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MFM Written/Oral Boards > CMV > Flashcards

CMV Flashcards

1
Q

How is maternal infection with CMV diagnosed?

A

Maternal serology : IgM + low avidity

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2
Q

How is CMV transmitted?

A
  • Sexually
  • Direct contact
  • Blood
  • Urine
  • Saliva
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3
Q

Do you recommend screening for CMV routinely in pregnancy?

A

No. Limitations of IgM antibody screening in differentiating primary from recurrent infection makes the results difficult to use in counseling patient about fetal risks.

  • Maternal immunity does not eliminate the possibility of fetal infection
  • 75% of congenital CMV are due to reactivation of latent virus or a new strain
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4
Q

How is primary CMV infection diagnosed?

A
  • Culture /PCR of blood, urine, saliva, cervical secretions, breast milk
  • IgG 2-4 weeks apart
  • Avidity testing (low avidity testing due to immature IgG being made 2-4 months after acute infection)
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5
Q

How is recurrent CMV infection diagnosed?

A

IgM + low avidity IgG

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6
Q

How do you counsel a patient with a positive CMV IgM and negative IgG results?

A

-Old infection
-New infection
-Reactivation of latent infection
75% of congenital infection are due to reactivation of latent virus or reinfection with new strain

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7
Q

How do you counsel a patient with a positive CMV IgM and positive IgG results?

A
  • New infection
  • old infection
  • Reactivation of older latent infection
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8
Q

What does high IgG avidity for CMV mean?

A

-Mature IgG

no infection in the last 2-4 months

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9
Q

What does low IgG avidity for CMV mean?

A

-Immature IgG (infection in the last 2-4 months)

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10
Q

What are maternal risks of CMV infection?

A

Child care worker

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11
Q

What are maternal symptoms of CMV infection?

A
  • Mononucleosis-like symptoms
  • Fever/chills
  • Myalgia
  • Malaise
  • Leukocytosis
  • Lymphocytosis
  • Lymphadenopathy
  • Abnormal liver function
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12
Q

What percentage of patients infected with CMV are sumptomatic?

A

Most are asymptomatic

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13
Q

What ultrasound findings are consistent with in utero CMV infection?

A
  • Abnormal liver calcifications
  • Hepatosplenomegaly
  • Echogenic bowel
  • Echogenic kidneys
  • Ascites
  • Cerebral ventriculomegaly
  • Intracranial calcifications
  • Microcephaly
  • Hydrops
  • Fetal growth restriction
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14
Q

How is in utero CMV infection confirmed?

A

Amniocentesis

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15
Q

If performing an amniocentesis for suspected CMV infection, what tests will you order on the amniotic fluid?

A

Culture (70-80%)

PCR (78-98%)

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16
Q

What is the risk of fetal transmission of CMV in the first trimester?

A

1-30%

17
Q

What is the risk of fetal transmission of CMV in the second trimester?

A

34-38%

18
Q

What is the risk of fetal transmission of CMV in the third trimester?

A

40-72%

19
Q

In which trimester of pregnancy is the greatest risk of fetal infection?

A

Risk of transmission is 30-40%. Third trimester; however, sequelae is worse in the first trimester.

20
Q

What patients are candidates for CMV serology?

A
  • Fetal ultrasound abnormality (calcifications in liver, kidneys, bowel, intracranial)
  • Microcephaly
  • Ascites
  • Known exposure
  • Abnormal LFTs with exposure
21
Q

What are fetal risks of in utero CMV infection?

A

Third trimester of pregnancy

22
Q

What is the most common neonatal morbidity associated with reactivation of maternal CMV infection and subsequent in utero CMV infection?

A

Hearing loss

23
Q

How do you counsel a patient regarding fetal and neonatal outcomes following in utero CMV infection?

A

Jaundice, thrombocytopenia, myocarditis, non-immune hydrops, congenital hearing loss

  • 12-18% will have signs/symptoms of CMV at birth
  • 25% will develop sequelae of CMV at birth
  • 30% of severely infected infants die
  • 65-80% of survivors have severe neurologic morbidity
24
Q

What are the fetal risks if fetal infection occurs following a primary maternal infection?

A

30-40%

25
Q

What are the fetal risks if fetal infection occurs following a reactivated maternal infection?

A

0.15-2%

26
Q

What is the likelihood of delivering a symptomatic neonate if fetal infection occurs following a primary maternal infection?

A

Higher

27
Q

What is the likelihood of delivering a symptomatic neonate if fetal infection occurs following a reactivated maternal infection?

A

Lower

28
Q

How do you counsel a patient regarding neonatal outcomes if the neonate is born and symptomatic following a primary maternal infection?

A

25% will get CMV infection sequelae including neurologic abnormalities

MFM Written/Oral Boards (127 decks)

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