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Gianolio L, Fumagalli M, Manfredini V, Mannarino S, Giacomet V, Zuccotti GV. Ventricular septal defect and aortic hypoplasia in congenital cytomegalovirus infection: occasional finding or underdetected correlation? J Matern Fetal Neonatal Med 2021; 35:6558-6560. [PMID: 33910458 DOI: 10.1080/14767058.2021.1918086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: While other viral infections occurring in early pregnancy are known to be associated with fetal cardiac malformations, little is known about CMV and its causative role. Only a few case repots have been described reporting a correlation between congenital CMV infection and cardiac defects.Case-report: We report the case of a 7-day-old neonate who was referred to our Pediatric Infectivology Department for maternal cytomegalovirus (CMV) seroconversion during the first trimester of pregnancy and confirmed congenital infection. At first evaluation, the baby presented with a cardiac murmur and signs of acute heart failure, along with jaundice and hypotonia. At cardiac ultrasound, a perimembranous doubly-committed ventricular septal defect and a reduced aortic isthmus diameter were revealed.Conclusion: Despite further large-scale prospective studies are needed to confirm or rule out this association, CMV DNA urine detection might be worth to be considered as part of the diagnostic process in neonates with isolated heart defects.
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Affiliation(s)
- Laura Gianolio
- Department of Pediatric Infectious Diseases, Luigi Sacco University Hospital, Milano, Italy.,University of Milan, Milano, Italy
| | - Mara Fumagalli
- Department of Pediatric Infectious Diseases, Luigi Sacco University Hospital, Milano, Italy.,University of Milan, Milano, Italy
| | - Valeria Manfredini
- Department of Neonatology, Luigi Sacco University Hospital, Milano, Italy
| | - Savina Mannarino
- Department of Pediatric Cardiology, Vittore Buzzi Children's Hospital, Milano, Italy
| | - Vania Giacomet
- Department of Pediatric Infectious Diseases, Luigi Sacco University Hospital, Milano, Italy.,University of Milan, Milano, Italy
| | - Gian Vincenzo Zuccotti
- University of Milan, Milano, Italy.,Department of Pediatric, Vittore Buzzi Children's Hospital, Milano, Italy
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Manzoor N, Rehan A, Akmal M, Khalid TB, Jamal A. Congenital Cytomegalovirus Infection and Tetralogy of Fallot: An Unusual Association in a Three-month-old Baby. Cureus 2019; 11:e4949. [PMID: 31453023 PMCID: PMC6701899 DOI: 10.7759/cureus.4949] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Congenital cytomegalovirus (cCMV) infection is the leading cause of infant morbidity and mortality worldwide. Despite being associated with significant neurological sequelae in infected infants, it remains an under-recognized public health entity. Symptomatic newborns most frequently display hepatosplenomegaly, petechiae, jaundice, microcephaly, intrauterine growth restriction, chorioretinitis, purpura, and seizures. Progressive sensorineural hearing loss is the most prominent adverse outcome of both symptomatic and asymptomatic CMV infections in infants. We report the case of a three-month-old baby who presented with complaints of progressive jaundice for three months and a two days history of fever associated with one episode of fits. The baby was diagnosed with congenital CMV infection on the basis of positive CMV IgM and IgG and positive maternal serum CMV IgG. Finding a murmur on physical examination prompted echocardiography which revealed Tetralogy of Fallot (TOF). The child was managed with a 6-week course of ganciclovir after which his symptoms improved and he was referred to cardiology for the evaluation of his heart defect. Follow-ups at the clinic have shown normal growth and development. This is the first reported association of cCMV infection with TOF. This case highlights the need to consider the possibility of the presence of heart defects in all infants with cCMV infection in addition to neurodevelopmental abnormalities. Clinicians should maintain a high degree of suspicion for cCMV infection in all neonates to ensure timely intervention and to prevent long-term neurological sequelae.
