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Zytomegalie

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S2k-Leitlinie - Labordiagnostik schwangerschaftsrelevanter Virusinfektionen

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Zusammenfassung

Die kongenitale CMV-Infektion ist die häufigste mit ZNS-Störungen assoziierte kongenitale Infektion weltweit. Man unterscheidet Länder mit niederer (50-70 % seropositiv) und hoher Seroprävalenz (> 70 % seropositiv). CMV kann durch Kontakt zu Körpersekreten (Speichel, Urin von Kleinkindern; Muttermilch), Sexualverkehr und Organtransplantate übertragen werden. Als Vertreter der Herpesviren geht das Virus nach meist asymptomatischer Primärinfektion des gesunden Individuums in ein Stadium der Latenz über und kann unter transienter Immunsuppression reaktiviert werden. Die vertikale Übertragung kann intrauterin, perinatal (CMV/HIV-Koinfektion) und postnatal durch Stillen erfolgen. Die latent infizierte Schwangere ist vor Primärinfektion geschützt. Findet die Primärinfektion der seronegativen Schwangeren perikonzeptionell oder im ersten und frühen zweiten Trimenon statt, kann diese in ca. 10 % der Fälle ZNS-Störungen (Gehörverlust, Visusverlust, kognitive Defizite) des Neugeborenen verursachen. Die viral induzierte Embryo/Fetopathie kann auch zu intrauterinem Fruchttod führen. Bei der Geburt asymptomatisch infizierte Neugeborene können innerhalb der ersten Lebensjahre Hörstörungen in bis zu 15 % der Fälle entwickeln. Die CMV-Diagnostik der Schwangeren basiert auf einer serologischen Stufendiagnostik. Jeder Nachweis von CMV-IgM in der Schwangerschaft muss mittels IgG-Avidität abgeklärt werden. Der Ausschluss fetaler Infektion kann über direkten Virusnachweis mittels PCR und Viruskultur erfolgen. Präventionsstrategien basierend auf Vakzinierung, Hyperimmunglobulingabe und antiviraler Therapie werden derzeit nicht empfohlen. Die frühe Erfassung des CMV-Serostatus ermöglicht jedoch die Identifikation der Schwangeren mit Risiko für den Erwerb einer CMV-Primärinfektion (Schwangere mit beruflichem oder familiärem Kontakt zu Kleinkindern unter 3 Jahren). Hygieneaufklärung der seronegativen Schwangeren kann die Virustransmission erheblich reduzieren.

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  1. Institut für Medizinische Virologie und Epidemiologie der Viruskrankheiten, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Str. 6, 72076, Tübingen, Deutschland

    Klaus Hamprecht

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    Hamprecht, K. (2014). Zytomegalie. In: S2k-Leitlinie - Labordiagnostik schwangerschaftsrelevanter Virusinfektionen. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-43481-9_18

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