A review on the prevention and treatment of congenital cytomegalovirus infection in mothers and infants

XU Wen-Fang; YUAN Tian-Ming

doi:10.7499/j.issn.1008-8830.2018.10.018

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Chinese Journal of Contemporary Pediatrics ›› 2018, Vol. 20 ›› Issue (10) : 870-875. DOI: 10.7499/j.issn.1008-8830.2018.10.018

REVIEW

A review on the prevention and treatment of congenital cytomegalovirus infection in mothers and infants

XU Wen-Fang, YUAN Tian-Ming

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Abstract

Human cytomegalovirus (HCMV) has a high infection rate worldwide, and 85%-90% of congenital cytomegalovirus (CMV) infections are asymptomatic at birth, with the clinical manifestations of hearing loss, psychomotor retardation, and learning disabilities, while 10%-15% are symptomatic infections. Some preterm infants develop CMV infection after birth, which can cause sepsis-like syndrome, thrombocytopenia, neutropenia, liver injury, and lung injury. However at present, women of childbearing age have a lack of awareness of CMV. CMV education and hygiene precautions for pregnant women can prevent CMV infections in themselves and congenital CMV infections in their infants. No definite Results have been obtained from the studies on the effect of CMV vaccine and high-titer immunoglobulin in preventing congenital CMV infection in fetuses. Recent studies have confirmed that the specificity and sensitivity of urinary or salivary CMV-DNA detection have reached more than 98%, which contributes to the early diagnosis of congenital CMV infection. In addition to short-term treatment with ganciclovir, long-term treatment with oral valganciclovir is safe for symptomatic congenital CMV infection and appears to have a better clinical effect than the short-term treatment. In the future, it is necessary to strengthen the health education for pregnant women, enhance the mother-to-child management of CMV infection, conduct the research on CMV vaccine, and further standardize treatment regimens.

Key words

Cytomegalovirus / Infection / Prevention / Neonate / Infant

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XU Wen-Fang, YUAN Tian-Ming. A review on the prevention and treatment of congenital cytomegalovirus infection in mothers and infants[J]. Chinese Journal of Contemporary Pediatrics. 2018, 20(10): 870-875 https://doi.org/10.7499/j.issn.1008-8830.2018.10.018

