Thursday, June 23, 2011

Cytomegalovirus infection in children - Signs and symptoms

Generalized form and "cytomegalovirus disease of the newborn" presents the characteristic triad: respiratory distress, lethargy and seizures.
Of clinically observed: hepatosplenomegaly (accompanied by jaundice and altered liver function tests), petechiae rash thrombocytopenia, subponderabilitate, anemia, impaired SN C (encephalitis with microcephaly, chorioretinitis, periventricular brain calcifications), hearing loss or deafness, microoftalmie, chronic diarrhea pneumonia.
Hepatosplenomegaly is common in newborn symptomatic. This may be the only manifestation persists 1-3 months to 1 year maximum. The liver is smooth and soft and can be palpated 5 cm below the costal sliding along the edge, is the possible presence intrahepatic calcifications.
Jaundice variza intensity is transient in the first 3 months. Mixed hyperbilirubinemia or direct bilirubin (DB) reaches even 30mg/dl or 50% of total bilirubin (BT).
Hepatitis if present mild wear. Transaminase levels exceed 300 IU dropping the first three weeks in the chronic form is exceptional.
Ascites may be present at birth, in some cases can persist longer than 1-2 weeks.
Petechiae and purpuric rash may be the only manifestation of disease. Appears as generalized or localized to the trunk and extremities. Thrombocytopenia is not mandatory. Characteristic aspect is the "needle stick". Petechiae are rarely present at birth.Usually occurring in the first hours after birth and disappears within 48 hours. Can persist for several weeks postnatally. It outlines symptoms extramedullary haematopoiesis (SDR mimics. Rubeolocongenital).
Most infants die within days or weeks after birth, those who remain suprvietuiesc with hepatomegaly, jaundice and impaired neuromotor development.Boppana, performing head CT in 56 children with symptomatic CMV infection, intracerebral calcification found in 70% of them, 90% of them subsequently developed one or more sequelae, compared with only 29% disabling in those with normal CT.Index was below 50 in IQ for those with abnormalities on CT, compared to 70 patients with normal neuroradiografie.
Intracranial calcifications are present in the lesions in 3-4 months of gestation. Their distribution characteristic: linear periventricular, bilateral and symmetrical. They are in the form of small lesions, or lesions larger point that may include the entire ventricle. cortical and subcortical regions may include or basal ganglia. Their discovery may be an indicator in the diagnosis of cognitive deficits and hearing that may occur later in life and predict a poor neurological development.
Microcephaly is present in 50-80% of infants with severe UTIs.Defined as head circumference less than 1 / 3 than for aged gestationla (PcEye disease is present in 10-20% of symptomatic children.Frequently manifested by old and inactive chorioretinitis at birth, if the building presents 23% retinal lesions or progression of postnatal development between ages corioretinitei delayed 0, 5-10 years. Retinitis is usually unilateral, associated with damage to the macula leads to blindness. Other symptoms are: optic atrophy, and strabismus. Typically does not produce microphthalmia or cataract.
Intrauterine growth retardation in and / or prematurity is frequently associated with CMV infection.
Sensorineural deafness is present in 50% of newborns with congenital CMV infection, symptomatic and 15% of those with asymptomatic infection. Introduce variable degrees of intensity, unilateral or bilateral.
Affecting the endocrine system is felt in the adrenal, pituitary, thyroid, parathyroid.
Pneumonia is another illness caused by cytomegalovirus.Evolution is the train with a high mortality rate.
CMV was found in different organs and can cause: in the lungs - interstitial pneumonia, liver - hepatitis, pancreas - pancreatitis, gastrointestinal tract, eso - esophagitis, gastritis, enteritis, enterocolitis, colitis, salivary glands - mumps, kidney - nephritistubulo-interstitial; infarction - myocarditis, CNS - encephalitis, myelitis. The retina - retinitis, conjunctivitis.
Subtle form includes monosindroame: lung, hepatosplenic, neurological, hematologic. It is characterized by attenuated symptoms that appear at 6-8 weeks of life up to four months.
Unapparent form (asymptomatic) is the most common, comprising 90% of all cases of newborns affected. They are apparently healthy at birth, by specifying virurie diagnosis.
All these forms can be followed late neuropsychological sequelae: microcephaly, mental retardation, defects of vision, spastic paralysis.

No comments:

Post a Comment