Oral valganciclovir treatment for congenital cytomegalovirus infection

Abstract

Key words cytomegalovirus infection, oral valganciclovir, progressive hearing loss.Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection. Approximately 10-15% of congenitally infected neonatal infants exhibit clinical evidence of congenital infection at birth. 1 This group is more likely to experience sequelae, including microcephalus, sensor neural hearing loss, cognitive, motor and visual deficits and seizures. 2 Previous studies have shown that approximately half of the children with symptomatic congenital CMV infection develop hearing loss, and the majority of these children experience continued postnatal deterioration of their hearing. 3,4 Ganciclovir is an antiviral agent that acts against herpes viruses and has been used successfully to treat CMV infection. 5 In addition, it has been reported that ganciclovir therapy, begun in the neonatal period in symptomatic infants with a CMV infection involving the central nervous system, prevents hearing deterioration. However, the efficacy of ganciclovir for hearing deterioration in patients beyond the neonatal period is unknown. 6 In this report we present the case of a five-month-old girl who was treated with oral valganciclovir for progressive hearing loss resulting from congenital CMV infection. Case report Clinical course before oral valganciclovir treatmentA 31-year-old pregnant woman was admitted to our hospital at 37 weeks of gestation with suspected intrauterine growth retardation and fetal bilateral lateral ventricle enlargements. She was a healthy woman of gravida 2, para 1, and had a healthy 3-year-old daughter who attended a kindergarten. She had worked in a dental clinic as a dental hygienist, including during her pregnancy. Her cytomegalovirus-specific immunoglobulin (Ig)M and IgG at 31 weeks of gestation were negative and positive, respectively.The female baby was born by vaginal delivery at 38 weeks of gestation. The umbilical artery pH was 7.309 and the Apgar score at five minutes was 7. The bodyweight, height and head circumference at birth were 2338 g (below 10th percent tile), 44.5 cm and 29.5 cm (below 10th percent tile), respectively. The baby's general condition was relatively good, and did not show hepatosplenomegaly or external malformation at birth. Although an ultrasonography of the head revealed the bilateral lateral ventricle enlargements and hypocerebellum, the presence of intracranial calcification was unclear. She was diagnosed as having congenital CMV infection at the first week of life by newborn screening for congenital CMV by urine specimen, which was one of the ongoing projects of a research group in the Ministry of Health, Labor and Welfare in Japan. Pediatricians, ophthalmologists, microbiologists and otolaryngologists in our hospital started regular checkups on her.The patient's bodyweight and head circumference at 1 month of age were 3364 g and 34.7 cm, respectively. She showed normal eye movements from 2 months of age. However, her head control was insufficient, and an assessment by developmen...

Symptomatic Congenital Cytomegalovirus Infection in Children of Seropositive Women

“…Studies have shown that a 6-week course of ganciclovir, especially when started during the neonatal period, is effective in terms of decreasing the severity of neurological dysfunction and hearing loss in symptomatic and asymptomatic infants (12–14). Oral valganciclovir is more easily administered to infants with cCMV infection (15, 16), and results in plasma concentrations are similar to those obtained when using ganciclovir (17). It was suggested that the initial benefit of a 6-week course of ganciclovir could wane over the first years of life (4).…”

Treatment of symptomatic congenital cytomegalovirus infection beyond the neonatal period

“…Patients were screened for congenital CMV infection because of: microcephaly (4 patients), failure to pass newborn hearing screening tests (3), ventriculomegaly detected during pregnancy (2), hepatosplenomegaly (2), cholestasis (1), and intracranial calcifications in a skull X-ray obtained for cephalohematoma (1). All patients had neurological signs and symptoms at the time of diagnosis, including sensorineural hearing loss (11), abnormal neuroimaging studies (9), microcephaly (5) and psychomotor retardation (5). Neuroimaging findings included ventriculomegaly, periventricular calcifications, abnormal white matter echogenicity or MRI signal intensity and lenticulostriate vasculopathy.…”

Prevention of congenital cytomegalovirus complications by maternal and neonatal treatments: a systematic review

“…Of the 24 articles, four were RCTs, two were randomised cluster control trials, three were non‐randomised phase I/II trials, six were observational studies, three were case–control studies and six were case series (Table ). Thirty‐seven case reports were also identified and not included in this review but were detailed elsewhere (Supplementary Table ).…”