RESUMO
BACKGROUND: Several screening strategies for identifying congenital CMV (cCMV) have been proposed; however, the optimal solution has yet to be determined. We aimed to determine the prevalence of cCMV by universal screening with saliva pool testing and to identify the clinical variables associated with a higher risk of cCMV to optimize an expanded screening strategy. METHODS: We carried out a prospective universal cCMV screening (September/2022 to August/2023) of 2186 newborns, analyzing saliva samples in pools of five (Alethia-LAMP-CMV®) and then performed confirmatory urine CMV RT-PCR. Infants with risk factors (small for gestational age, failed hearing screening, HIV-exposed, born to immunosuppressed mothers, or <1000 g birth weight) underwent expanded screening. Multivariate analyses were used to assess the association with maternal/neonatal variables. RESULTS: We identified 10 infants with cCMV (prevalence: 0.46%, 95% CI 0.22-0.84), with significantly higher rates (2.1%, 95% CI 0.58-5.3) in the high-risk group (p = 0.04). False positives occurred in 0.09% of cases. No significant differences in maternal/neonatal characteristics were observed, except for a higher prevalence among infants born to non-Chilean mothers (p = 0.034), notably those born to Haitian mothers (1.5%, 95% CI 0.31-4.34), who had higher odds of cCMV (OR 6.82, 95% CI 1.23-37.9, p = 0.04). Incorporating maternal nationality improved predictive accuracy (AUC: 0.65 to 0.83). CONCLUSIONS: For low-prevalence diseases such as cCMV, universal screening with pool testing in saliva represents an optimal and cost-effective approach to enhance diagnosis in asymptomatic patients. An expanded screening strategy considering maternal nationality could be beneficial in resource-limited settings.
Assuntos
Infecções por Citomegalovirus , Citomegalovirus , Países em Desenvolvimento , Triagem Neonatal , Saliva , Humanos , Saliva/virologia , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/virologia , Recém-Nascido , Feminino , Citomegalovirus/genética , Citomegalovirus/isolamento & purificação , Estudos Prospectivos , Triagem Neonatal/métodos , Masculino , Técnicas de Diagnóstico Molecular/métodos , Prevalência , Programas de Rastreamento/métodos , Sensibilidade e Especificidade , Gravidez , Fatores de RiscoRESUMO
Introducción: La infección congénita por el citomegalovirus en neonatos menores de 1500 gramos puede ser causa de morbilidad, mortalidad y discapacidad. Objetivo: Describir el comportamiento de la infección congénita por citomegalovirus en un servicio de neonatología. Métodos: Se realizó un estudio descriptivo y transversal con 61 neonatos. Se les realizó detección de citomegalovirus en la primera semana de vida en suero y orina, mediante reacción en cadena de la polimerasa, para determinar infección congénita. Se evaluaron variables perinatales en todos los neonatos, así como elementos clínicos y resultados de exámenes complementarios en los infectados. Resultados: La incidencia de infección congénita fue de un 10 por ciento (6/61). El 5 por ciento de los estudios fueron positivos (6/122). Ninguna muestra de orina resultó positiva (0/61) y en el 10 por ciento de las muestras de suero (6/61) se detectó el genoma del virus. Se encontró asociación entre valoración nutricional al nacer e infección por citomegalovirus (p< 0,05). El 83 por ciento de los neonatos infectados presentaron algún signo clínico y el síndrome de dificultad respiratoria fue el más frecuente (67 por ciento). En todos los neonatos con infección congénita el ultrasonido cerebral fue normal y en el 33 por ciento se detectó retinopatía de la prematuridad en el fondo de ojo. Conclusiones: La incidencia de infección congénita por citomegalovirus es alta en este grupo de riesgo. Los signos clínicos encontrados y los resultados del fondo de ojo en neonatos con infección congénita se relacionaron con la prematuridad y la valoración nutricional de hipotrófico se asoció con esta infección(AU)
