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Congenital Cytomegalovirus Infection - Causes, Symptoms and Treatment

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Congenital cytomegalovirus infection affects newborn babies. Read below to learn about the same.

Medically reviewed by

Dr. Sajeev Kumar

Published At February 22, 2023
Reviewed AtMarch 7, 2023

Introduction

Cytomegalovirus (CMV) belongs to the family of herpes virus diseases. It is intermittently inactive like herpes but is a lifelong incurable infection. It most frequently occurs at the time of birth. Hence, it is known as a congenital cytomegalovirus infection. Out of all the children with congenital CMV, 80 percent never experience any symptoms or problems. The remaining 20 percent may experience mental difficulties besides breathing, hearing, and vision issues. To ensure that the condition has a minimal impact on the baby's health, therapy should start soon after the detection of CMV.

What Are the Causes of Congenital Cytomegalovirus Infection?

These are exclusively related to women becoming pregnant for the first time and having never been exposed to CMV. Women infected at least six months before conception seem to be at low risk of CMV-related problems. The rate of neonatal CMV infection for this group, which comprises 50 to 80 percent of women of childbearing age, is one percent, and the infants in this group do not seem to have any serious illnesses or abnormalities. The virus can also be passed from mother to baby through breast milk or contact with vaginal secretions during childbirth. However, the clinical sickness these infections cause in infants is typically mild to nonexistent.

Blood transfusions and close contact with big groups of youngsters are other ways CMV can spread. In conclusion, when a woman who has never had a CMV infection contracts the virus during pregnancy, there is a chance that the baby will be born with CMV-related issues, the most prevalent of which are linked to hearing loss, visual impairment, or impaired mental and physical ability. On the other hand, healthy newborns and children who contract CMV after delivery show little to no signs or symptoms. However, preterm infants that contract CMV after delivery (particularly through breastmilk) may suffer from cognitive and motor deficits in later life.

What Are the Sign and Symptoms Associated With Congenital Cytomegalovirus Infection?

Saliva, urine, semen, and other bodily fluids are places for cytomegalovirus to live. It can be passed from an infected mother to the fetus during pregnancy. Most newborns have congenital CMV infection with no other health issues. Approximately 10 percent of newborns with congenital CMV infection will experience birth-related health issues, which include:

  • Rash.

  • Jaundice (yellowing of the skin or whites of the eyes).

  • Microcephaly (small head).

  • A low birth weight.

  • Restricted intrauterine growth.

  • Hepatosplenomegaly (enlarged liver and spleen).

  • Seizures.

  • Retinitis (damaged eye retina).

Infants born with congenital CMV illness will typically experience 40 to 60 percent of the following long-term health issues:

  • Loss of hearing.

  • Loss of vision.

  • Intellectual handicap.

  • Microcephaly (small head).

  • Inability to coordinate or fragility.

How to Make a Diagnosis of Congenital Cytomegalovirus Infection?

Within three weeks after delivery, DNA in urine, saliva (preferred specimen), or blood can be used to diagnose congenital CMV infection. The infection cannot be identified using a test that looks for CMV antibody detection. Samples taken more than three weeks after birth cannot be used to diagnose congenital CMV infection, because testing done beyond this point cannot differentiate between a congenital infection and an infection acquired during or after delivery.

The doctor will do the test if a person is expecting and is aware that they have CMV or had it in the past.Due to the virus's lack of symptoms, most CMV infections in mothers go undetected. However, the following tests can identify the virus:

  • Blood test examination of the mother's blood for antibody detection.

  • Swab culture involves collecting a sample using a cotton swab from the mother's or baby's throat.

  • Urine test examination of the mother's or the child's urine.

  • Imaging test.

What Are the Imaging Results of Congenital Cytomegalovirus Infection?

Various imaging tests are required, such as:

  • Ultrasound: Ultrasound will give the details of the fetus's development.

  • Computed Tomography (CT) Scan: Computed tomography will give a detailed analysis of the developing child.

  • Magnetic Resonance Imaging (MRI): It gives a developing baby’s soft tissue details.

Findings of Brain Imaging- The most prevalent hallmark is prenatal cerebral calcification (calcification in the brain), hydrocephalus (fluid accumulation) in fetuses, microcephaly (small head), or internal adhesions in the brain.

What Is the Treatment of Congenital Cytomegalovirus Infection?

Antiviral drugs, such as Ganciclovir or Valganciclovir, may improve hearing and developmental outcomes for infants who exhibit congenital CMV illness at birth. Ganciclovir has only been tested in newborns with symptomatic congenital CMV illness and can have substantial side effects. The usefulness of Ganciclovir or Valganciclovir in treating newborns with isolated hearing loss needs to be understood better. Numerous studies have demonstrated the effectiveness of hyperimmune globulin treatment in avoiding congenital illness in mothers with primary CMV infection.

What Are the Steps for Prevention of Congenital Cytomegalovirus Infection?

Center for Disease Control (CDC) has given guidelines for the prevention of pregnancy-related CMV infection, including the following:

  • Maintain proper personal hygiene during pregnancy, especially after coming in contact with diapers or oral secretions, by washing your hands with soap and water (particularly with a child in daycare).

  • Avoid using eating and drinking utensils together, sharing food, and coming into touch with toddlers' saliva.

  • Pregnant women who experience a mononucleosis-like illness should be tested for CMV infection and advised about potential dangers to the unborn child.

  • Laboratory testing for CMV antibodies can be done to identify if a woman has already had a CMV infection.

  • A cesarean section is unnecessary if CMV is found in a woman's cervix or urine at the time of delivery or earlier.

  • The CMV infection risk from the breastfeeding mother is negligible compared to the proven advantages of breastfeeding.

  • Because the virus is regularly present in many healthy children and people, there is no need to either screen for CMV or ban children who have the virus from schools or other institutions.

Conclusion

A newborn with congenital CMV infection should have routine hearing and vision examinations. Most newborns with congenital CMV have normal lives. Early detection and intervention may improve results for kids with hearing and vision issues. If a child receives treatment quickly, CMV will not negatively affect their health. However, if treatment is delayed, the infection may cause the child to have some major health issues. Even though an infected individual can spread the virus at any moment, properly washing hands with soap and water successfully gets the virus off the hands. It is ideal to avoid sharing food and beverages with others while a woman is pregnant. Additionally, efforts are being made to create a CMV vaccine to provide protection against it.

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Dr. Sajeev Kumar
Dr. Sajeev Kumar

Pediatrics

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congenital abnormalitiescytomegalovirus
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