References

[1] Pass RF, Arav-Boger R. Maternal and fetal cytomegalovirus infection:diagnosis, management, and prevention[J]. F1000Res, 2018, 7:255.
[2] Boppana SB, Ross SA, Fowler KB. Congenital cytomegalovirus infection:clinical outcome[J]. Clin Infect Dis, 2013, 57 Suppl 4:S178-S181.
[3] Gunkel J, Wolfs TF, de Vries LS, et al. Predictors of severity for postnatal cytomegalovirus infection in preterm infants and implications for treatment[J]. Expert Rev Anti Infect Ther, 2014, 12(11):e1345-e1355.
[4] Jim WT, Chiu NC, Ho CS, et al. Outcome of preterm infants with postnatal cytomegalovirus infection via breast milk:a twoyear prospective follow-up study[J]. Medicine (Baltimore), 2015, 94(43):e1835.
[5] Morioka I, Sonoyama A, Tairaku S, et al. Awareness of and knowledge about mother-to-child infections in Japanese pregnant women[J]. Congenit Anom (Kyoto), 2014, 54(1):35-40.
[6] Wizman S, Lamarre V, Coic L, et al. Awareness of cytomegalovirus and risk factors for susceptibility among pregnant women, in Montreal, Canada[J]. BMC Pregnancy Childbirth, 2016, 16:54.
[7] Willame A, Blanchard-Rohner G, Combescure C, et al. Awareness of cytomegalovirus infection among pregnant women in Geneva, Switzerland:a cross-sectional study[J]. Int J Environ Res Public Health, 2015, 12(12):15285-15297.
[8] Adler SP. Prevention of maternal-fetal transmission of cytomegalovirus[J]. EBioMedicine, 2015, 2(9):1027-1028.
[9] Adler SP, Finney JW, Manganello AM, et al. Prevention of childto-mother transmission of cytomegalovirus among pregnant women[J]. J Pediatr, 2004, 145(4):485-491.
[10] Adler SP. Cytomegalovirus and child day care. Evidence for an increased infection rate among day-care workers[J]. N Engl J Med, 1989, 321(19):1290-1296.
[11] Vauloup-Fellous C, Picone O, Cordier AG, et al. Does hygiene counseling have an impact on the rate of CMV primary infection during pregnancy? Results of a 3-year prospective study in a French hospital[J]. J Clin Virol, 2009, 46 Suppl 4:S49-S53.
[12] Revello MG, Tibaldi C, Masuelli G, et al. Prevention of primary cytomegalovirus infection in pregnancy[J]. EBioMedicine, 2015, 2(9):1205-1210.
[13] Wu SJ, Villarreal DO, Shedlock DJ, et al. Synthetic DNA approach to cytomegalovirus vaccine/immune therapy[J]. Adv Exp Med Biol, 2015, 848:131-148.
[14] Rieder F, Steininger C. Cytomegalovirus vaccine:phase Ⅱ clinical trial results[J]. Clin Microbiol Infect, 2014, 20 Suppl 5:95-102.
[15] Nigro G, Adler SP, La Torre R, et al. Passive immunization during pregnancy for congenital cytomegalovirus infection[J]. N Engl J Med, 2005, 353(13):1350-1362.
[16] Revello MG, Lazzarotto T, Guerra B, et al. A randomized trial of hyperimmune globulin to prevent congenital cytomegalovirus[J]. New Engl J Med, 2014, 370(14):1316-1326.
[17] Fowler KB, Boppana SB. Congenital cytomegalovirus infection[J]. Semin Perinatol, 2018, 42(3):149-154.
[18] Davis NL, King CC, Kourtis AP. Cytomegalovirus infection in pregnancy[J]. Birth Defects Res, 2017, 109(5):336-346.
[19] Rawlinson WD, Boppana SB, Fowler KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate:consensus recommendations for prevention, diagnosis, and therapy[J]. Lancet Infect Dis, 2017, 17(6):177-188.
[20] Grangeot-Keros L, Mayaux MJ, Lebon P, et al. Value of cytomegalovirus (CMV) IgG avidity index for the diagnosis of primary CMV infection in pregnant women[J]. J Infect Dis, 1997, 175(4):944-946.
[21] Yinon Y, Yagel S, Tepperberg-Dikawa M, et al. Prenatal diagnosis and outcome of congenital cytomegalovirus infection in twin pregnancies[J]. BJOG, 2006, 113(3):295-300.
[22] Rawlinson WD, Boppana SB, Fowel KB, et al. Congenital cytomegalovirus infection in pregnancy and the neonate:consensus recommendations for prevention, diagnosis, and therapy[J]. Lancet Infect Dis, 2017, 17(6):177-188.
[23] Leyder M, Vorsselmans A, Done E, et al. Primary maternal cytomegalovirus infections:accuracy of fetal ultrasound for predicting sequelae in offspring[J]. Am J Obstet Gynecol, 2016, 215(5):638.e1-638.e8.
[24] Benoist G, Leruez-Ville M, Magny JF, et al. Management of pregnancies with confirmed cytomegalovirus fetal infection[J]. Fetal Diagn Ther, 2013, 33(4):203-214.
[25] Averill LW, Kandula VV, Akyol Y, et al. Fetal brain magnetic resonance imaging findings in congenital cytomegalovirus infection with postnatal imaging correlation[J]. Semin Ultrasound CT MR, 2015, 36(6):476-486.
[26] Gouarin S, Gault E, Vabret A, et al. Real-Time PCR quantification of human cytomegalovirus DNA in amniotic fluid samples from mothers with primary infection[J]. J Clin Microbiol, 2002, 40(5):1767-1772.
[27] Leruez-Ville M, Stirnemann J, Sellier Y, et al. Feasibility of predicting the outcome of fetal infection with cytomegalovirus at the time of prenatal diagnosis[J]. Am J Obstet Gynecol, 2016, 215(3):342.e1-e9.
[28] Leruez-Ville M, Ville Y. Optimum treatment of congenital cytomegalovirus infection[J]. Expert Rev Anti Infect Ther, 2016, 14(5):479-488.
[29] Section on Breastfeeding. Breastfeeding and the use of human milk[J]. Pediatrics, 2012, 129(3):e827-e841.
[30] Buxmann H, Falk M, Goelz R, et al. Feeding of very low birth weight infants born to HCMV-seropositive mothers in Germany, Austria and Switzerland[J]. Acta Paediatr, 2010, 99(12):e1819-e1823.
[31] Mehler K, Oberthuer A, Lang-Roth R, et al. High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk[J]. Neonatology, 2014, 105(1):27-32.
[32] Hamprecht K, Maschmann J, Jahn G, et al. Cytomegalovirus transmission to preterm infants during lactation[J]. J Clin Virol, 2008, 41(3):198-205.
[33] Quigley M, McGuire W. Formula versus donor breast milk for feeding preterm or low birth weight infants[J]. Cochrane Database Syst Rev, 2014, (4):CD002971.
[34] O'connor DL, Ewaschuk JB, Unger S. Human milk pasteurization:benefits and risks[J]. Curr Opin Clin Nutr Metab Care, 2015, 18(3):269-275.
[35] Hosseini M, Esmaili HA, Abdoli Oskouei S, et al. Evaluation of the freeze-thawing method in reducing viral load of cytomegalovirus in breast milk of mothers of preterm infants[J]. Breastfeed Med, 2016, 11:557-560.
[36] Abranches AD, Soares FV, Junior SC, et al. Freezing and thawing effects on fat, protein, and lactose levels of human natural milk administered by gavage and continuous infusion[J]. J Pediatr (Rio J), 2014, 90(4):384-388.
[37] Christen L, Lai CT, Hartmann B, et al. The effect of UV-C pasteurization on bacteriostatic properties and immunological proteins of donor human milk[J]. PLoS One, 2013, 8(12):e85867.
[38] Josephson CD, Caliendo AM, Easley KA, et al. Blood transfusion and breast milk transmission of cytomegalovirus in very low-birth-weight infants:a prospective cohort study[J]. JAMA Pediatr, 2014, 168(11):1054-1062.
[39] Boppana SB, Ross SA, Shimamura M, et al. Saliva polymerasechain-reaction assay for cytomegalovirus screening in newborns[J]. N Engl J Med, 2011, 364(22):2111-2118.
[40] Luck SE, Wieringa JW, Blázquez-Gamero D, et al. Congenital cytomegalovirus:a European expert consensus statement on diagnosis and management[J]. Pediatr Infect Dis J, 2017, 36(12):1205-1213.
[41] Kimberlin DW, Jester PM, Sánchez PJ, et al. Valganciclovir for symptomatic congenital cytomegalovirus disease[J]. N Engl J Med, 2015, 372(10):933-943.
[42] Amir J, Wolf DG, Levy I. Treatment of symptomatic congenital cytomegalovirus infection with intravenous ganciclovir followed by long-term oral valganciclovir[J]. Eur J Pediatr, 2010, 169(9):1061-1067.