Cytomegalovirus Infection in the Fetus and Neonate

Objectives

After completing this article, readers should be able to:

1. Describe the transmission of cytomegalovirus (CMV) to the fetus and newborn and the differences between congenital, natal, and postnatal infection with CMV.

2. Delineate the clinical manifestations and sequelae of congenital, natal, and postnatal infection with CMV.

3. Know how to diagnose CMV infection in the fetus and newborn.

4. Describe potential treatment options for neonatal CMV infections.

Introduction

Human CMV is a DNA virus of the herpesvirus group. CMV infection was described first in the early 1900s in pathologic specimens from an infant who died of presumed congenital syphilis. The virus initially was named salivary gland virus due to the characteristic pathologic changes seen in the salivary glands. It was isolated in tissue culture in 1956, and in the early 1960s, the more descriptive name cytomegalovirus was adopted. CMV infection of host cells results in a characteristic massive enlargement of the affected cells that contain intranuclear and cytoplasmic inclusions (Fig. 1).

Infection of the fetus and neonate with CMV is an important health problem worldwide. In the United States, CMV is the most common congenital viral infection, affecting 0.2% to 2.5% of all live births. Of the 40,000 infants born each year with congenital CMV infection, more than 8,000 develop mental retardation, cerebral palsy, or, most commonly, hearing impairment.

Epidemiology

Infection with CMV is ubiquitous, occurring in all populations and socioeconomic groups throughout the year without any seasonal variation. Person-to-person transmission of CMV occurs by close contact with infected body fluids and secretions. CMV can be isolated from body tissues and fluids such as tears, saliva, human milk, urine, stool, semen, cervical secretions, amniotic fluid, blood, and transplanted organs. In addition, infected secretions on …