Congenital cytomegalovirus infection: the state of the art and future perspectives

Abstract

Congenital cytomegalovirus (cCMV) infection is the most common congenital infection, with an estimated incidence of approximately one in 200 infants in high-income settings. Approximately one in four children may experience life-long consequences, including sensorineural hearing loss and neurodisability. Knowledge regarding prevention, diagnosis, and treatment increased in the recent years, but some challenges remain. In this review, we tried to summarize the current knowledge on both the obstetrical and pediatric areas, while also highlighting controversial aspects and future perspectives. There is a need to enhance awareness among the general population and pregnant women through specific information programs. Further research is needed to better define the classification of individuals at birth and to have a deeper understanding of the long-term outcomes for so defined children. Finally, the availability of valaciclovir medication throughout pregnancy, where appropriate, has prompted the assessment of a universal serological antenatal screening. It is recommended to establish a dedicated unit for better evaluation and management of both mothers and children.

Lissencephaly and Advanced-Stage Congenital Cytomegalovirus Infection in a Neonate

“…A peculiar finding with our patient was that she developed lissencephaly, a condition characterized by a smooth brain surface resulting from disruptions in fetal brain development. CMV infection is implicated in lissencephaly, as CMV pathogenesis interferes with the migration of neurons during this crucial developmental stage, directly affecting neural progenitor cells and impeding their normal function [ 13 ]. Additionally, CMV infection induces an inflammatory response in the fetal brain.…”

“…Additionally, CMV infection induces an inflammatory response in the fetal brain. This inflammatory cascade can result in secondary effects like hypoxia or ischemia in the developing brain, further exacerbating the condition [ 13 ]. Collectively, these factors contribute to the detrimental effects associated with lissencephaly.…”

Characterization of Natural Killer Cell Profile in a Cohort of Infected Pregnant Women and Their Babies and Its Relation to CMV Transmission

“…The treatment was initiated whenever the infection was classified as symptomatic at birth (retinal, auditory, CNS abnormalities, etc.) as defined by one of the most recent consensus conferences on the topic [32]. The treatment started within 3 months of age.…”

Viral microRNA regulation of Akt is necessary for reactivation of Human Cytomegalovirus from latency in CD34+hematopoietic progenitor cells and humanized mice

“…Latent infection is punctuated by sporadic reactivation events that are stringently controlled by robust T cell responses in immunocompetent hosts. However, HCMV reactivation remains a significant cause of morbidity and mortality in the immunocompromised, including solid organ and hematopoietic stem cell transplant recipients (4,5), and is the leading cause of viral congenital infection (6). Given its clinical importance, understanding how the virus manipulates infected HPCs during latency and reactivation is essential for developing novel approaches to target the latent reservoir.…”