JLE

Médecine thérapeutique / Pédiatrie

MENU

Congenital cytomegalovirus infections – Update on diagnosis, therapy and prevention Volume 23, issue 1, Janvier-Février-Mars 2021

Tables

Author
Professeur émérite de pédiatrie
Ancien chef de service de réanimation et pédiatrie néonatales
* Correspondance

Congenital cytomegalovirus (CMV) is the most frequent, yet under-recognised, infectious cause of newborn malformation. Prevalence rate during pregnancy of CMV infection is 0,6 to 2%. Primary CMV infection is associated with a high maternal-to-child transmission rate (30 à 70%); up to 15% of these infected neonates will be symptomatic at birth and develop permanent sequelae that usually involve the central nervous system. During pregnancy, congenital infection is suspected more on foetal abnormality by ultra sound and MRN than invasive procedures via amniotic fluid puncture. Specific serology is not routinely recommended in France at the beginning of pregnancy. IgG, IgM and especially anti-CMV IgG avidity confirm maternal infection and its occurrence during pregnancy. At birth, a specific PCR in urines confirm the diagnosis; higher whole blood viral load before initiation of antiviral therapy has a predictive value for long-term outcomes. These investigations are recommended if a CMV infection was suspected/confirmed during pregnancy and also in neonates who have clinical signs – including isolated retarded growth foetus – consistent with viral infection. Children with symptomatic congenital CMV may have sequelae in 50% of cases, including deafness and neurological impairment; these complications are also observed in 10 % of asymptomatic children. Prediction of developmental disabilities, at birth, is difficult. A blood viral load, in the first month of life, more than 10 000 copies/ml in symptomatic forms and more than 17 000 copies in latent forms, increases the risk of sequelae.

Ganciclovir (GCV) and valganciclovir (VGCV) are efficient against CMV but its use in neonates and infants infected by CMV is always under investigations. The main questioning concerns the paucity of clinical data on medium/long term toxicity in infants and children. In symptomatic infants, GCV/VGCV during 6 months decreases the rate of severe deafness and improves neurological development in the first years of life.

CMV infection during pregnancy is reduced by hygienic measures avoiding particularly closed contact with infants who are the main reservoir of infection.