May, 2020 a 1992 editorial entitled, congenital cytomegalovirus disease20 years is long enough, by yow and demmler lamented the lack of progress in preventing congenital cytomegalovirus cmv disease. Apr 02, 2020 for most people cmv infection is not a problem. Cytomegalovirus infection article about cytomegalovirus. Cytomegalovirus cmv is a ubiquitous herpesvirus spread by close interpersonal contact through saliva, blood, genital secretions, urine, or breast milk that infects up to 90% of the us population by the 8th decade of life and establishes lifelong latency in monocytes and granulocytes. Cytomegalovirus infection is a common feature of aids. Human cytomegalovirus is one of the vertically transmitted infections that lead to congenital abnormalities. However, some infants with congenital cmv infection who appear healthy at birth develop hearing or vision loss over time. Human cytomegalovirus an overview sciencedirect topics. Burden of congenital cytomegalovirus cmv infection and. Apr 06, 2018 immunity induced by primary human cytomegalovirus infection protects against secondary infection among women of childbearing age. Cmv can be harmful to an unborn baby and lead to severe health problems. Cmv is easily spread through an infected persons saliva or other body.
Sometimes it causes problems in babies if you catch it during pregnancy congenital cmv. But usually, its people with a weakened immune system, such as those with hivaids, who become ill from cmv infection. When a baby is born with cytomegalovirus cmv infection, it is called congenital cmv. Congenital cytomegalovirus infection the journal of. Treatment guideline for infants with congenital cmv disease ccmv this guideline is for the use of consultant paediatricians, in consultation with paediatric infection management team, for treating infants within the first 1 month of life with confirmed cmv disease. Congenital cytomegalovirus cmv infection is the most common vertically transmitted disease with the rate of the infection ranging from 0. Congenital cytomegalovirus infection cmv article pdf available in journal of perinatology 2. Cytomegalovirus cmv is a common infection, and, although serious disease is rare in immunocompetent individuals, cmv is a major pathogen for immunocompromised patients, including solid organ transplant recipients, hematopoietic cell transplant recipients, hivinfected patients, and patients treated with immunomodulating drugs.
Abstract the overall prevalence of congenital cytomegalovirus infection among the offspring of a highly immune young female population was 2. Hearing loss in children with asymptomatic congenital. Congenital cytomegalovirus infection congenital cmv infection. Pdf congenital cytomegalovirus infection drora fisher. Debate open access diagnosing congenital cytomegalovirus infection. Congenital cytomegalovirus cmv infection is the leading cause of nonhereditary sensorineural hearing loss and can cause other longterm neurodevelopmental disabilities, including cerebral palsy, intellectual disability, vision impairment, and seizures. In a phase 2 open label, nonrandomized trial, valaciclovir valacv was given to women carrying a cmvinfected fetus. Risk of chronic infection and subsequent liver disease is inversely proportional to age at time of infection 9095% of hep b infections chronic liver disease 25 50% of infections in 1 5 yo 6 10% in adults. Although antiviral treatment of congenitally cmv infected infants can ameliorate cmv. The disease burden due to cmv is tremendous, because disabilities due to congenital cmv ccmv infection are estimated to be more common than many other well recognized conditions such as downs syndrome, spina bifida, or fetal alcohol syndrome. Dec 11, 2018 cmv infection is therefore a concern because of the risk of infection to the unborn baby, people who work with children, and immunodeficient people such as transplant recipients and those with hiv.
To assess this relationship more precisely, a metaanalysis was performed. The chronic inflammatory process including cytomegalovirus cmv infection has been hypothesized to induce the progression of atherosclerosis in coronary heart disease chd. Congenital cytomegalovirus infection occurrence in an. Signs at birth, if present, are intrauterine growth restriction, prematurity, microcephaly, jaundice, petechiae, hepatosplenomegaly, periventricular calcifications, chorioretinitis, pneumonitis, hepatitis, and sensorineural hearing loss. Congenital cmv occurs when the infection is passed across the placenta from a pregnant woman to her developing baby. Cmv has been isolated from urine, blood harbored within leukocytes, stool, amniotic fluid, most bodily secretions e. The sequela encountered most frequently is hearing impairment, affecting approximately one out of five infants congenitally infected. Pdf cytomegalovirus is the most common cause of congenital infections in humans and it produces considerable morbidity in newborns. Cytomegalovirus cmv is the most common congenital infection in humans. Explore mayo clinic studies testing new treatments, interventions and tests as a means to.
