CMV Flashcards
prevalence of congenital CMV
0.5-1% of live births
cCMV is leading cause of what?
non-genetic SNHL
rate of neurologic sequelae in asymptomatic cCMV?
5-15%
neurologic sequelae in children with symptomatic cCMV
40-90%
percentage of fetal infection with primary maternal infection
30-50%
percentage of fetal infections in non-primary maternal CMV
1-3%
major source of infection in adult caregivers
preschool children, children in day care
features of symptomatic cCMV
microcephaly rash hepatosplenomegaly jaundice seizures pneumonitis SNHL chorioretinitis optic atrophy thrombocytopenia elevated ALT conjugated hyperbili CSF pleocytosis
head imaging features in CMV
calcifications (periventricular) ventriculomegaly atrophy of ventricles cerebellar, ependymal, parenchymal cysts polymicrogyria lisencephaly etc lenticulstriate vasculopathy
best test for cCMV
urine PCR prior to 21 days of age
indications for cCMV testing
maternal CMV infection fetal ultrasound with findings placental pathology consistent with CMV infection HIV exposure primary immunodeficiency failed NB hearing screen symptoms
evaluation of CVM + newborn
- CBC, bili, AST, ALT
- HUS (if abnormal then MRI)
- hearing
- optho
when to do LP for cCMV
NOT routine
only if CNS disease
how to classify as mild cCMV
1 or 2 isolated transient and mild feautres (Ex transient thrombocytopenia, transaminitis)
NO CNS involvment
moderate-severe CMV
CNS disease (microcephaly,seizures, CSF CMV,
chorioretinitis
multisystem (i.e. 3 organ systems) not transient
OR
severe single organ disease
who should be referred to ID?
all confirmed symptomatic cases
all cases with cCMV SNHL even if asymptomatic
probable cases
who should be treated
moderate-severe symptomatic
treatment for cCMV
valganciclovir BID x 6 months, to be started within 30 days of life
can consider starting ganciclovir if very sick neonate while in hospital
treatment monitoring for cCMV
weekly CBNC and diff x 1 month, then biweekly x 2 months, then monthly x 3 months
monly AST, ALT, urea and creatinine x 6 months
audiology frequent
optho as soon as possible
Dental for enamle hypoplasia
late onset SNHL occurs when?
mean 27 months, can occur up to 5 years
