Current Treatment Options in Neurology

, Volume 10, Issue 3, pp 186–192

Congenital cytomegalovirus infection: Update on management strategies

Article

Opinion statement

Congenital cytomegalovirus (CMV) infections are underrecognized as a cause of serious morbidity in newborn infants. The era of therapeutic nihilism regarding these infections has come to an end, however, as useful therapies are now available that may modify the outcome. The infected fetus can be treated in utero, or the newborn infant can be treated when CMV is recognized in the neonatal period. Expanded screening of newborns for congenital CMV infection will make it even more important for clinicians to be aware of current therapeutic options. The most effective option for the treatment of life-threatening or sight-threatening CMV disease at any age is the nucleoside analog ganciclovir. For the newborn with congenital CMV infection, the value of ganciclovir appears to relate to its ability to preserve hearing; other improvements in overall neurodevelopmental status are inferred but remain to be proven. In the pregnant woman with primary CMV infection, the use of CMV-specific immune globulin, though still investigational, is garnering attention and may prove to be a valuable therapy.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References and Recommended Reading

  1. 1.
    Demmler GJ: Infectious Diseases Society of America and Centers for Disease Control. Summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev Infect Dis 1991, 13:315–329.PubMedGoogle Scholar
  2. 2.
    Ross DS, Dollard SC, Victor M, et al.: The epidemiology and prevention of congenital cytomegalovirus infection and disease: activities of the Centers for Disease Control and Prevention Workgroup. J Womens Health (Larchmt) 2006, 15:224–229.CrossRefGoogle Scholar
  3. 3.
    Colugnati F, Staras S, Dollard S, Cannon M: Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infect Dis 2007, 7:71.PubMedCrossRefGoogle Scholar
  4. 4.
    Adler SP: Cytomegalovirus and child day care. Evidence for an increased infection rate among day-care workers. N Engl J Med 1989, 321:1290–1296.PubMedGoogle Scholar
  5. 5.
    Stagno S, Pass RF, Cloud G, et al.: Primary cytomegalovirus infection in pregnancy. Incidence, transmission to fetus, and clinical outcome. JAMA 1986, 256:1904–1908.PubMedCrossRefGoogle Scholar
  6. 6.
    Kenneson A, Cannon MJ: Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 2007, 17:253–276.PubMedCrossRefGoogle Scholar
  7. 7.
    Boppana SB, Fowler KB, Britt WJ, et al.: Symptomatic congenital cytomegalovirus infection in infants born to mothers with preexisting immunity to cytomegalovirus. Pediatrics 1999, 104:55–60.PubMedCrossRefGoogle Scholar
  8. 8.
    Ahlfors K, Ivarsson SA, Harris S: Report on a long-term study of maternal and congenital cytomegalovirus infection in Sweden. Review of prospective studies available in the literature. Scand J Infect Dis 1999, 31:443–457.PubMedCrossRefGoogle Scholar
  9. 9.
    Boppana SB, Rivera LB, Fowler KB, et al.: Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity. N Engl J Med 2001, 344:1366–1371.PubMedCrossRefGoogle Scholar
  10. 10.
    Ahlfors K, Harris S: Secondary maternal cytomegalovirus infection—a significant cause of congenital disease. Pediatrics 2001, 107:1227–1228.PubMedCrossRefGoogle Scholar
  11. 11.
    Schleiss MR: Role of breast milk in acquisition of cytomegalovirus infection: recent advances. Curr Opin Pediatr 2006, 18:48–52.PubMedGoogle Scholar
  12. 12.
    Pass RF, Stagno S, Myers GJ, Alford CA: Outcome of symptomatic congenital cytomegalovirus infection: results of long-term longitudinal follow-up. Pediatrics 1980, 66:758–762.PubMedGoogle Scholar
  13. 13.
    Noyola DE, Demmler GJ, Nelson CT, et al.: Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 2001, 138:325–331.PubMedCrossRefGoogle Scholar
  14. 14.
    Boppana SB, Fowler KB, Vaid Y, et al.: Neuroradiographic findings in the newborn period and long-term outcome in children with symptomatic congenital cytomegalovirus infection. Pediatrics 1997, 99:409–414.PubMedCrossRefGoogle Scholar
  15. 15.
