Infecção perinatal por citomegalovírus: muito freqüente mas pouco diagnosticada

Abstract

Objective

To determine the incidence rate of perinatal cytomegalovirus (CMV) infection and to describe the clinical presentation of this infection in non-transfused term infants seen at a general hospital in Ribeirão Preto, SP, Brazil. Population and Methods: We followed up 34 infants free of CMV infection at birth during their first 4 months of life. We established the diagnosis of perinatal CMV infection by isolating the virus in tissue culture, or by using urine samples for polymerase chain reaction (PCR) DNA amplification. Results: We detected a 38.2% (13/34) incidence rate of perinatal CMV infection, and only 3 of the infected infants were symptomatic (respiratory tract symptoms in one infant and splenomegaly in two). Conclusions: There was a high incidence rate of perinatal CMV infection in the group studied. Clinical symptoms were present in 23% of these patients. These results suggest that this agent should be investigated as a cause of pneumonitis and splenomegaly in infants.

Population and Methods

We followed up 34 infants free of CMV infection at birth during their first 4 months of life. We established the diagnosis of perinatal CMV infection by isolating the virus in tissue culture, or by using urine samples for polymerase chain reaction (PCR) DNA amplification. Results: We detected a 38.2% (13/34) incidence rate of perinatal CMV infection, and only 3 of the infected infants were symptomatic (respiratory tract symptoms in one infant and splenomegaly in two). Conclusions: There was a high incidence rate of perinatal CMV infection in the group studied. Clinical symptoms were present in 23% of these patients. These results suggest that this agent should be investigated as a cause of pneumonitis and splenomegaly in infants.

Results

We detected a 38.2% (13/34) incidence rate of perinatal CMV infection, and only 3 of the infected infants were symptomatic (respiratory tract symptoms in one infant and splenomegaly in two). Conclusions: There was a high incidence rate of perinatal CMV infection in the group studied. Clinical symptoms were present in 23% of these patients. These results suggest that this agent should be investigated as a cause of pneumonitis and splenomegaly in infants.

Conclusions

There was a high incidence rate of perinatal CMV infection in the group studied. Clinical symptoms were present in 23% of these patients. These results suggest that this agent should be investigated as a cause of pneumonitis and splenomegaly in infants.

Resumen

Objetivo

Avaliar a freqüência da infecção perinatal por citomegalovirus (CMV) em lactentes e descrever a sua apresentação clínica.

Casuística e métodos

Foram estudados, prospectivamente, 34 recém-nascidos até o quarto mês de vida. Colheram-se amostras de urina ao nascimento, com 15 dias e mensalmente, bem como amostras de sangue ao nascimento e no terceiro mês de vida. O diagnóstico laboratorial de citomegalovirose foi realizado pela detecção dos CMV na urina por isolamento viral em cultura de células e por detecção do DNA viral através da reação de amplificação gênica catalisada pela polimerase (PCR). Em todas as crianças foi excluído o diagnóstico de citomegalovirose congênita.

Resultados

A incidência da infecção perinatal foi de 38,2% (13/34) e apenas três dessas crianças apresentaram manifestações clínicas. Observou-se um caso com quadro respiratório e diarréia, e outros dois pacientes apresentaram esplenomegalia.

Conclusões

Observou-se uma elevada taxa de incidência de infecção perinatal por CMV. Das crianças infectadas, 23% apresentaram sintomas. Esses resultados estimulam a que se faça a pesquisa dos CMV como parte da investigação etiológica de pneumonites e esplenomegalia em lactentes jovens.