Introduction: Congenital cytomegalovirus infection in neonates weighing less than 1500 grams can be a cause of morbidity, mortality, and disability. Objective: To describe the behavior of congenital cytomegalovirus infection in a neonatal service. Methods: A descriptive and cross-sectional study was conducted with 61 neonates. Cytomegalovirus was detected in the first week of life in serum and urine, by polymerase chain reaction, to determine congenital infection. Perinatal variables were evaluated in all neonates, as well as clinical elements and results of complementary examinations in infected infants. Results: The incidence of congenital infection was 10 percent (6/61). 5 percent of the studies were positive (6/122). No urine samples were positive (0/61) and the virus genome was detected in 10 percent of serum samples (6/61). An association was found between nutritional assessment at birth and cytomegalovirus infection (p < 0.05). A total of 83 percent of infected neonates had some clinical sign, with respiratory distress syndrome being the most common (67 percent). In all neonates with congenital infection, brain ultrasound was normal, and retinopathy of prematurity was detected in 33 percent of patients with fundus retinopathy. Conclusions: The incidence of congenital cytomegalovirus infection is high in this risk group. The clinical signs found and the results of the fundus in neonates with congenital infection were related to prematurity and the nutritional assessment of hypotrophic was associated with this infection(AU)
Assuntos
Humanos , Recém-Nascido , Síndrome do Desconforto Respiratório do Recém-Nascido , Retinopatia da Prematuridade/diagnóstico , Infecções por Citomegalovirus/urina , Infecções por Citomegalovirus/epidemiologia , Recém-Nascido de muito Baixo Peso , Grupos de Risco , Epidemiologia Descritiva , Estudos Transversais , Fundo de OlhoRESUMO
Universal congenital cytomegalovirus (cCMV) screening in saliva is increasingly recommended. The aim of our study was to correlate the performance of a point-of-care rapid molecular test with CMV real time PCR (CMV RT-PCR) detection, using saliva pool-testing in newborns under a universal screening strategy. Saliva swabs were prospectively collected from newborns < 21 days old and tested by Alethia-LAMP-CMV assay in pools of 5 samples. In positive pools, subjects were tested individually and by saliva and urine CMV RT-PCR. A subset of negative pools were studied with both techniques and viral loads in whole blood were determined in positive patients. From 1,642 newborns included in 328 pools, 8 were confirmed by urine CMV RT-PCR, (cCMV prevalence 0,49%). The PPA and NNA of the pooled saliva Alethia-LAMP-CMV testing were 87,5% and 99,8% with a negative and positive predictive value of 99,9% and 77,7%, respectively. Two false positives were detected (0,12%). A subset of 17 negative pools (85 samples), studied by saliva CMV RT-PCR, showed 100% concordance. Conclusion: CMV pool-testing using a rapid molecular test in saliva proved feasible when compared to PCR gold standards. This strategy could improve cost-effectiveness for cCMV universal neonatal screening, based on the low prevalence of the infection and could be a more affordable approach in less developed regions with reduced detection capacity. What is Known: ⢠cCMV is the most frequent congenital infection and a leading nongenetic cause of sensorineural hearing loss and brain disease. ⢠Universal screening could allow early detection of congenitally infected infants, improving clinical outcome. ⢠Saliva PCR is the preferred and non-invasive test for newborn cCMV screening. What is New: ⢠The feasibility of a universal cCMV screening by pool-testing in saliva using a rapid test in pools of 5 samples. ⢠PPA and NPA were 87,5 and 99,8% compared to CMV PCR in urine. ⢠This strategy could be relevant specially in LMIC where detection capacity is reduced and could improve cost-effectiveness. ⢠cCMV prevalence in our center was 0,49%.
