstract

Congenital CMV is the leading cause of congenital infections in newborns worldwide and can lead to significant morbidity, mortality, or long-term consequences.

Purpose — to demonstrate the results of screening for cytomegalovirus infection of pregnant women and children in the first months of life and illustrate a clinical case of severe congenital CMV and the difficulties in selecting specific therapy.

Materials and methods. The article presents the results of a retrospective analysis of CMV testing of 302 pregnant women at living in the Zaporozhye region. The presence of CMV-specific immunoglobulin G (IgG) and M (IgM) antibodies was assessed. In addition, the clinical manifestations of CMV in 56 infants were retrospectively evaluated. A clinical case of congenital CMV in a newborn complicated by hepatitis, nephritis, carditis, pneumonia, thrombocytopenia, was presented. Statistical processing of the results was carried out by the methods of variation statistics.

Results. The result of a study of a specific immunological profile for CMV in pregnant women showed that the majority of women of fertile age, residents of Zaporozhye region were seropositive to CMV. In 3% of pregnant women, CMV-specific IgM antibodies was recorded in the blood, which indicates the manifestation of an acute form of CMV and the possibility of infection of the fetus. Prolonged neonatal jaundice was the dominant clinical symptom of congenital CMV in 59.3% patients. The syndrome of perinatal CNS lesion was the second most frequent in these children. In order to illustrate the features of the course, the difficulties of diagnosis and the selection of specific therapy for severe forms of congenital CMV, a clinical case of the corresponding disease was presented.

Conclusions. Most women of fertile age are immune to CMV, and 5% of pregnant women have acute primary CMV infection. CMV is the most common cause of congenital infection with substantial morbidity, mortality, and long$term squeal, including sensorineural hearing loss for newborns. Diagnosis of congenital CMV is complicated by both the polysyndromic manifestations of the disease and the lack of a clear system for testing pregnant women and newborns for CMV. The presence of alertness of neonatologists and pediatricians for CMV is a guarantee of timely diagnosis of the disease in newborns. Difficulties in the selection of specific therapy to congenital CMV due to the low sensitivity of the pathogen to acyclovir and the need to use a toxic drug — ganciclovir. Timely administration of highly specific anti-CMV-therapy not only saves the patient's life, but also improve hearing and developmental outcomes.

The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of these Institutes. The informed consent of the patient was obtained for conducting the studies.

No conflict of interest was declared by the authors.

Key words: congenital cytomegalovirus infection, newborns, severe forms, diagnostics, manifestations, treatment.