Successful Treatment with Oral Valganciclovir of Primary CMV Enterocolitis in a Congenitally Infected Infant

Irizarry, Karina; Honigbaum, Stefany; Demmler-Harrison, Gail J.; Rippel, Sara; Wilsey, Michael

doi:10.3109/15513815.2011.587501

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…The trials conducted by Collaborative Antiviral Study Group (CASG) recommend six weeks therapy with IV Gancyclovir or six months therapy with enteral Valgancyclovir in infants with congenital CMV infection and central nervous system manifestations (CNS) or end organ dysfunction, without separate mention of CMV enterocolitis [7,8]. Successful treatment of CMV enterocolitis with IV or enteral Gancyclovir and enteral Valgancyclovir has been previously documented [9,10]. Similar response was seen in our case.…”

Section: Discussionsupporting

confidence: 69%

Cytomegalovirus Enterocolitis in a Term Neonate

et al. 2018

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Background Cytomegalovirus (CMV) enterocolitis is rare in term neonates. Case characteristics A term newborn with persistent pneumonia from birth developed enterocolitis on day 18 of life. Outcome Polymerase chain reaction (PCR) for CMV DNA was positive in urine sample. Antiviral therapy for six weeks resulted in successful treatment without any stricture formation. Message CMV enterocolitis should be considered as a differential diagnosis in atypical cases of necrotizing enterocolitis in neonates.

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Section: Discussionsupporting

confidence: 69%

Cytomegalovirus Enterocolitis in a Term Neonate

et al. 2018

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“…Four other reports 11,38,50,51 described a possible association between CMV infection and intestinal perforation: two ileal perforations, 11,43 one perforated appendicitis as a complication of CMV enterocolitis 51 and one Merkel's diverticulum perforation. 50 Déchelotte et al 41 described 3 cases of pseudo-meconium ileus caused by a CMV infection, two of which with antenatal ultrasound detection of increased echogenicity of the lower foetal abdomen.…”

Section: Discussionmentioning

confidence: 92%

“…When data was available, the onset of gastrointestinal symptoms in the first 24 hours of life 20,43,50,62 or in the first 7 days of life 49 was rarely reported and, respectively, in patients with: ileal ulceration, 43 51 CMV enterocolitis complicated by perforated appendicitis in a premature infant (30 WGA, onset at 9 weeks of age) Shetty et al, 2007 (Cardiff, UK) 52 CMV as cause of colonic stricture in a premature infant (27+2 WGA, birth weight 490 g, onset at 36 th days of life) Srinivasjois et al, 2008 (Perth, Australia) 53 CMV-associated enteritis and ileal stricture in a 23+5 WGA preterm newborn, birth weight 580 g, onset at 90 th day of life Abdulhannan et al, 2008 (Leeds, UK) 54 Primary CMV colitis in a 74 days old infant, born at term Nigro et al, 2010 (L'Aquila, Italy) 55 Description of three infants with prenatal or immediately postnatal CMV infection with severe enterocolitis (onset 1-3 months of life) Fischer et al, 2010 (Lausanne, Switzerland) 56 Acquired postnatal CMV infection in an extremely low birth weight infant, that presented with colitis in a multi-organ syndrome Tzialla et al, 2010 (Pavia, Italy) 57 Large bowel stricture and retinitis due to CMV in an immunocompetent infant, onset at 20 th day of life. Born at 37 WGA, birth weight 2490 g Berardi et al, 2011 (Modena, Italy) 58 Acquired CMV colitis and anaemia in a 2 months old infant with previous surgery for ileum-caecal valve atresia.…”

Section: Discussionmentioning

confidence: 99%

Neonatal gastrointestinal involvement and congenital cytomegalovirus

et al. 2016

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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 ...

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“…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 ).…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2014

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Human cytomegalovirus is the leading non-genetic cause of congenital malformation in developed countries. Congenital CMV may result in fetal and neonatal death or development of serious clinical sequelae. In this review, we identified evidence-based interventions for prevention of congenital CMV at the primary level (prevention of maternal infection), secondary level (risk reduction of fetal infection and disease) and tertiary level (risk reduction of infected neonates being affected by CMV). A systematic review of existing literature revealed 24 eligible studies that met the inclusion criteria. Prevention of maternal infection using hygiene and behavioural interventions reduced maternal seroconversion rates during pregnancy. However, evidence suggested maternal adherence to education on preventative behaviours was a limiting factor. Treatment of maternal CMV infection with hyperimmune globulin (HIG) showed some evidence for efficacy in prevention of fetal infection and fetal/neonatal morbidity with a reasonable safety profile. However, more robust clinical evidence is required before HIG therapy can be routinely recommended. Limited evidence also existed for the safety and efficacy of established CMV antivirals (valaciclovir, ganciclovir and valganciclovir) to treat neonatal consequences of CMV infection, but toxicity and lack of randomised clinical trial data remain major issues. In the absence of a licensed CMV vaccine or robust clinical evidence for anti-CMV therapeutics, patient education and behavioural interventions that emphasise adherence remain the best preventative strategies for congenital CMV. There is a strong need for further data on the use of HIG and other antivirals in pregnancy, as well as the development of less toxic, novel, antiviral agents.

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Successful Treatment with Oral Valganciclovir of Primary CMV Enterocolitis in a Congenitally Infected Infant

Cited by 8 publications

References 17 publications

Cytomegalovirus Enterocolitis in a Term Neonate

Cytomegalovirus Enterocolitis in a Term Neonate

Neonatal gastrointestinal involvement and congenital cytomegalovirus

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

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