Thursday, June 23, 2011

Neonatal infections - Infection with CMV (cytomegalovirus)

Transmission from mother to fetus is transplacental and fetal injury severity is greater in primary infection and those occurring in the first half of gestation. Transplacental transmission of maternal immunity does not prevent, but reduced to 0 damage to the fetus.
Fetal pathology may be caused by viral replication continue in the affected organs, vasculitis and other immune-mediated injury and the host's defense.In recurrent maternal infection, maternal immunity may inhibit persistent viremia and transplacental antibodies can block viral transmission to the fetus.Reactivation of maternal infection accompanied by this virus leads to cervical intrapartum transmission, but remain asymptomatic newborn in most cases.
Intrapartum transmission through cervical secretions and postpartum through breast milk and blood products are not neglected.Most often the infant is asymptomatic. Rarely can occur with mononucleosis syndrome similar to primoinfectie. Only 10% of newborns are symptomatic in the neonatal period.The most common clinical signs are hepatosplenomegaly, thrombocytopenia, petechiae, jaundice with increased direct bilirubin.Signs of severity are microcephaly, intracranial calcifications, ICIU, prematurity.
Evolution:
About 25% of symptomatic children die early in life by: severe neurologic, hepatic dysfunction, bacterial superinfection, bleeding phenomenon of CID.The most common complication of long-term auditory deficit, 50-60% in symptomatic children, 5-10% in asymptomatic children.Half of these children develop severe deficit after the first year of life.Long-term prognosis in 90% of asymptomatic children is good.Only 5-15% of this group are at risk of developing complications: hearing, microcephaly, motor defects, psycho-motor retardation, chorioretinitis, dental defects.
Diagnosis:
The most sensitive and specific method is isolation of CMV in urine cultures. To confirm intrauterine contamination cultures should be positive in the first 2 weeks. After this period is considered that the infection occurred in or postpartum. In order to demonstrate to be proved that the urine of the first two weeks does not contain anti-CMV Ac.
Reveals non-specific tests: IgM in cord above 20 mg%, 5-42% lymphocytosis, SGOT greater than 80 IU, thrombocytopenia, the indirect bilirubin is increased, proteinorahie 120 mg%.
Treatment:
Prophylactic treatment consists of: measures of hygiene of pregnant women and health professionals antiCMV vaccination, control of blood for CMV.
In terms of curative treatment, many studies with antiviral agents have been discouraging.Currently investigating the effectiveness of ganciclovir in children with symptomatic intrauterine infection. It will take into account that this drug shows toxic side effects from moderate to severe.Other agents studied: idoxuridin, citozinarabinozid, alfainterferon, gammaglobulins.And treatment is supportive.

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