However, the risk of developing snhl after age 5 years among casepatients was not different than in uninfected children. It may be activated and cause illnesses when there is a breakdown of the immune system. Treatment guideline for infants with congenital cmv disease. After infection, cytomegalovirus remains latent in the body because it cannot be completely eradicated even by a competent immune system. The clinical importance of early diagnosis of congenital neonatal infections and initiation of early therapy was recognized more than half a century ago.
Congenital varicella syndrome 2% if maternal infection at 2040 0. Pass, in principles and practice of pediatric infectious diseases fifth edition, 2018. Researchers are studying new medications and vaccines to treat and prevent cmv. Human cytomegalovirus hcmv infects most individuals within the first few years of childhood, with approximately 70% of adults having immunoglobulin ig g antibodies specific for cytomegalovirus antigens. Department of pediatrics, university of alabama at birmingham, birmingham, al. Cytomegalovirus cmv is the most common congenital viral infection in the united states. Communicable diseases factsheet cmv is a common viral. The rate of cmv infection in adolescents in industrialized countries is about 1015%, increasing to about 50% by 35 years of age. Hearing loss caused by congenital cytomegalovirus ccmv infection was first observed in 1964. Babies who do not have a normal hearing screening te st at birth swish can also be tested for congenital cmv, as hearing loss is the most common sign of congenital cmv. Images in clinical medicine from the new england journal of medicine congenital cytomegalovirus infection. It is related to the viruses that cause chickenpox and infectious mononucleosis mono.
Cytomegalovirus cmv is a ubiquitous betaherpes virus that infects the majority of humans. In adults with iatrogenic infection, illness usually occurs 38 weeks after blood transfusion and between 4 weeks and 4 months after organ transplantation. Research article congenital cytomegalovirus infection. The virus that causes cmv is part of the herpes virus family and, like other herpes viruses, may become dormant for a period of time and then be reactivated. Babies born with congenital cytomegalovirus cmv cdc. Congenital cytomegalovirus cmv is a viral infection that your child gets before birth. Incidence of cytomegalovirus infection among the general. Pregnant women diagnosed with primary cmv infection. Over half of adults have been infected with cmv by age 40. Cytomegalovirus cmv and pregnancy fact sheet fact sheets. However, the study design and the small number of treated women limit its applicability. Most people dont know they have cmv because it rarely causes problems in healthy people if youre pregnant or if your immune system is weakened, cmv is cause for concern. For infants who are infected by their mothers before.
In this issue of the journal, new developments in screening for and treatment of congenital cytomegalovirus cmv infection are reported. Congenital cytomegalovirus cmv infection is the most common congenital viral infection worldwide. Cytomegalovirus pronounced sytoemegalowvyrus, or cmv, is a common virus that infects people of all ages. Valacv was associated with a greater proportion of asymptomatic neonates when compared with a historical cohort 82 vs. Cmv is a member of the virus family herpesviridae and is the most common intrauterine infection. For most healthy people who acquire cmv after birth, there are few symptoms and no longterm health consequences. Some babies with congenital cmv infection show signs of disability at birth, while others are born healthy. Department of pediatrics, university of nebraska medical centerchildrens hospital and medical center, omaha, ne. Despite its clinical and public health importance, questions remain regarding the best diagnostic. Cytomegalovirus cmv infection, the most common congenital infection cause, occurs in 0. Cytomegalovirus cmv from the greek cyto, cell, and megalo, large is a genus of viruses in the order herpesvirales, in the family herpesviridae, in the subfamily betaherpesvirinae. Cytomegalovirus infection nord national organization for.
Cytomegalovirus infections definition of cytomegalovirus. State the major antiviral agents for treatment of cmv infection in the immunocompromised host. These specimens must be collected for testing within two to three weeks after the baby is born in order to confirm a diagnosis of congenital cmv infection. Infection with the cytomegalovirus cmv or human herpes virus 5 is generally asymptomatic in immunocompetent hosts, but can cause mild mononucleosis like symptoms. Others include toxoplasmosis, rubella, herpes simplex, and syphilis. Approximately 90% of congenitally infected infants are asymptomatic at birth.
