VP016 Congenital cytomegalovirus infection: a clinical study

Objective

Congenital Cytomegalovirus (CMV) infection is the most common intrauterine viral infection, affecting around 1% of newborns, and the must common cause of non-genetic sensorineural hearing loss in children. Nearly 90% of these newborns are asymptomatic at birth, but late neurosensory sequelae (hearing loss, vision impairement) and neurodevelopmental delays may occur in 10% of cases. These sequelae are variable in severity and difficult to predict in the antenatal setting. The aim of our study is to analyze the clinical, para-clinical, therapeutic and evolutionary data on congenital CMV infection diagnosed in the neonatal period.

Methods

A descriptive cross-sectional study, conducted over a period of 24 years (2000-2023), in the neonatology department of the Farhat-Hached University Hospital in Sousse, covering all symptomatic newborns (NB) hospitalized in our department and in whom congenital CMV infection was confirmed by qPCR.

Results

In our study, we included 20 newborns with symptomatic congenital CMV infection, divided into 10 girls and 10 boys. Eight NB were born prematurely. The main antenatal ultrasound abnormalities were intra-uterine growth retardation in 8 cases and microcephaly in 1 case. The main clinical manifestations suggesting congenital CMV infection were hypotrophy in 10 cases, neurological distress in 7 cases, jaundice, microcephaly and hepatosplenomegaly in 7 cases respectively, and petechiae in 3 cases. Age at diagnosis ranged from the 1st to the 16th day of life. Biological abnormalities included thrombocytopenia and hepatic cytolysis in 9 cases respectively, and cholestasis in 3 cases. Cerebral radiological examination revealed agenesis of the corpus callosum and periventricular calcifications in 2 cases respectively, and hydrocephalus in 1case. Treatment with Ganciclovir at a dose of 12mg/kg/d was indicated in 4 cases. The subsequent course was fatal in 5 cases, with multi-visceral failure secondary to macrophagic activation syndrome and disseminated intra-vascular coagulation. Long-term sequelae included deafness and ophthalmological damage (chorioretinitis pigmentosa and cataracts) in 3 cases respectively.

Conclusion

Congenital CMV infections are a public health problem. They are particularly serious because of the high mortality rate in symptomatic forms and the sequelae, mainly deafness. The justification for systematic screening for CMV infection during pregnancy is still controversial, and is not recommended in most developed countries. Hygienic measures avoiding contact with infected individuals and biological secretions are the only effective preventive measures.

Keywords

Cytomegalovirus, Congenital infection, fetal diseases, neurosensory sequelae.