    Kylat RI, Kelly EN, Ford-Jones EL: Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection. Eur J Pediatr 2006, 165:773–778.PubMedCrossRefGoogle Scholar
  16. 16.
    Sharon B, Schleiss MR: Congenital cytomegalovirus infection: an unrecognized epidemic. Infect Med 2007, 24:402–415.Google Scholar
  17. 17.
    Ancora G, Lanari M, Lazzarotto T, et al.: Cranial ultrasound scanning and prediction of outcome in newborns with congenital cytomegalovirus infection. J Pediatr 2007, 150:157–161.PubMedCrossRefGoogle Scholar
  18. 18.
    Boesch C, Issakainen J, Kewitz G, et al.: Magnetic resonance imaging of the brain in congenital cytomegalovirus infection. Pediatr Radiol 1989, 19:91–93.PubMedCrossRefGoogle Scholar
  19. 19.
    Stagno S, Pass RF, Dworsky ME, et al.: Congenital cytomegalovirus infection: the relative importance of primary and recurrent maternal infection. N Engl J Med 1982, 306:945–949.PubMedGoogle Scholar
  20. 20.
    Boppana SB, Pass RF, Britt WJ, et al.: Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality. Pediatr Infect Dis J 1992, 11:93–99.PubMedCrossRefGoogle Scholar
  21. 21.
    Conboy TJ, Pass RF, Stagno S, et al.: Intellectual development in school-aged children with asymptomatic congenital cytomegalovirus infection. Pediatrics 1986, 77:801–806.PubMedGoogle Scholar
  22. 22.
    Bale JF, Miner L, Petheram SJ: Congenital cytomegalovirus infection. Curr Treat Options Neurol 2002, 4:225–230.PubMedCrossRefGoogle Scholar
  23. 23.
    Dahle AJ, Fowler KB, Wright JD, et al.: Longitudinal investigation of hearing disorders in children with congenital cytomegalovirus. J Am Acad Audiol 2000, 11:283–290.PubMedGoogle Scholar
  24. 24.
    Hicks T, Fowler K, Richardson M, et al.: Congenital cytomegalovirus infection and neonatal auditory screening. J Pediatr 1993, 123:779–782.PubMedCrossRefGoogle Scholar
  25. 25.
    Iwasaki S, Yamashita M, Maeda M, et al.: Audiological outcome of infants with congenital cytomegalovirus infection in a prospective study. Audiol Neurootol 2007, 12:31–36.PubMedCrossRefGoogle Scholar
  26. 26.
    Madden C, Wiley S, Schleiss M, et al.: Audiometric, clinical and educational outcomes in a pediatric symptomatic congenital cytomegalovirus (CMV) population with sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2005, 69:1191–1198.PubMedCrossRefGoogle Scholar
  27. 27.
    Fowler KB, McCollister FP, Dahle AJ, et al.: Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection. J Pediatr 1997, 130:624–630.PubMedCrossRefGoogle Scholar
  28. 28.
    Rivera LB, Boppana SB, Fowler KB, et al.: Predictors of hearing loss in children with symptomatic congenital cytomegalovirus infection. Pediatrics 2002, 110:762–767.PubMedCrossRefGoogle Scholar
  29. 29.
    Boppana SB, Fowler KB, Pass RF, et al.: Congenital cytomegalovirus infection: association between virus burden in infancy and hearing loss. J Pediatr 2005, 146:817–823.PubMedCrossRefGoogle Scholar
  30. 30.
    Pass RF: Congenital cytomegalovirus infection and hearing loss. Herpes 2005, 12:50–55.PubMedGoogle Scholar
  31. 31.
    Barbi M, Binda S, Caroppo S: Diagnosis of congenital CMV infection via dried blood spots. Rev Med Virol 2006, 16:385–392.PubMedCrossRefGoogle Scholar
  32. 32.
    Schleiss MR: Antiviral therapy of congenital cytomegalovirus infection. Semin Pediatr Infect Dis 2005, 16:50–59.PubMedCrossRefGoogle Scholar
  33. 33.
    Kimberlin DW, Lin CY, Sanchez PJ, et al.: Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr 2003, 143:16–25.PubMedCrossRefGoogle Scholar
  34. 34.
    Drug Topics Red Book 2007. Montvale, NJ: Medical Economics; 2007.Google Scholar
  35. 35.
    Nigro G, Adler SP, La Torre R, Best AM: Passive immunization during pregnancy for congenital cytomegalovirus infection. N Engl J Med 2005, 353:1350–1362.PubMedCrossRefGoogle Scholar
  36. 36.
    Duff P: Immunotherapy for congenital cytomegalovirus infection [editorial]. N Engl J Med 2005, 353:1402–1404.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2008

Authors and Affiliations

  1. 1.Division of Infectious Diseases and ImmunologyUniversity of Minnesota Children’s Hospital and Department of Pediatrics, Center for Infectious Diseases and Microbiology TranslationalMinneapolisUSA

Personalised recommendations