Assuntos
Infecções por Citomegalovirus , Citomegalovirus , Lactente , Humanos , Recém-Nascido , Citomegalovirus/genética , Saliva , Infecções por Citomegalovirus/diagnóstico , Triagem Neonatal/métodos , Reação em Cadeia da Polimerase em Tempo Real/métodosRESUMO
El síndrome "blueberry muffin" es una dermatosis maculopapular eritematoviolácea como resultado de una hematopoyesis extramedular. Se ha asociado con infecciones del espectro TORCH y causas no infecciosas. Presentamos el caso de un recién nacido pretérmino, quien desde el control prenatal presentó una ecografía con signos sugerentes de infección congénita por citomegalovirus (microcefalia, ventriculomegalia y calcificaciones intracerebrales). Al examen físico presentaba una dermatosis macular violácea compatible con síndrome "blueberry muffin". Se detectó carga viral de citomegalovirus en orina (81,200 copias/ml) e inició tratamiento con ganciclovir, con desenlace fatal. La infección congénita por CMV debe considerarse ante el síndrome "blueberry muffin"; el adecuado abordaje diagnóstico debe ser oportuno y debe incluir antecedentes maternos y perinatales, así como estudios serológicos para infecciones por TORCH con el fin del inicio precoz de tratamiento para evitar complicaciones y secuelas.
Blueberry muffin syndrome is characterized by an erythematousviolaceous maculopapular dermatosis due to extramedullary hematopoiesis. This entity has been associated with TORCH spectrum infections and noninfectious causes. We present the case of a preterm newborn, who since the prenatal control gave an ultrasound with data suggestive of congenital infection by cytomegalovirus (microcephaly, ventriculomegaly, intracerebral calcifications). On physical examination, he presented a violaceous macular dermatosis compatible with blueberry muffin syndrome. Cytomegalovirus viral load was detected in urine (81,200 copies/ml), with fatal outcome. Congenital cytomegalovirus infection should be considered in the presence of a blueberry muffin syndrome; an adequate diagnostic approach that includes maternal and perinatal history is essential, as well as serology studies for diseases of the TORCH spectrum in order to start early with treatment and avoid major comorbidities.
Assuntos
Humanos , Masculino , Recém-Nascido , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/diagnóstico , Antivirais/uso terapêutico , Ganciclovir/uso terapêutico , Evolução Fatal , Infecções por Citomegalovirus/tratamento farmacológicoRESUMO
Introducción: La infección congénita por citomegalovirus es causa de pérdida auditiva y alteraciones cognitivas. La infección perinatal por este virus es más frecuente en neonatos< 1500 g y produce menos secuelas neurológicas. Objetivo: Describir la evaluación neurológica en el primer año de vida en niños muy bajo peso al nacer con infección por citomegalovirus. Métodos: Estudio descriptivo y longitudinal en el que se incuyeron 14 neonatos< 1500 g, con diagnóstico de infección congénita o perinatal por citomegalovirus; a los cuales se les realizó evaluación del neurodesarrollo, ultrasonido craneal, potenciales evocados auditivos de tallo cerebral y potenciales visuales a las 40 semanas, a los seis meses y al año de edad gestacional corregida. En la primera evaluación se realizó además, electroencefalograma. Resultados: El 43 por ciento tuvo infección congénita y 57 por ciento infección perinatal. A las 40 semanas se evaluaron completamente 79 % de los casos, a los seis meses 64 por ciento y al año 36 por ciento. No se observaron anormalidades en el ultrasonido craneal, ni en el electroencefalograma. Al año de edad corregida, se detectaron alteraciones ligeras del neurodesarrolo en 33,3 por ciento del total de casos (2/6) y con igual porcentaje en los niños con infección congénita (1/3) y perinatal (1/3). En ningún paciente evaluado se detectó sordera neurosensorial, ni daño del nervio visual. Conclusiones: Las alteraciones del neurodesarrollo encontradas al año de edad corregida pueden estar relacionadas con la prematuridad o la infección por citomegalovirus. El seguimiento a mediano y largo plazo es necesario para detectar otras secuelas neurológicas de debut tardío(AU)