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Affiliation(s)
- Nida Manzoor
- Pediatrics, Civil Hospital Karachi, Karachi, PAK
| | - Aiman Rehan
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Manahil Akmal
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
| | - Tayram B Khalid
- Internal Medicine, Dow University of Health Sciences, Karachi, PAK
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Putri ND, Wiyatno A, Dhenni R, Sriyani IY, Dewantari AK, Handryastuti S, Iskandar ATP, Rahma MM, Jumiyanti N, Aprilia YY, Prayitno A, Karyanti MR, Satari HI, Hadinegoro SR, Myint KSA, Safari D. Birth prevalence and characteristics of congenital cytomegalovirus infection in an urban birth cohort, Jakarta, Indonesia. Int J Infect Dis 2019; 86:31-39. [PMID: 31207385 DOI: 10.1016/j.ijid.2019.06.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 06/10/2019] [Accepted: 06/11/2019] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Little is known about the birth prevalence and characteristics of congenital cytomegalovirus (CMV) infection in developing countries. To determine the prevalence and characteristics of congenital CMV infection in Indonesia, we conducted a prospective study in an urban birth cohort of neonates at a national referral hospital in 2016-2017, Jakarta, Indonesia. METHODS Consecutively born neonates were screened for the presence of CMV by using pan-herpesvirus nested-PCR and Sanger sequencing in saliva and/or urine specimens. Both the neonatal clinical findings as well as maternal characteristics were also evaluated. RESULTS From a total of 411 newborns screened, congenital CMV infection was confirmed in 5.8% of the neonates. These CMV-positive newborns were more likely to have ventriculomegaly and thrombocytopenia compared to CMV-negative neonates. Notably, 67% CMV-positive neonates in our study had clinical findings that required medical intervention, from which only nine presented with symptoms suggestive of congenital CMV infection. Furthermore, congenital CMV infected babies were almost four times more likely to be born to mothers that had placenta previa and placental abruption. CONCLUSIONS Our work highlights the high prevalence of congenital CMV infection in neonates born in one of the biggest referral hospitals in metropolitan Jakarta, Indonesia.
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Affiliation(s)
- Nina Dwi Putri
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ageng Wiyatno
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | - Rama Dhenni
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia
| | | | | | - Setyo Handryastuti
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Adhi Teguh Perma Iskandar
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Meka Medina Rahma
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Niphidiah Jumiyanti
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Yuni Yudha Aprilia
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Ari Prayitno
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Mulya Rahma Karyanti
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Hindra Irawan Satari
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | - Sri Rezeki Hadinegoro
- Department of Pediatrics, Dr. Cipto Mangunkusumo National Central Hospital, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
| | | | - Dodi Safari
- Eijkman Institute for Molecular Biology, Jakarta, Indonesia.
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Van Mieghem T, Hodges R, Jaeggi E, Ryan G. Functional echocardiography in the fetus with non-cardiac disease. Prenat Diagn 2013; 34:23-32. [DOI: 10.1002/pd.4254] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Revised: 09/23/2013] [Accepted: 10/07/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Tim Van Mieghem
- Fetal Medicine Unit, Mount Sinai Hospital; University of Toronto; Toronto Canada
| | - Ryan Hodges
- Fetal Medicine Unit, Mount Sinai Hospital; University of Toronto; Toronto Canada
| | - Edgar Jaeggi
- Fetal Cardiac Program, Pediatric Cardiology, Hospital for Sick Children; University of Toronto; Toronto Canada
| | - Greg Ryan
- Fetal Medicine Unit, Mount Sinai Hospital; University of Toronto; Toronto Canada
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Benoist G, Leruez-Ville M, Magny JF, Jacquemard F, Salomon LJ, Ville Y. Management of pregnancies with confirmed cytomegalovirus fetal infection. Fetal Diagn Ther 2013; 33:203-14. [PMID: 23571413 DOI: 10.1159/000342752] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2011] [Accepted: 07/11/2012] [Indexed: 11/19/2022]
Abstract
Systematic screening for cytomegalovirus (CMV) maternal infection is not recommended in most countries. Nevertheless, primary CMV infection will occur in around 1% of women. The vertical transmission rate is estimated to be around 30-50%. Newborns with congenital CMV infection remain asymptomatic in the majority of cases and around 10% will present with a wide range of abnormalities. Fetal infection can be diagnosed by amniocentesis with amplification of the viral genome in the amniotic fluid by polymerase chain reaction. This prenatal diagnosis is mainly performed when ultrasound abnormalities are observed. The purpose of this mini-review is to describe the management options when a fetus is known to be infected.
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Affiliation(s)
- Guillaume Benoist
- Department of Obstetrics and Maternal-Fetal Medicine, GHU Necker-Enfants Malades, AP-HP, Université Paris Descartes, Paris, France
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