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Cytomegalovirus Georges Hobeika Omar El Baba • Group of infections transmitted from mother to the fetus with similar clinical manifestations • Toxoplasma, Rubella, Cytomegalovirus, Herpes simplex virus TORCH complex • CMV is a member of the herpes virus family. as with rubella it is likely that the virus infects the placenta and then the fetus. • Fetuses with the virus are often delivered prematurely. • CMV is the most common viral infection of the fetus occurring in approximately 1% of the neonates. Modes of maternal transmission • Sexual Contact • Organ transplant Matenal manifestations • Usually asymptomatic; mononucleosis-like illness • May cause atypical pneumonia in patients with posttransplant immunosuppression or chemotherapy Neonatal manifestations • Hearing loss • Hyperbilirubinemia • Seizures • Microcephaly • Petechial rash • Hydrocephalus • “Blueberry muffin” • Mental deficiency rash • Hepatosplenomegaly • Chorioretinitis • Cerebral palsy • Periventricular calcifications • Detection of the virus in the urine or saliva • Detection is often accomplished by traditional virus culture methods but can take several weeks to obtain a result Diagnosis • Rapid culture methods using centrifugation to enhance infectivity and monoclonal antibody to detect early antigens in infected tissue culture can give results in 24 hours • PCR can be used to detect small amount of CMV DNA in the urine • Detection within the first three weeks after birth is considered proof of congenital CMV infection Treatment • Infants less than or equal to 30 days of age should be offered treatment as a standard of care if they have: • symptomatic focal organ disease (severe hepatitis, severe bone marrow suppression (anaemia, neutropenia, thrombocytopenia), colitis or pneumonitis) or • CNS disease (microcephaly, radiological abnormalities on MRI or Cranial USS, abnormal CSF parameters or a positive CMV CSF PCR, chorioretinitis, or a sensorineural hearing loss) • Treatment on advice of Infectious Diseases Paediatrician: • Valganciclovir oral 16 mg/kg/dose twice daily for at least 6 weeks (treatment will be extended to 6 months in most cases) • Ganciclovir IV 6 mg/kg/dose twice daily • Ganciclovir IV at initiation (starting dose: 6mg/kg/dose IV twice daily) followed by oral Valganciclovir (VGCV) (16mg/kg/dose twice daily) (on advice of Infectious Diseases Paediatrician)