Most people infected with cmv show no signs or symptoms. This viral infection can be spread through coughing, contact with blood, urine or faeces, or via the mucous membranes, such as the mouth and genitals. Congenital cmv is the main nongenetic cause of congenital neurosensory hearing loss and potentially serious lifelong neurological disability. Abnormally small head microencephaly enlarged spleen. This virus occurs worldwide and humans are the only source of human cmv. Delayedonset and progression of snhl among children with asymptomatic congenital cytomegalovirus infection continued to occur throughout adolescence. Congenital cytomegalovirus is the most common intrauterine infection and the leading nongenetic cause of sensorineural hearing loss. Apr 17, 2017 cytomegalovirus cmv is the most frequent cause of congenital infection worldwide, with an estimated incidence in developed countries of 0. For babies with signs of congenital cmv infection at birth, antiviral. Some babies without signs of congenital cmv infection at birth may have hearing loss. Although most infants with symptomatic congenital cytomegalovirus ccmv infection. Cytomegalovirus cmv is a common virus that is usually harmless.
Congenital cytomegalovirus is the most frequent, yet underrecognised, infectious cause of newborn malformation in developed countries. Cmv infection is not a reportable condition case definition a case of cytomegalovirus is defined as an illness characterized by clinical symptoms compatible with cytomegalovirus infection including an infectious mononucleosislike syndrome with prolonged fever and mild hepatitis in adults and is laboratory confirmed by one or more methods. Although commonly asymptomatic, congenital cmv infection is the leading cause of nonhereditary snhl. Once you have the virus, it stays in your body for the rest of your life. Describe the specific risk of neurodevelopmental impairment in infants with congenital cmv infection. Cmv affects young children mainly, but it is estimated that by age 30 in the united states, half of. Cytomegalovirus cmv infection is a disease caused by a type of herpes virus. As a leading cause of congenital infections worldwide, ccmv infection meets many of the. The burden of disease related to congenital cmv in substantial, as it is the leading nongenetic cause of sensorineural hearing loss and an important cause of neurodevelopmental disabilities in children. Congenital cmv infection can be diagnosed by testing a newborn babys saliva, urine preferred specimens, or blood. Cytomegalovirus infection and coronary heart disease risk. Both primary and recurrent infection in the mother can be transmitted to the fetus, but primary infection has a higher rate of transmission 40% vs.
Today ccmv is the most common cause of nonhereditary sensorineural hearing loss in childhood. Our objective was to provide an overview of the prevalence of ccmvrelated hearing loss, to better define the nature of ccmvassociated hearing loss, and to investigate the. Congenital cytomegalovirus cmv infection is a leading cause of hearing loss and neurologic disabilities in children worldwide. Some babies with signs of congenital cmv infection at birth may have longterm health problems, such as.
Despite its clinical and public health importance, questions remain regarding the best diagnostic methods for identifying maternal and neonatal infection, and regarding optimal prevention and therapeutic strategies for infected mothers and neonates. Primary infection in individuals with normal immune function is usually asymptomatic. The overall prevalence of congenital cytomegalovirus infection among the offspring of a highly immune young female population was 2. Public health significance and occurrence of cytomegalovirus infection although infection with cmv is very common around the world, symptomatic disease is rare. Prior maternal exposure to cmv does not preclude neonatal infection. Cytomegalovirus infection definition of cytomegalovirus. Congenital cytomegalovirus infection oxford academic journals. Data on the birth prevalence and risk factors of congenital cmv infection in the netherlands are scarce. Keywords congenital infections, cytomegalovirus, placental immunology, vaccines c ongenital infection with human cytomegalovirus cmv infection is common. Congenital cytomegalovirus infection the journal of pediatrics.
