Congenital CMV, Lights and Shadows on Its Management: The Experience of a Reference Center in Northern Italy

Abstract

Congenital cytomegalovirus infection (cCMV) is the most common congenital viral infection, with a consistent rate of morbidity, mortality, and long-term sequelae, especially in the case of late diagnosis. Nevertheless, a universal screening for CMV is not currently recommended, and global awareness about this infection, as well as accurate and shared indications on follow-up and treatment, are still lacking. We reviewed data about 59 suspect cCMV cases who referred to our center from 2014 to 2021. We report 41 cases of confirmed cCMV diagnosed at birth, with clinical or radiological abnormalities in 36.6% of them. Other five patients received a late diagnosis and all presented neurological impairment. Twelve patients received therapy with Valganciclovir within the first month of life, with favorable outcome in nine cases. Therapy after the first month of life was attempted in four patients, with improvement in one case. The overall awareness about cCMV infection was 32.6%. Considering our population, maternal serological screening followed by targeted testing of neonates could be an effective strategy. Some aspects of cCMV infection management should be further investigated, such as indication of treatment after the first month of life or in asymptomatic patients. Awareness about the infection should be improved to implement preventive strategies.

Molecular diagnosis of Cytomegalovirus infection: clinical performance of Transcription Mediated Amplification (TMA) towards conventional qPCR chemistry on whole blood samples

“…Among adults genital secretions are a common fluid for CMV shedding, consistent with several studies that identified sexual risk factors for CMV seropositivity or seroconversion (10,13,19). Another important transmission route for primary infection consists in solid organ transplantation (SOT), especially in cases where there is a serological mismatch between donor and recipient (the recipient is CMV seronegative and the donor is seropositive) (20).…”

“…The heterogeneous CMV seroprevalence appear to be related with race, ethnicity, socioeconomic status and education level (11). Focusing on Italy, the seroprevalence of HCMV appear to be as high as 70-80% (12,13).…”

Congenital Cytomegalovirus and Hearing Loss: The State of the Art

“…Therefore, according to the general agreement, CMV serologic testing should be offered only to pregnant women with symptoms and/or signs suggestive of primary CMV infection (e.g., influenza-like illness and/or fetal abnormalities on prenatal ultrasound examination) [ 42 ]. However, most pregnant women want to have CMV serological screening once informed about cCMV infection [ 43 ]; some of them make use of the maternal serological screening even if it is not recommended by the national guidelines [ 28 , 30 , 38 , 44 , 45 ]. As a matter of fact, maternal CMV screening followed by targeted neonatal CMV screening (testing neonates whose mothers become seropositive during pregnancy) may help identify asymptomatic cCMV cases in an early stage; Naessens et al reported that this type of screening allowed the detection of 82% of all cCMV infections [ 46 ].…”

Molecular diagnosis of Cytomegalovirus infection: clinical performance of the Aptima transcription-mediated amplification assay toward conventional qPCR chemistry on whole blood samples

“…Human Cytomegalovirus (HCMV) is a ubiquitous herpesvirus that is highly widespread throughout the world with a seroprevalence rate among women of reproductive age ranging from 100% in Africa and Asia to 45.6%–95.7% in Europe and North America ( 1 ). Focusing on Italy, HCMV seroprevalence appears to reach 70%–80% ( 2 , 3 ).…”

“…As congenital HCMV infection, primary and non-primary maternal infection (exogenous reinfection with a different strain or endogenous viral reactivation) of the virus during pregnancy can result in in utero transmission to the developing fetus (vertical route) ( 4 , 5 ). In the postnatal period, HCMV is transmitted through exposure to different biological fluids (saliva, stool, and urine) as a consequence of community exposure or by genital secretions, especially in the adult stage ( 1 , 3 , 6 , 7 ). Another important route of transmission of primary infection is solid organ transplantation, especially in cases where there is a serological mismatch between donor and recipient (HCMV-seronegative recipient/HCMV-seropositive donor) ( 8 ).…”