Introduction: Congenital cytomegalovirus infection is a cause of hearing loss and cognitive impairments. Perinatal infection by this virus is more frequent in neonates< 1500 g and produces fewer neurological sequelae. Objective: To describe neurological evaluation in the first year of life in very low birth weight children with cytomegalovirus infection. Methods: A descriptive and longitudinal study involving 14 neonates< 1500 g, with a diagnosis of congenital or perinatal cytomegalovirus infection; to which neurodevelopmental evaluation, cranial ultrasound, auditory brain stem evoked potentials and visual potentials were performed at 40 weeks, six months and one year of corrected gestational age. In the first evaluation, electroencephalogram was also performed. Results: 43 percent had congenital infection and 57 percent perinatal infection. At 40 weeks, 79 percent of cases were fully evaluated, at six months 64 percent and at one year 36 percent. No abnormalities were observed on the cranial ultrasound or electroencephalogram. At one year of corrected age, slight alterations in neurodevelopment were detected in 33.3 percent of all cases (2/6) and with the same percentage in children with congenital (1/3) and perinatal (1/3) infection. In no patient evaluated, sensorineural deafness or visual nerve damage was detected. Conclusions: The neurodevelopmental alterations found at one year of corrected age may be related to prematurity or cytomegalovirus infection. Medium- and long-term follow-up is necessary to detect other late-onset neurological sequelae(AU)
Assuntos
Humanos , Recém-Nascido , Assistência ao Convalescente/métodos , Infecções por Citomegalovirus/etiologia , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Perda Auditiva Neurossensorial , Epidemiologia Descritiva , Estudos Longitudinais , Citomegalovirus/genética , Estudos Observacionais como AssuntoRESUMO
From 2009-2015 to 2016-2019, the proportion of infants in the US with congenital cytomegalovirus treated with valganciclovir roughly doubled for infants enrolled with employer-sponsored insurance (from 16% to 29%) and Medicaid (from 16% to 36%). The proportion treated with valganciclovir increased for all congenital cytomegalovirus disease severity groups.
Assuntos
Infecções por Citomegalovirus , Citomegalovirus , Antivirais/uso terapêutico , Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/tratamento farmacológico , Humanos , Lactente , Medicaid , Estados Unidos , Valganciclovir/uso terapêuticoRESUMO
Fetal cytomegalovirus infection may be detected by ultrasonographic signs in various organs. Though uncommon, cardiac compromise may take various presentations, from isolated pericardial effusion to cardiomyopathy with calcifications. We report a case of fetal cytomegalovirus infection with cardiac involvement.
La infección fetal por citomegalovirus puede ser detectado por signos ultrasonográficos en diversos órganos. El compromiso del corazón es informado con poca frecuencia, pero puede abarcar desde efusión pericárdica aislada hasta miocardiopatía con calcificaciones. Comunicamos un caso de citomegalovirus fetal con afectación cardiaca.
RESUMO
OBJECTIVE: To evaluate the impact of race and ethnicity upon the prevalence and clinical spectrum of congenital cytomegalovirus infection (cCMV). STUDY DESIGN: From 2007 to 2012, 100 332 infants from 7 medical centers were screened for cCMV while in the hospital. Ethnicity and race were collected and cCMV prevalence rates were calculated. RESULTS: The overall prevalence of cCMV in the cohort was 4.5 per 1000 live births (95% CI, 4.1-4.9). Black infants had the highest cCMV prevalence (9.5 per 1000 live births; 95% CI, 8.3-11.0), followed by multiracial infants (7.8 per 1000 live births; 95% CI, 4.7-12.0). Significantly lower prevalence rates were observed in non-Hispanic white infants (2.7 per 1000 live births; 95% CI, 2.2-3.3), Hispanic white infants (3.0 per 1000 live births; 95% CI, 2.4-3.6), and Asian infants (1.0 per 1000 live births; 95% CI, 0.3-2.5). After adjusting for socioeconomic status and maternal age, black infants were significantly more likely to have cCMV compared with non-Hispanic white infants (adjusted prevalence OR, 1.9; 95% CI, 1.4-2.5). Hispanic white infants had a slightly lower risk of having cCMV compared with non-Hispanic white infants (adjusted prevalence OR, 0.7; 95% CI, 0.5-1.0). However, no significant differences in symptomatic cCMV (9.6%) and sensorineural hearing loss (7.8%) were observed between the race/ethnic groups. CONCLUSIONS: Significant racial and ethnic differences exist in the prevalence of cCMV, even after adjusting for socioeconomic status and maternal age. Although once infected, the newborn disease and rates of hearing loss in infants are similar with respect to race and ethnicity.