Cmv is passed from an infected mother through the placenta to her unborn baby. Cytomegalovirus cmv is a common opportunistic infection among hivinfected individuals, a major source of serious complications among organtransplant recipients, and a leading cause of hearing loss, vision loss, and mental retardation among congenitally infected children. Congenital cytomegalovirus ccmv infection is the most common intrauterine infection in the u. In infants the infection causes liver enlargement, jaundice and blood disorders, and is sometimes fatal. Cytomegalovirus cmv infection is the most common cause of congenital infection in the developed world, occurring in. Cmv infection may be acquired for the first time during pregnancy. Cytomegalovirus infection may be acquired prenatally or perinatally and is the most common congenital viral infection.
Women who develop an active cmv infection during pregnancy can pass the virus to their babies, who might then. Congenital cytomegalovirus infection is the most common congenital infection in neonates in the usa, affecting approximately 0. Most congenital cmv infections 7590% are asymptomatic at birth but 1025% of these infants will develop neurological sequelae such as sensorineural hearing loss, delayed psychomotor development and visual impairment. Cmv is the most common congenital infection in the u. Cytomegalovirus infection an overview sciencedirect topics. Maternal primary and nonprimary cytomegalovirus cmv infection during pregnancy can result in in utero transmission to the developing fetus. The risk of intrauterine transmission is highest when primary infection occurs during pregnancy, with a significantly increased risk of adverse fetal effects if fetal infection occurs during the first half of pregnancy.
Babies with congenital cmv who are sick at birth tend to have significant signs and symptoms, including. The incidence of congenital cmv infection varies by geography and the underlying cmv seroprevalence in the maternal population. Incidence of cytomegalovirus infection among the general population and pregnant women in the united states. As mentioned, % of babies born with congenital cmv infection will be. Of seronegative women, 14% will acquire a primary infection during pregnancy, and the majority of these women will be asymptomatic.
Yellow skin and eyes jaundice enlarged and poorly functioning liver. Congenital cmv infection can follow either a primary or recurrent maternal infection, but the likelihood of fetal infection and the risk of associated damage is higher after a primary infection. Describe the treatment of immunocompromised patients who have cmv infections. Congenital and perinatal cytomegalovirus infection cmv. Like all herpesviridae infections, cmv persists for the lifetime of its host. Congenital cmv infection is worldwide in distribution. Departments of pediatrics, keimyung university school of medicine, daegu, korea abstract cytomegalovirus cmv is currently the most common agent of congenital infection and the leading infectious cause of brain damage and hearing loss in children. Once cmv is in a persons body, it stays there for life. Cytomegalovirus cmv infection is usually harmless and rarely causes illness.
Congenital or transplacental cytomegalovirus infection is also a fairly common event. In the fetus, cmv infection may lead to cytomegalic inclusion disease, characterised by severe neurological abnormalities, intellectual disability, and hearing defects. Others include toxoplasmosis, rubella, and herpes simplex. Apr 06, 2018 the history must be tailored to the specific clinical circumstances and disease category. Maternal infection should be suspected if women have a mononucleosislike syndrome and negative epsteinbarr virus, hiv, and cytomegalovirus antibody or pcr testing, isolated regional adenopathy not due to another cause eg, hiv, or chorioretinitis. Cytomegalovirus infection american academy of pediatrics. Cmv is transmitted in blood, and rarely is a serious infection unless the host is previously immunocompromised e. Serologic testing is important in diagnosing maternal and congenital infection. However, two groups of people are at high risk of neurological or other severe symptoms that may lead to longterm effects. Neurological consequences of cytomegalovirus infection. Congenital cytomegalovirus infection refers to a condition where cytomegalovirus is transmitted in the prenatal period. Between 50 percent and 80 percent of adults in the united states have had a cmv infection by age 40.
Pediatric cytomegalovirus infection clinical presentation. Pdf cytomegalovirus cmv is the most frequent cause of congenital infection worldwide, with an estimated incidence in developing countries of. Once a person becomes infected, the virus remains alive, but usually dormant within that persons body for life. Congenital and perinatal cytomegalovirus infection chun soo kim, m. Women infected for the first time during pregnancy are especially likely to transmit cmv to their fetuses. Cytomegalovirus cmv is the most common congenital infection. Pdf congenital cytomegalovirus infection researchgate. Incidence estimates of congenital cmv infection range between 0. Congenital cmv is the most common congenital infection and the leading infectious cause of infant hearing loss and neurologic deficits, complicating up to 2% of all pregnancies globally. An estimate of its prevalence gleaned from a metaanalysis indicated that approximately 0. Congenital cmv ccmv can result in significant morbidity, mortality or longterm sequelae, including sensorineural hearing loss, the most common sequela. Related viruses include epsteinbarr causes glandular fever, varicellazoster causes chicken pox and herpes simplex causes cold sores.
