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Cytomegalovirus infections of the neonate and infant
1Department of Pediatrics, Northeastern Ohio Universities College of Medicine, Children's Hospital Medical Center, Akron.
Abstract:
Cytomegalovirus is ubiquitous. While most infections are asymptomatic, infants and children acquiring CMV may excrete the virus for years in spite of significant antibody responses. CMV may be transmitted vertically or horizontally. Transplacental passage of CMV leads to congenital infection of the neonate. The most severely affected infants are born to mothers who develop a primary infection early in pregnancy and have a suboptimal cell-mediated response. During the perinatal period, the virus may be acquired by the infant from infected breast milk, passage through an infected birth canal, or by blood transfusion. Full-term infants infected during the perinatal period, though usually asymptomatic, may present with rash, hepatomegaly, lymphadenopathy, and/or pneumonia. Perinatally acquired infections in sick preterm infants may cause significant morbidity and mortality. Although specific therapy for infected individuals is currently unavailable, the outlook for an effective vaccine is promising.
Insights
Cytomegalovirus (CMV) is common, with infants and children potentially shedding the virus long-term. While congenital CMV can be severe, especially with early maternal infection, perinatal transmission routes and potential for a future vaccine are key considerations.
Area of Science:
- Virology
- Immunology
- Pediatrics
Background:
- Cytomegalovirus (CMV) is a ubiquitous virus with varied clinical presentations.
- Infants and children can excrete CMV for extended periods, even with robust antibody responses.
- CMV transmission occurs vertically (transplacental) or horizontally.
Purpose of the Study:
- To review the transmission routes of Cytomegalovirus in infants and children.
- To discuss the clinical implications of congenital and perinatal CMV infections.
- To highlight the current therapeutic landscape and future vaccine prospects for CMV.
Main Methods:
- Literature review of Cytomegalovirus transmission and pathogenesis.
- Analysis of clinical outcomes in congenital and perinatal CMV infections.
- Evaluation of current and emerging strategies for CMV management.
Main Results:
- Congenital CMV, particularly from early maternal primary infection with suboptimal cell-mediated immunity, poses the greatest risk to neonates.
- Perinatal acquisition via breast milk, birth canal, or transfusion can lead to symptomatic disease, especially in preterm infants, causing significant morbidity and mortality.
- Despite asymptomatic presentation in many full-term infants, symptoms like rash and hepatomegaly can occur.
Conclusions:
- CMV infection presents diverse challenges in pediatric populations, ranging from asymptomatic shedding to severe congenital or perinatal disease.
- Effective therapies are currently limited, underscoring the need for preventative strategies.
- Promising developments in vaccine research offer hope for future control of CMV infections.