Assuntos
Infecções por Citomegalovirus/etnologia , Etnicidade , Programas de Rastreamento/métodos , Grupos Raciais , Adulto , Infecções por Citomegalovirus/congênito , Feminino , Seguimentos , Humanos , Recém-Nascido , Masculino , Prevalência , Estudos Retrospectivos , Estados Unidos/epidemiologiaAssuntos
Encefalopatias/diagnóstico por imagem , Calcinose/diagnóstico por imagem , Infecções por Citomegalovirus/diagnóstico , Recém-Nascido Pequeno para a Idade Gestacional , Pneumopatias/diagnóstico por imagem , Encefalopatias/complicações , Encefalopatias/fisiopatologia , Calcinose/etiologia , Calcinose/fisiopatologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/tratamento farmacológico , Seguimentos , Ganciclovir/uso terapêutico , Humanos , Recém-Nascido , Infusões Intravenosas , Pneumopatias/fisiopatologia , Masculino , Radiografia Torácica/métodos , Medição de Risco , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X/métodos , Resultado do TratamentoRESUMO
BACKGROUND: CMV is the most common cause of congenital infection in the whole world (0.2 to 2.2 %). That infection may be symptomatic or asymptomatic at birth and, although asymptomatic cases at birth are more common, some children may develop late sequelae, and require medical intervention. This study aimed to determine the prevalence of CMV congenital infections in children who were born in a public hospital in Ilhéus, Brazil, and to evaluate the clinical progression in infected newborns. METHODS: CMV congenital infection was determined by detecting viral DNA through nested PCR. RESULTS: The viral DNA was detected in 25 newborns, showing a prevalence of 1.19 % (25/2100) of CMV congenital infection. In regards to the risk factors from mothers, only the variables: age of mothers (p = 0.003), number of children (p = 0.011), and use of medications (p < 0.001) were associated with the congenital infection. Approximately 12 % of children presented symptoms. One death and two auditory alterations were detected during the monitored period. Only 50 % of children diagnosed attended their medical follow. CONCLUSIONS: The prevalence found confirms the findings from other studies which involved other poor populations. Two children presented impaired hearing during the monitored period; that was one of the main sequelae from the infection. It is noteworthy that there was low adherence to medical follow-up which may underestimate data on complications of the infection CMV. Late symptoms can be mistaken for other diseases or even go unnoticed.
Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/economia , Citomegalovirus/isolamento & purificação , Adolescente , Brasil/epidemiologia , Criança , Pré-Escolar , Citomegalovirus/genética , Citomegalovirus/fisiologia , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/virologia , Feminino , Humanos , Lactente , Masculino , Pobreza , Prevalência , População Rural/estatística & dados numéricosRESUMO
OBJECTIVE: To determine the role of viral infections in causing fetal and infant death. STUDY DESIGN: We assessed a well-validated population database of fetal (≥20 weeks gestation) and infant death for infective deaths and deaths from viruses over a 21-year period (1988-2008). We analyzed by specific viral cause, timing (late fetal loss [20-23 weeks], stillbirth [≥24 weeks], neonatal death [0-27 days], and post-neonatal infant death [28-364 days]) and across time. RESULTS: Of the 989 total infective deaths, 108 were attributable to viral causes (6.5% of late fetal losses, 14.5% of stillbirths, 6.5% of neonatal deaths, and 19.4% of postneonatal infant deaths). Global loss (combined fetal and infant losses per 100,000 registerable births) was 139.6 (95% CI, 130.9-148.3) for any infective cause and 15.2 (95% CI, 12.3-18.1) for viral infections. More than one-third (37%) of viral-attributed deaths were before live birth, from parvovirus (63%) or cytomegalovirus (33%). Parvovirus accounted for 26% (28 of 108) of all viral deaths. Cytomegalovirus was associated with a global loss rate of 3.1 (95% CI, 1.8-4.4) and an infant mortality rate of 1.3 (95% CI, 0.4-2.1) per 100,000 live births; 91% of cases were congenital infections. Herpes simplex virus caused death only after live births (infant mortality rate, 1.4; 95% CI, 0.5-2.3). No changes in rates were seen over time. CONCLUSION: We have identified a substantial contribution of viral infections to global fetal and infant losses. More than one-third of these losses occurred before live births. Considering our methodology, our estimates represent the minimum contribution of viral illness. Strategies to reduce this burden are needed.
