Severe Postnatal Cytomegalovirus Infection in a Very Premature Infant

Abstract

Several studies have reported that postnatally acquired cytomegalovirus (CMV) infection can cause sepsis-like syndrome in premature infants. We here report a 622-gram birth weight male infant of 23 weeks’ gestation who had sepsis-like syndrome and pneumonia. Substantial CMV loads were detected in peripheral blood cells, plasma, and urine when the patient was in crisis, but was decreased in parallel to clinical improvement without using ganciclovir. CMV DNA was not detected from his umbilical cord or Guthrie card, even by highly sensitive real-time PCR. Molecular profiles were indistinguishable between the CMV strain isolated from his urine and that from maternal breast milk, indicating postnatal acquisition of CMV through breast milk. Although he had transient hearing impairment, his neurodevelopmental outcome of 30 months of corrected age was normal. Further accumulation of clinical and virological data in postnatal CMV infection is necessary for evaluating the severity and selecting patients requiring antiviral therapy.

Impaired Surfactant Production by Alveolar Epithelial Cells in a SCID-hu Lung Mouse Model of Congenital Human Cytomegalovirus Infection

“…ALI is a syndrome characterized by acute inflammation and lung tissue injury resulting in increased vascular permeability and an influx of inflammatory cells. Clinically severe ALI is manifested as ARDS, and ARDS caused by HCMV in immunocompetent infants was described recently (14), even though pneumonitis is a common clinical manifestation of HCMV infection in premature infants (3,22,34,65) and immunocompromised children (27,30). HCMV was also detected by histopathology in 30% of cases of critically ill patients with ARDS (46).…”

“…Although pneumonitis is rarely the sole manifestation of congenital HCMV disease in the neonate (62), histological examinations of HCMV-infected fetuses identified the lung as a major target organ, with a large number of HCMV-infected cells (8,25). The main burden of lung-associated HCMV diseases occurs during postnatal infection in premature infants (3,22,34,65) and in immunocompromised children (predominantly after organ or bone marrow transplantation) (27,30,67). Some authors reported high rates (up to 37%) of postnatal cytomegalovirus transmission from seropositive breastfeeding mothers to premature infants (31,41,69).…”

Active retinitis in an infant with postnatally acquired cytomegalovirus infection

“…1 Usually the course of the disease in term neonates is asymptomatic, whereas in prematures or in immunocompromised infants the disease can lead to a broad spectrum of symptoms, including potentially life-threatening disease. 2 We report the case of postnatal CMV infection in a term neonate. The baby presented with anemia and active retinitis, which showed rapid improvement under antiviral therapy.…”

Transmission of human cytomegalovirus via breastmilk and potential risks to very preterm infants

“…All additional parameters included were self-limiting and there was no impact on neonatal outcome parameters like intracranial hemorrhage, periventricular leucomalacia, retinopathy of prematurity and necrotizing enterocolitis (NEC) 30 . However, a large number of cases and case seriesincluding a case from our department which was observed later on -describe severe illness in VLBW infants including pneumonia requiring artificial ventilation, hepatitis and gastrointestinal involvement, with some infants needing antiviral treatment with (val)ganciclovir 11,26,28,[31][32][33][34][35][36][37] . The onset of viral excretion was detected at day 6 post partum (p.p.)…”