Congenital cytomegalovirus infection

What I talk about in this video -

1.  CMV infection in neonates:

Signs and symptoms may include neurologic deficits (eg, seizures, chorioretinitis, hypotonia, hearing loss, microcephaly, and intracranial calcifications) as well as hematologic abnormalities (eg, petechiae, thrombocytopenia, and evidence of liver disease as manifested by jaundice, transaminitis, hyperbilirubinemia, and hepatosplenomegaly). Infants may also show evidence of growth restriction and failure to thrive. Of CMV-infected children who are asymptomatic at birth, 8% to 15% will develop hearing loss and psychomotor delay later in life

2. Mnemonic:

Congenital cytomegalovirus infection mnemonic

3. How is CMV spread?

CMV is spread by direct contact with body fluids such as saliva, blood, urine, semen, vaginal fluids, and breast milk.

4. What are the symptoms of CMV during pregnancy?

Usually asymptomatic. Can present with a sore throat, fever, weakness - mononucleosis-like symptoms.

5. How is CMV transmitted to the newborn?

Infection in the newborn can be acquired through close contact (via contaminated blood, urine, and secretions), vertically through transplacental transmission, and postnatally through breast milk.

6. Primary versus secondary infection in the mother

Mothers who are CMV seropositive prior to pregnancy can develop a secondary CMV infection either due to reactivation of virus residing at specific sites in the body (primarily the salivary glands) or reinfection with a different viral strain. Such infections tend to be less severe and are usually asymptomatic for both mother and newborn. Infants born to such mothers can also have sequelae of congenital CMV, but this is far less likely (estimated at 0.2% to 2%).

7. If the disease is transmitted in the first trimester, it is more severe.

As compared with women who are infected in the latter half of pregnancy, women who develop primary CMV infection in the first trimester are more likely to deliver fetuses with sensorineural hearing loss (24% vs 2.5%) or other CNS sequelae, such as mental retardation, cerebral palsy, seizures, or chorioretinitis (32% vs 15%).

8. In the third trimester, the risk of transmitting the disease is higher.

The risk of intrauterine transmission following primary maternal infection in the third trimester is high, but the risk of neonatal disease is low.

Source: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3046747/