CMV

Question 1

High risk groups for cmv

Answer 1

Daycare workers
Parents w kids in daycare
Health care workers

Question 2

CMV negative

Answer 2

Igg and igm negative

Question 3

Igg+

Igm -

Answer 3

Past cmv

Question 4

Igg -

Igm+

Answer 4

Possible infection -test avidity igg
Low avidity recent primary infection
High avidity past infection

Question 5

Fetal dx through amino

Answer 5

Needs to be after 21/40
80-100% specific, high specificity
Done 6/52 after primary infection (but >21/40)

Question 6

Uss features of cmv

Answer 6

Microcephalic
Ascites 
Oli or poly
Abdo calc
Hydrocephalus 
Intracranial calc
Hydrops 
Pseudomeconium ileus 
Iugr
Pleural or pericardial effusions
Hepatomegaly
Hyperechogenic bowel

Question 7

Tx

Answer 7

Top
Antenatal cmv immunoglobulin (IVIG)
Valcyclovir 500mg BD form 34/40

Question 8

Neonatal

Answer 8

CMV PCR of saliva or urine within first 3 weeks of life - distinguish congenital from neonatal
Opthal
Hearing screen
Uss or mri head
Neurodevelopmental assessment

Ok to BF

Need to be followed up 3-6 monthly for 2 years

Question 9

Advice to pregnant women

Answer 9

Assume all kids under 3 have cmv in saliva and urine
Throughly wash hands
Do not share food
Do not kiss kid on the mouth
Don’t sleep in the same bed
Do not put dummy/soother in mouth
Clean toys, countertops and other surfaces that come into contact with children’s urine or saliva

Question 10

Clinical feature of symptomatic CMV neonate

Answer 10

Stillbirth, neonatal death
Neurological abnormality (hearing loss, developmental delay, microcephalic,, seizures, chorioretinitis
Thrombocytopenia
Hepatosplenomegaly
Petechiae, outputs
IUGR
Myocarditis
Pneumonitis

Question 11

Risk of infection and damage with primary CMV

Answer 11

30-35% chance of fetal infection
30-35% chance of fetus being affected
(10-15% chance of fetus being damaged (90% asymptomatic)

Question 12

Tx of neonate

Answer 12

CMV nuclei acid test from urine (PCR)
Hancock our or valganciclovir for babies with moderate to severe disease
No tx if asymptomatic

Question 13

What’s in a TORCH screen

Answer 13

Toxo
Rubella
CMV
Herpes

Request also syphilis,, Zika and Parvo

Question 14

CMV make up

Answer 14

Herpetoviridae family
DNA virus
Several strains
Serologic testing can’t differentiate strain

Question 15

Incidence

Answer 15

1% all live births
3.85/100000
Most frequent cause mental retardation and sensory neural hearing loss

Question 16

Pathogenesis

Answer 16

Replication t-helper cells
Endothiolel cells and PML are main cells infected, followed by haematogenous spread
Placenta and amnion infection causes vascular remodeling and change in protein expression- villous hypoplasia

Indirect or direct contact

Question 17

Investigations with active infection

Answer 17

USS- CNS signs, hydrops, echogenic bowel IUGR
MRI - microcephalic with abnormal gyral patterns (28 if first trimester infection and 34 weeks if late infection)
Amniocentesis- after 8 weeks of suspected infection and >21 weeks gestation (otherwise high false negative rate)

Question 18

Treatment of woman

Answer 18

If immunocompromised :

An I lovin, valganciclovir, valaciclovir

Question 19

Cytomegalic inclusion disease

Answer 19

CNS abnormalities
Choroidretinitis
Sensorineural deafness
Hepatosleponmegaly
Pneumonitis
Myocarditis
Haemolytic anaemia
Reduced intelligence

Question 20

Neonatal manifestations

Answer 20

CP
Sensorineural hearing loss
Visual impairment
Delayed psychomotor development