Assuntos
Morte Fetal/epidemiologia , Morte Fetal/virologia , Natimorto/epidemiologia , Viroses/mortalidade , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Estudos RetrospectivosRESUMO
La infección perinatal más frecuente es causada por citomegalovirus (CMV), en el feto y el recién nacido esta infección es la principal causa de sordera y compromiso en el desarrollo psicomotor; el tamizaje, diagnóstico y manejo no se han protocolizado en el control prenatal. El pronóstico de estos pacientes dependerá de un manejo adecuado. Se presentan tres casos con el objetivo de revisar el diagnóstico prenatal y el manejo en el neonato. Materiales y métodos: se muestran tres casos de infección congénita por citomegalovirus diagnosticados en el Hospital Universitario Hernando Moncaleano de Neiva-Huila, centro de referencia de la región suroccidental de Colombia. Se realizó una búsqueda electrónica en las bases de datos de PudMed, Embase, Medline, Lilacs, Cochrane. Resultados: se encontraron 31 artículos, dos guías basadas en evidencia, seis revisiones sistemáticas, dos consensos de la Asociación Española de Pediatría, cuatro estudios de casos y controles, cuatro estudios de cohortes, doce revisiones narrativas, un estudio analítico de decisiones y de costos. Conclusión: el tamizaje rutinario para CMV en el control prenatal no está recomendado. Se debe hacer tamizaje en mujeres gestantes de alto riesgo. El método de tamizaje son la inmunoglobulina IgM específica y el test de avidez por IgG, si esta es baja confirma infección reciente. La prueba confirmatoria es la PCR para CMV. En recién nacidos la prueba de tamizaje es la PCR y el patrón de oro es el cultivo viral. En mujeres con infección gestacional se debe aplicar inmunoglobulina específica para protección fetal.
The most frequently occurring perinatal infection is caused by cytomegalovirus (CMV); this infection is the main cause of deafness and compromise during psychomotor development in the fetus and the newborn. Screening, diagnosis and management have not been protocolized in prenatal control. The prognosis for such patients will depend on their suitable management. Three cases are presented with the aim of reviewing prenatal diagnosis and newborn management. Materials and methods: Three cases of congenital CMV infection are presented; they were diagnosed at the Hernando Moncaleano teaching hospital in Neiva (Huila department) which is a reference centre for Colombias south-western region. A search was made of Medline/PudMed, Embase, Lilacs and the Cochrane library databases. Results: 31 articles were found: 2 evidence-based guidelines, 6 systematic reviews, 2 consensus opinions/guidelines from the Asociación Española de Pediatría, 4 case-control studies, 4 cohort studies, 12 narrative reviews and 1 analytical decisions and costs study. Conclusion: Routine screening for CMV during prenatal control is not recommended; screening should be done in high-risk pregnant females. Usual screening methods would include specific immunoglobulin IgM (ELISA) and the G (IgG) antibody avidity test. If such test is low, then this would confirm recent infection; the confirmatory test would be PCR for CMV. PCR is used as the screening test in the newborn and the gold standard would be viral culture. Specific immunoglobulin should be used for fetal protection in females suffering gestational infection.
