Congenital cytomegalovirus infection in pregnancy: a review of prevalence, clinical features, diagnosis and prevention

Abstract

Human cytomegalovirus (CMV) is under-recognised, despite being the leading infectious cause of congenital malformation, affecting ~0.3% of Australian live births. Approximately 11% of infants born with congenital CMV infection are symptomatic, resulting in clinical manifestations, including jaundice, hepatosplenomegaly, petechiae, microcephaly, intrauterine growth restriction and death. Congenital CMV infection may cause severe long-term sequelae, including progressive sensorineural hearing loss and developmental delay in 40-58% of symptomatic neonates, and ~14% of initially asymptomatic infected neonates. Up to 50% of maternal CMV infections have nonspecific clinical manifestations, and most remain undetected unless specific serological testing is undertaken. The combination of serology tests for CMV-specific IgM, IgG and IgG avidity provide improved distinction between primary and secondary maternal infections. In pregnancies with confirmed primary maternal CMV infection, amniocentesis with CMV-PCR performed on amniotic fluid, undertaken after 21-22 weeks gestation, may determine whether maternofetal virus transmission has occurred. Ultrasound and, to a lesser extent, magnetic resonance imaging are valuable tools to assess fetal structural and growth abnormalities, although the absence of fetal abnormalities does not exclude fetal damage. Diagnosis of congenital CMV infection at birth or in the first 3 weeks of an infant's life is crucial, as this should prompt interventions for prevention of delayed-onset hearing loss and neurodevelopmental delay in affected infants. Prevention strategies should also target mothers because increased awareness and hygiene measures may reduce maternal infection. Recognition of the importance of CMV in pregnancy and in neonates is increasingly needed, particularly as therapeutic and preventive interventions expand for this serious problem.

Zika virus infection and pregnancy: what we do and do not know

“…53 As the author stated, the risk of about 1% is much lower than that observed for other well-known maternal viral infections, such as CMV and rubella, that are known to cause fetal congenital syndrome at rates of 13% and 38-100%, respectively. 54,55 However, the population risk may be potentially high during epidemics, when a high number of ZIKV infection occurs among pregnant women. Moreover, the study considered only microcephaly, that could represent only the tip of the iceberg of the congenital ZIKV syndrome, and was based only on eight cases.…”

State of knowledge concerrning congenital cmv infection among pregnant women and those who plan pregnancy

“…Do objawów neurologicznych zalicza się małogłowie, wodogłowie, drgawki, hipotonie, letarg, zapalenie naczyniówki i siatkówki lub zanik nerwu wzrokowego, lekkie opóźnienie umysłowe oraz zwapnienia wewnątrzczaszkowe [33,34]. Zakażenie wrodzone CMV jest wiodącą niegenetyczną przyczyną utraty słuchu u dzieci.…”

Value of immunoglobulin G avidity for primary cytomegalovirus diagnosis in pregnant women compared to nested polymerase chain reaction

“…It was reported that the risk of foetal damage is greater if the primary infection occurs during the first trimester of pregnancy. Prevalence of congenital infection ranges from 0.2% to 2.5% in different populations (1,6,7,12,17,21,22). The seroprevalence of HCMV among women of childbearing age varies from 35% to 95% in different countries (4,11,20,27).…”

“…Serological assessment of specific antibodies toward HCMV is not sufficient. Supplementary serologic assays such as the specific IgG avidity enzyme immunoassay (EIA) or the micro neutralisation test have been used to differentiate between primary and recurrent or past infections and have been shown to be useful for determining the onset of infection (1,7,12,17,21,25).…”