Comparison of Clinical and Neuroimaging Characteristics of Congenital and Possible Congenital Cytomegalovirus Infected Infants: A Retrospective Study

Abstract

Background To evaluate clinical and neurodevelopmental outcomes and neuroimaging results of patients diagnosed with congenital cytomegalovirus (cCMV) infection and those diagnosed with possible congenital CMV (possible cCMV) infection.

Methods From January 2014 to January 2016, 24 patients were diagnosed with congenital CMV infection. Clinical and neuroimaging results of these patients were examined from their medical records.

Results Of the 24 patients, 6 were diagnosed with cCMV, whereas 18 patients were diagnosed with possible cCMV. Petechia was the most common symptom observed in patients with cCMV infection, whereas microcephaly was more common in patients with possible cCMV. Of the 24 patients, 5 (20.8%) showed normal neuroimaging characteristics. The most commonly encountered abnormal findings in brain magnetic resonance imaging were hypoplasia of corpus callosum (16.7%) and hydrocephalous (16.7%). All of the patients had poor neurodevelopmental outcomes.

Conclusions Early diagnosis of asymptomatic cCMV infection is difficult. This study suggests that possible cCMV infections are more prevalent compared with cCMV infections, and delays in diagnosis occur due to not keeping suspicion of CMV infection in early phase. Clinicians should consider long-term neurodevelopmental sequelae of cCMV and possible cCMV infections and remember to screen congenital CMV infection in suspected individuals.

Keywords

congenital CMV - possible congenital CMV - neuroimaging

• References

• 1 Picone O, Vauloup-Fellous C, Cordier AG. , et al. A series of 238 cytomegalovirus primary infections during pregnancy: description and outcome. Prenat Diagn 2013; 33 (08) 751-758
• 2 Syggelou A, Iacovidou N, Kloudas S, Christoni Z, Papaevangelou V. Congenital cytomegalovirus infection. Ann NY Acad Sci 2010; 1205: 144-147
• 3 Fowler KB, Boppana SB. Congenital cytomegalovirus infection. Semin Perinatol 2018; 42 (03) 149-154
• 4 Kwak M, Yum MS, Yeh HR, Kim HJ, Ko TS. Brain magnetic resonance imaging findings of congenital cytomegalovirus infection as a prognostic factor for neurological outcome. Pediatr Neurol 2018; 83: 14-18
• 5 Noyola DE, Demmler GJ, Nelson CT. , et al; Houston Congenital CMV Longitudinal Study Group. Early predictors of neurodevelopmental outcome in symptomatic congenital cytomegalovirus infection. J Pediatr 2001; 138 (03) 325-331
• 6 Bartlett AW, McMullan B, Rawlinson WD, Palasanthiran P. Hearing and neurodevelopmental outcomes for children with asymptomatic congenital cytomegalovirus infection: a systematic review. Rev Med Virol 2017 . doi: 10.1002/rmv.1938
• 7 Demmler-Harrison GJ. Congenital cytomegalovirus infection: clinical features and diagnosis. Available at: https://www.uptodate.com/contents/congenital-cytomegalovirus-infection-clinical-features-and-diagnosis . Accessed May 24, 2018
• 8 Munro SC, Hall B, Whybin LR. , et al. Diagnosis of and screening for cytomegalovirus infection in pregnant women. J Clin Microbiol 2005; 43 (09) 4713-4718
• 9 Coll O, Benoist G, Ville Y. , et al; WAPM Perinatal Infections Working Group. Guidelines on CMV congenital infection. J Perinat Med 2009; 37 (05) 433-445
• 10 Boppana SB, Ross SA, Fowler KB. Congenital cytomegalovirus infection: clinical outcome. Clin Infect Dis 2013; 57 (4, Suppl 4): S178 –S181
• 11 Kylat RI, Kelly EN, Ford-Jones EL. Clinical findings and adverse outcome in neonates with symptomatic congenital cytomegalovirus (SCCMV) infection. Eur J Pediatr 2006; 165 (11) 773-778
• 12 Dreher AM, Arora N, Fowler KB. , et al. Spectrum of disease and outcome in children with symptomatic congenital cytomegalovirus infection. J Pediatr 2014; 164 (04) 855-859
• 13 Buonsenso D, Serranti D, Gargiullo L, Ceccarelli M, Ranno O, Valentini P. Congenital cytomegalovirus infection: current strategies and future perspectives. Eur Rev Med Pharmacol Sci 2012; 16 (07) 919-935
• 14 Williamson WD, Desmond MM, LaFevers N, Taber LH, Catlin FI, Weaver TG. Symptomatic congenital cytomegalovirus. Disorders of language, learning, and hearing. Am J Dis Child 1982; 136 (10) 902-905
• 15 Barkovich AJ, Lindan CE. Congenital cytomegalovirus infection of the brain: imaging analysis and embryologic considerations. Am J Neuroradiol 1994; 15 (04) 703-715
• 16 Nigro G, La Torre R, Sali E. , et al. Intraventricular haemorrhage in a fetus with cerebral cytomegalovirus infection. Prenat Diagn 2002; 22 (07) 558-561
• 17 Persoons MC, Stals FS, van dam Mieras MC, Bruggeman CA. Multiple organ involvement during experimental cytomegalovirus infection is associated with disseminated vascular pathology. J Pathol 1998; 184 (01) 103-109
• 18 Golden MP, Hammer SM, Wanke CA, Albrecht MA. Cytomegalovirus vasculitis. Case reports and review of the literature. Medicine (Baltimore) 1994; 73 (05) 246-255
• 19 Manara R, Balao L, Baracchini C, Drigo P, D'Elia R, Ruga EM. Brain magnetic resonance findings in symptomatic congenital cytomegalovirus infection. Pediatr Radiol 2011; 41 (08) 962-970
• 20 Boesch C, Issakainen J, Kewitz G, Kikinis R, Martin E, Boltshauser E. Magnetic resonance imaging of the brain in congenital cytomegalovirus infection. Pediatr Radiol 1989; 19 (02) 91-93
• 21 Oosterom N, Nijman J, Gunkel J. , et al. Neuro-imaging findings in infants with congenital cytomegalovirus infection: relation to trimester of infection. Neonatology 2015; 107 (04) 289-296
• 22 van der Knaap MS, Vermeulen G, Barkhof F, Hart AA, Loeber JG, Weel JF. Pattern of white matter abnormalities at MR imaging: use of polymerase chain reaction testing of Guthrie cards to link pattern with congenital cytomegalovirus infection. Radiology 2004; 230 (02) 529-536
• 23 Suzuki Y, Toribe Y, Mogami Y, Yanagihara K, Nishikawa M. Epilepsy in patients with congenital cytomegalovirus infection. Brain Dev 2008; 30 (06) 420-424