Neonatal gastrointestinal involvement and congenital cytomegalovirus

Abstract

Cytomegalovirus (CMV) is the most common cause of congenital viral infection, affecting 0.2 to 2.3% of all live births in developed countries. Very low birth weight and extremely low birth weight newborns are at higher risk of symptomatic CMV infection, most commonly secondary and acquired through breast milk. Gastrointestinal involvement is rare in acquired CMV infections, but it could be an important manifestation of postnatal infection in preterm infants admitted to neonatal intensive care units. Early onset of CMV gastrointestinal signs/symptoms is very rare. In a review of the literature it is described in 5 newborns in the first 24 hours of life, and 6 considering the onset in the first week of life. This review describes also a case report of congenital CMV in an immunocompetent newborn with onset of gastrointestinal signs immediately after birth: a possible association between viral infection and enteric manifestations was considered in the differential diagnosis. A review of the literature of the different case reports found has done, with description and comparison of the different patients and clinical presentations. IntroductionCytomegalovirus (CMV) is the most common cause of congenital viral infection, affecting 0.2 to 2.3% of all live births in developed countries; 1-12 it is also estimated as the leading infectious cause of nongenetic hearing loss, mental retardation 1,2,13-15 and non-genetic congenital malformations. 16 Very low birth weight and extremely low birth weight newborns are at higher risk of symptomatic CMV infection, most commonly secondary, acquired through breast milk. 17 Maternal primary CMV infection or reinfection during pregnancy are the cause of neonatal congenital infection, with a mean risk of transmission of 40% (24-75%), 3,18 lower in the first three months (36%) than in the last three months of gestation (78%). 3,19 Considering all the infected newborns, only 5 to 10% are symptomatic at birth, in particular with neurodevelopmental delay signs and sensorial hearing loss. Among asymptomatic patients, 10% to 15% will show developmental disorders, mainly sensory hearing loss. 1,2,8,10,11,13,14,[20][21][22] Most of congenital infections (85-90%) remain asymptomatic: 3,16,23 among them, 8 to 15% will show developmental disorders or sensorial hearing loss. [1][2][3]13,14 Possible signs and symptoms of congenital CMV infection with onset at birth are the following: 3,16,24 unilateral or bilateral sensorial hearing loss, visual loss, microcephaly, hepatomegaly and/or hepatitis, splenomegaly, thrombocytopenia, jaundice, petechiae, motor defects, mental disability, chorioretinitis, strabismus, optic atrophy, dental defects. Rarely it could present as a severe multi organ dysfunction with polyserositis.Gastrointestinal involvement is considered very rare in congenital and acquired CMV infection. 7,8,10,11,20 On the other hand, CMV gastrointestinal symptoms could be an important manifestation of postnatal infection in patients admitted to neonatal intensive care units 25 or a ...

Refractory Ileal Perforations in a Cytomegalovirus-Infected Premature Neonate Resolved After Ganciclovir Therapy

“…Bonnard et al also reported that CMV may cause intestinal atresia and perforation when combined with other local factors such as ischemia (12). CMV infection in the gastrointestinal tract is associated with vasculitis of an affected segment and cause perforation in the immunocompromised host or premature or low birth weight infants (13). Thus, although the incidence or the causality of CMV for gastrointestinal involvement in premature infants are not demonstrated to date, there are accumulating findings which support a hypothesis that CMV has an important role in such gastrointestinal disease at least by exacerbating the course of disease.…”

“…Among the causative etiology of severe gastrointestinal complication in premature infants (e.g., prematurity, ischemia, indomethacin for PDA), CMV infection is regarded as rare ( 13 ) and generally not included in the differential diagnosis of gastrointestinal disease in premature newborns, however recent study showed that CMV infection was highly prevalent in surgical intestinal specimen from infants with NEC or SIP and may exacerbate the course of NEC ( 11 , 15 ). Since definitive diagnosis of CMV infection in the intestine requires obtaining bowel tissue, there may be underdiagnosis of CMV-associated gastrointestinal disease in premature infants ( 11 ).…”

Jejunal diaphragm disease associated with cytomegalovirus infection

“…Although the existence of CMV in the stricture lesions was not confirmed, CMV was detected by immunohistochemistry in biopsy specimens from the jejunal ulcer and both symptoms and endoscopic findings improved after ganciclovir treatment, strongly suggesting that the multiple thin strictures of the jejunum were induced by CMV infection. There are a few reports of colonic and ileal strictures like DD that occurred secondary to CMV infection in infants 6 and adults 7 . To our knowledge, this is the first report of jejunal DD related to CMV infection.…”

Sigmoid Colonic Stricture Mimicking Hirschsprung Disease in a Cytomegalovirus Positive Immunocompetent Infant

“…To the Editor: Cytomegalovirus (CMV) is the commonest intrauterine viral infection with less than forty reported cases of gastrointestinal involvement in the postnatal period [1,2].…”

“…Perinatal CMV transmission is transplacental or postnatal [1]. Infected infants are rarely symptomatic at birth and gastrointestinal involvement is anecdotal in the immunocompetent [3].…”