cCMV syndrome presentation
Newborns with cCMV who are born symptomatic face many challenges as they can be critically ill for the first few weeks and months of life. More than 75% of these neonates will have been born with a petechial rash, elevated alanine aminotransferase (ALT) levels, elevated bilirubin levels, and thrombocytopenia. More than 50% of affected infants are born with microcephaly, periventricular calcifications, and hepatosplenomegaly, and are small for gestational age.3
These newborns may be further afflicted with hypotonia, pneumonitis, chorioretinitis, hearing loss, poor suck, hemolysis, or seizures. Some of these infants will die soon after birth or in early childhood.10Infants born affected should also be screened for other congenital conditions and viral infections in order to receive optimal treatment.3
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The majority of children who are symptomatic at birth, especially those with neurologic symptoms, will develop long-term sequelae that can include hearing loss, vision loss, cerebral palsy, mental retardation, seizure disorder, and developmental delays.3,11Hearing loss associated with cCMV is progressive, and children congenitally infected with CMV will require close monitoring and follow-up throughout childhood as well as early intervention therapy to help decrease the severity of developmental delays.3
Diagnosis of cCMV
Neither pregnant women nor newborns are routinely screened for CMV infection.11The clinician may suspect that a pregnant woman has primary CMV infection if the woman experiences a mononucleosis-like illness, has been exposed to somebody with CMV infection, or may have suffered occupational exposure (such as if she works for a children’s day-care facility).5
When congenital CMV is suspected or a general screening is desired during pregnancy, the mother should undergo serum testing for CMV antibodies. The provider must keep in mind that antibodies can take more than 2 weeks to appear and can be present for more than 6 months following infection.3With this in mind, if the initial testing is negative but the suspicion is high, the test should be repeated in 2 to 4 weeks. If immunoglobulin (Ig) G alone is present, or both IgG and IgM are present, an IgG avidity test should be performed to determine the maturity of the IgG present.9Avidity of less than 30% indicates that the infection was acquired within the previous 3 to 4 months, and the diagnosis of primary infection can be made.3