The virus can be passed from persontoperson, usually through close contact with saliva, breast milk, urine or other body fluid, or through sexual contact with someone with the. May 01, 2020 cytomegalovirus cmv is a virus found around the world. A cmv infection increases your babys risk for hearing or vision problems. Maternal torch screening showed primary cytomegalovirus cmv infection with positive. Explain the appropriate methods for the diagnosis of congenital cmv infection.
Most people come into contact with cmv in their lifetime. Congenital cytomegalovirus infection in the netherlands. Congenital cytomegalovirus cmv is the most common viral infection, affecting nearly 40,000 infants each year in the united states. Other members of this family include herpes simplex viruses which cause cold sores and genital herpes, varicellazoster virus which causes chickenpox and shingles, and epsteinbarr virus which causes infectious mononucleosis. Congenital cytomegalovirus cmv infection is a leading cause of congenital sensorialneural hearing loss and developmental delay. Even though initial observational data suggested that. Most infants will have no permanent health consequences, but a small. They can slow reproduction of the virus, but cant eliminate it. Congenital cytomegalovirus infection article pdf available in archives of disease in childhood 5912. Torch toxoplasmosis, other infections, rubella, cytomegalovirus infection and herpes simplex. Cytomegalovirus cmv is the most common cause of congenital infection, affecting 0. Overall, 2% of casepatients developed snhl that was severe. Pdf congenital cytomegalovirus is the most common intrauterine infection and the leading nongenetic cause of sensorineural hearing loss. Numbers studies were conducted to analyze the association between cmv infection and risk of chd, but no clear consensus had been reached.
Cytomegalovirus infection knowledge for medical students. Cytomegalovirus infection cmv is a viral infection that rarely causes obvious illness. Once infected, your body retains the virus for life. Congenital cmv remains underdiagnosed, partially due to lack of screening and awareness, but also due to unrecognized prenatal findings suspicious for cmv infection in prenatal imaging. Cytomegalovirus cmv, a member of the human herpesvirus family, is the most common viral cause of congenital infection, affecting 0. Congenital cytomegalovirus infection paediatrics and child health. Symptomatic disease occurs in 10% of all congenitally infected infants, resulting in a spectrum of clinical manifestations that include microcephaly, chorioretinitis, hepatosplenomegaly and sensorineural. After primary infection, cmv establishes a state of lifelong latency in various host cells, with periodic subclinical reactivations that are controlled by a. The mri spectrum of congenital cytomegalovirus infection. As a result, a serology screening panel was established for toxoplasma gondii, rubella virus, cytomegalovirus, and herpes simplex virus torch that is still widely used in many institutions. Congenital cytomegalovirus infection swiss society of neonatology.
Pdf congenital cytomegalovirus infections mona lisa. Cytomegalovirus cmv infection diagnosis and treatment. Cmv is a common viral infection, especially among young children. Cytomegalovirus cmv is a member of the herpes family. Congenital cytomegalovirus infection in pregnancy and the. Cytomegalovirus cmv and congenital cmv infection cdc. Cmv is similar to the herpes virus that causes cold sores and chickenpox. Cytomegalovirus pronounced sitomegalovirus, or cmv, is a virus that belongs to the herpesviridae family, hence its older name, human herpes virus 5 hhv 5. Cmv is a member of the herpesvirus group, which also includes herpes simplex virus, varicellazoster virus which causes chickenpox and epstein. Other sequelae that may be evident only after the neonatal period can include chorioretinitis, neurodevelopmental delay with mental or motor impairment, and microcephaly. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Screening for cytomegalovirus infection in pregnancy the bmj. Risk factors for congenital cytomegalovirus infection in the offspring of young women.
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