Congenital cytomegalovirus infection: from suspicion to confirmation

Abstract

Introduction: Congenital cytomegalovirus (CMV) infection is the most common intrauterine infection and the leading cause of sensorineural hearing loss in childhood. Maternal seroconversion during pregnancy carries a 30% to 75% risk of vertical transmission. Serological surveillance is not indicated. In a confirmed infection there is no effective treatment and, in seropositive pregnant women, reactivation and even reinfection by different strains may occur.

Methods: A retrospective observational study (2008-2018) was conducted, analyzing children born in our hospital that maintained follow-up by suspected congenital CMV (cCMV) infection.

Results: We identified 125 cases of children with suspected cCMV infection. In 91 (72.8%) cases, the mothers had positive IgM; in 23 of them a seroconversion was documented and 4 cases corresponded to reactivation. Only 13 of the pregnant women had immunity to CMV, but 3 of the confirmed cases came from this group. Almost 17% of mothers had an unknown serological status and, in these cases, the suspicion was raised by placental changes, identification of abnormalities on the transfontanellar ultrasound, fetal growth restriction or other clinical signs compatible with CMV infection. cCMV infection was confirmed in 12 cases, 4 of them with sensorineural hearing loss and/or psychomotor development delay.

Discussion: Counseling all pregnant women on prevention strategies has proven to be an effective prophylactic measure. Even though universal screening for CMV in pregnant women remains unrecommended, studying children with suspected clinical signs allows early screening for vertical transmission and early detection of possible sequelae.