Congenital cytomegalovirus infection: contribution and best timing of prenatal MR imaging

Cannie, Mieke; Devlieger, Roland; Leyder, Mina; Claus, Filip; Leus, Astrid; Catte, Luc De; Cossey, Veerle; Foulon, Ina; Valk, E.; Foulon, Walter; Cos, T.; Bernaert, Anja; Oyen, Raymond; Jani, Jacques

doi:10.1007/s00330-015-4187-0

Cited by 73 publications

(100 citation statements)

References 27 publications

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“…The most frequent finding on MRI was white matter hyperintense T2 signal. In CMV positive fetuses, Cannie et al found that isolated hyperintense T2 signal of the temporal lobe was associated with sensorineural hearing loss in 14.3% of cases, and all these babies had otherwise normal neurological outcome. These findings correlate with our study.…”

Section: Discussionmentioning

confidence: 99%

Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation

et al. 2020

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Objective To describe the prognosis of subtle findings on fetal brain imaging in pregnant women with primary CMV infection during pregnancy. Methods This was a retrospective study. The data included: timing of infection, amniocentesis results, imaging findings, obstetric outcome, and developmental assessment. Results For the 27 included patients, the time of infection was: periconception, first, second, third trimesters or unknown in 14.8%, 29.7%, 40.7%, 7.4%, and 7.4%, respectively. Seventy‐four percent had only MRI findings; white matter hyperintense T2 signal (HT2) (51.8%), mild ventriculomegaly (18.5%), HT2 and temporal cyst (7.4%), dilated occipital horn (7.4%), Periventricular pseudo cyst (PVPC) with dilated occipital horn (3.7%), isolated PVPC (7.4%), choroid plexus cyst (3.7%). In 26% of fetuses, additional ultrasound findings were observed: Lenticulostriatal vasculopathy (LSV) (11.1%), LSV with PVPC (3.84%), isolated PVPC (3.84%), mild ventriculomegaly (3.84%), and bilateral temporal cysts (3.84%). In 66.6%, the MRI had false‐positive findings (due to noninfected neonates). All children are developing normally, and one has a hearing deficit. Postnatal ultrasound (US) was normal in 21/27, with LSV in five, and a resolving subependymal cyst in one patient. Conclusion Subtle imaging findings are more common on MRI than US and the prognosis is most likely favorable. Performing amniocentesis will significantly reduce the false‐positive rate.

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Section: Discussionmentioning

confidence: 99%

Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation

et al. 2020

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“…It can occur immediately after birth in symptomatic CMV infected children, but approximately half of reported cases of hearing loss due to cCMV infection are late-onset and, therefore, cannot always be detected at birth through newborn hearing screening (9). A recent study describes how the timing of seroconversion in primary maternal CMV infection is a strong predictor of postnatal sequelae, with a higher risk when seroconversion occurs in the first trimester rather than later in pregnancy (10). …”

Section: Discussionmentioning

confidence: 99%

“…In pregnancies with CMV-proven seroconversion, prenatal prediction of SNHL and neurological impairment by prenatal MRI showed comparable accuracy at the end of the second or in the third trimester, with a high negative predictive value. It has been shown that MRI and the time of onset of seroconversion in pregnancy are independent predictors of postnatal SNHL, and that only MRI is an independent predictor of neurological impairment (10). Furthermore, ventriculomegaly and calcifications were estimated as non-specific findings for CMV and accordingly were not graded separately (10).…”

Section: Discussionmentioning

confidence: 99%

“…It has been shown that MRI and the time of onset of seroconversion in pregnancy are independent predictors of postnatal SNHL, and that only MRI is an independent predictor of neurological impairment (10). Furthermore, ventriculomegaly and calcifications were estimated as non-specific findings for CMV and accordingly were not graded separately (10). …”

Section: Discussionmentioning

confidence: 99%

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Symptomatic Congenital Cytomegalovirus Infection in Children of Seropositive Women

et al. 2017

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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.

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“…MRI is advised whenever fetal intracranial abnormalities are detected by US and should be performed during the third trimester (54). MRI was shown to be more sensitive than US (45), though results might be more difficult to interpret, and specialized neuroradiology consultation is required.…”

Section: Prenatal Diagnosis Of Ccmvmentioning

confidence: 99%

Testing for Cytomegalovirus in Pregnancy

et al. 2017

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Congenital cytomegalovirus (CMV) infection represents a relevant cause of deafness and neurological damage in newborns. Intrauterine CMV transmission might result after primary or nonprimary infections, though at different rates (30% versus 0.2%, respectively). At present, a prenatal diagnosis of CMV infection is based mainly on maternal serology, the detection of CMV-DNA in amniotic fluid and fetal blood, and ultrasound (US) and magnetic resonance imaging (MRI). Recent evidences suggest that congenital CMV infection may be an immune-mediated disease and that evaluation of humoral and especially T-cell immunities may improve the overall prenatal diagnosis. This review summarizes the most recent advancements in the diagnosis of maternal and prenatal CMV infections.KEYWORDS human cytomegalovirus, laboratory assays, congenital infections, IgG avidity, CMV-ELISPOT, CMV-QuantiFERON, immunoserology, imaging T he human cytomegalovirus (CMV) is a ubiquitous betaherpesvirus causing morbidity and mortality in immunocompromised patients and congenitally infected fetuses and newborns, resulting in a broad range of disabilities, including sensorineural hearing loss (SNHL), visual impairment, and motor and cognitive deficits. Other transient symptoms of congenital CMV infection (cCMV) may include hepatosplenomegaly, thrombocytopenia, and jaundice. The global prevalence of cCMV has been estimated at 0.7% (1), and fetal CMV transmission may arise from a maternal primary or nonprimary infection. The highest rate of cCMV occurs after primary infections in seronegative mothers (30 to 40%), while nonprimary infections, including CMV reactivations or reinfections, result in cCMV in 0.2 to 2% of cases, suggesting that preconceptional immunity may play a role in preventing intrauterine transmission (2). If the main burden of congenital infections in Europe and North America results from primary infections, then nonprimary infections represent the main cause of cCMV in developing countries or in poor socioeconomical contexts, since the seroprevalences among the resident populations are much higher (3). The severities of infections in neonates and infants are highly variable. It has been estimated that 10 to 15% of congenitally infected neonates are symptomatic at birth, and 40 to 58% of them will experience permanent long-term sequelae. Moreover, 13.5% of children with asymptomatic infections will develop late-onset sequelae, mainly consisting of hearing impairments and neurologic deficits. The effectiveness of antiviral treatment during pregnancy is still debated. Most of the concerns are related to the potential genotoxicity and teratogenicity of the drugs. The clinical benefits of CMV-specific hyperimmune globulin treatment are also disputed, due to discordant results obtained from different studies (4,5).In the last decade, major efforts have been made to improve the early laboratory diagnosis of maternal and fetal infections. Despite these efforts, at present, many countries in the world have not yet adopted a consolidate...

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Congenital cytomegalovirus infection: contribution and best timing of prenatal MR imaging

Cited by 73 publications

References 27 publications

Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation

Subtle findings on fetal brain imaging in CMV infected pregnancies: What is the clinical significance? A retrospective analysis with outcome correlation

Symptomatic Congenital Cytomegalovirus Infection in Children of Seropositive Women

Testing for Cytomegalovirus in Pregnancy

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