Congenital cytomegalovirus infection: a review study

Background Cytomegalovirus (CMV), a member of the herpes virus family, is the leading non-genetic cause of congenital infection in humans, affecting 0.5–3% of all newborns worldwide, which frequently acquired in early life and is usually asymptomatic. The main source of maternal infection is from contact with young children. This virus produces a mild flu-like illness in healthy individuals. Primary CMV infection is associated with a high maternal to child transmission rate (40%). Despite the clinical importance of congenital CMV, surveys show there is limited awareness and knowledge in the medical and general community about CMV. Therefore, aim of this study is review of congenital CMV Methods In this review article, the information was obtained through searching in databases of PubMed, Scopus, and Google Scholar by entering the keywords of Congenital Cytomegalovirus Infection, and CMV during 2000 to 2018. The articles which were less relevant to the subject were excluded. Of the 150 articles was found, 22 articles were included. Results In general, the majority of infants with congenital CMV infection are asymptomatic, but 10-15% present with CMV manifestations at birth, 40-58% of whom develop adverse outcomes,including cerebral palsy, neonatal signs include intrauterine growth restriction, microcephaly,hepatosplenomegaly, petechiae, jaundice, chorioretinitis, thrombocytopenia and anemia, and long-term sequelae consist of sensorineural hearing loss, mental retardation, delay of psychomotor development, and visual impairment. Mortality for such infants can reach 30%.The prenatal diagnosis of fetal CMV infection should be based on amniocentesis, which should be done at least 7 weeks after presumed time of maternal infection and after 21 weeks of gestation. Researchers 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). Prevention of maternal infection using hygiene and behavioral interventions reducedmaternal seroconversion rates during pregnancy. Treatment of maternal CMV infection with hyper immune globulin (HIG) showed some evidence for efficacy in prevention of fetal infection and fetal/neonatal morbidity with a reasonable safety profile. Limited evidence also existed for the safety and efficacy of established CMV antivirals (valaciclovir, ganciclovir and valganciclovir) to treat neonatal consequences of CMV infection Conclusion According to these literatures, diagnosis and treatment of congenital CMV infection at birth or in the first 3 weeks of an infant s life is crucial. Currently, the only effective means of prevention is through reducing exposure to the virus. So prevention strategies should target mothers because increased awareness and hygiene measures may reduce maternal infection. However, almost maternity clinicians lack confidence and knowledge about congenital CMV. Therefore, there is urgent need for clinical guidance and patient information to reduce the burden of disease

Keywords:

Cytomegalovirus , congenital infection , maternal-to-child transmission