Assuntos
Feminino , Gravidez , Recém-Nascido , Citomegalovirus , Assistência Perinatal , GravidezRESUMO
El citomegalovirus (CMV) es la infección viral congénita más frecuente con una prevalencia de 0,5% al nacimiento. La primoinfección aparece entre el 1-4% de las gestantes seronegativas. El 40% de estos fetos se infectan y un 10% presentan síntomas al nacimiento. Presentamos un caso de infección congénita por CMV con hidrops fetal, con afectación neonatal del sistema nervioso central. Se trató con ganciclovir intravenoso y posteriormente con valganciclovir oral hasta los 6 meses, con buenos resultados al año de vida. Se realiza una revisión bibliográfica del diagnóstico y pronóstico de los recién nacidos con infección congénita por CMV y las expectativas y experiencia actual del tratamiento con ganciclovir y valganciclovir.
Cytomegalovirus (CMV) is the leading cause of congenital infection affecting 0.5% of all live births. Primary CMV infection occurs in 1-4% of seronegative woman during pregnancy and may be transmitted to the fetus in 40%. Up to 10% of intrauterine CMV infections result in symptomatic congenital disease at birth. We present a case of congenital CMV infection in the third trimester of gestation with central nervous disease involvement, who was treated with intravenosus ganciclovir followed by oral valganciclovir for six months with successful results in the first year of life. We review the literature on the diagnosis and prognosis of newborns with congenital CMV infection and the expectations and current experience of treatment with ganciclovir and valganciclovir.
Assuntos
Humanos , Feminino , Gravidez , Adulto Jovem , Hidropisia Fetal/etiologia , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/tratamento farmacológico , Valganciclovir/uso terapêutico , Ganciclovir/uso terapêutico , Infecções por Citomegalovirus/diagnósticoRESUMO
ANTECEDENTES: Citomegalovirus (CMV) es la infección congénita más frecuente, demostrado en el 1% de recién nacidos en países desarrollados. Es la primera causa de sordera y alteraciones del desarrollo neuro-lógico infantil. Recientes estudios han demostrado que la seropositividad no evita una reinfección materna ni la enfermedad congénita, por lo que la caracterización de la seroprevalencia permite saber si la infección congénita proviene mayoritariamente de primoinfección o de reinfección. OBJETIVOS: Conocer la seroprevalencia al parto en 583 mujeres beneficiarías del Hospital Padre Hurtado durante mayo y junio del 2006. MÉTODOS: Estudio prospectivo, observacional, en que se estudio la presencia de IgG anti CMV en sangre materna al parto. RESULTADOS: Se obtuvo una seroprevalencia de 95%, sin casos de infección sintomática al nacer. CONCLUSIÓN: La seroprevalencia es elevada, lo que sugiere que la reinfección sería la forma principal de infección congénita. Un estudio en recién nacidos con cultivos virales o PCR permitiría conocer la tasa de infección congénita real, y no un estudio basado en seroconversión pues omitiría todos los casos que reinfección, que serían mayoritarios.
BACKGROUND: Cytomegalovirus is the most frequent congenital infection, affecting 1% of the population in developed countries, and the leading cause of deafness and brain development abnormalities in children. Recent studies have demonstrated that seropositivity do not avoid reinfection and congenital disease. OBJECTIVE: To study the seroprevalence in 583 pregnant women at delivery at Padre Hurtado Hospital, during 2006. METHODS: Prospective, observational study, in which maternal blood at delivery was studied for the presence of anti CMV IgG. RESULTS: There was 95% seroprevalence, without any case of symptomatic infection. CONCLUSION: The high prevalence supports that most of the cases of congenital disease would occur in seropositive women, supporting that reinfection is the main way of neonatal compromise. This supports that a study with direct detection in liveborns would be suitable to reveal the impact of cytomegalovirus in our population and not that of seroconversión.