To determine the prevalence of congenital cytomegalovirus (CMV) infection, to evaluate the importance of this agent as cause of congenital disease, and to describe the clinical findings in children treated at a General Hospital in Ribeirão Preto, SP, Brazil. Patients and methods: A group of 189 newborns and their mothers were evaluated for the prevalence of congenital CMV infection. A second group, comprising 130 newborns and 74 infants who presented with clinical signs of congenital disease, was also investigated to evaluate the importance of CMV as a cause of the disease, and to describe clinical findings. Diagnosis of congenital CMV infection was established by viral isolation in tissue culture, polymerase chain reaction DNA amplification in urine samples, and detection of specific anti-CMV IgM and IgG by immunofluorescence indirect test. Results: The prevalence of congenital CMV infection was 2.6% and the prevalence of CMV antibodies in mothers was 95%. In the first group, none of the 5 newborns congenitally infected presented clinically apparent disease at birth, although one had intracranial calcifications. In the second group, CMV was a cause of congenital disease in 12 children (5.9%). Of these, 10 (83%) were diagnosed after the neonatal period. Clinical findings included hepatosplenomegaly (75%), jaundice with direct hyperbilirubinemia (42%), and neurologic disease consisting of microcephaly and intracranial calcifications (42%). Conclusions: The prevalence of congenital CMV infection was similar to that reported in other studies of highly immune populations. Infants with asymptomatic congenital CMV infection may have diseases of the central nervous system that are not clinically evident at birth. Patients infected by CMV and who are symptomatic at birth have a multisystem disease, and the differential diagnosis of any newborn with clinical abnormalities in the hepatobiliary, hematopoietic and central nervous systems should include congenital CMV infection. CMV is an important agent of these abnormalities, and most symptomatic patients were identified after the neonatal period, which makes diagnosis more difficult.
Patients and methodsA group of 189 newborns and their mothers were evaluated for the prevalence of congenital CMV infection. A second group, comprising 130 newborns and 74 infants who presented with clinical signs of congenital disease, was also investigated to evaluate the importance of CMV as a cause of the disease, and to describe clinical findings. Diagnosis of congenital CMV infection was established by viral isolation in tissue culture, polymerase chain reaction DNA amplification in urine samples, and detection of specific anti-CMV IgM and IgG by immunofluorescence indirect test. Results: The prevalence of congenital CMV infection was 2.6% and the prevalence of CMV antibodies in mothers was 95%. In the first group, none of the 5 newborns congenitally infected presented clinically apparent disease at birth, although one had intracranial calcifications. In the second group, CMV was a cause of congenital disease in 12 children (5.9%). Of these, 10 (83%) were diagnosed after the neonatal period. Clinical findings included hepatosplenomegaly (75%), jaundice with direct hyperbilirubinemia (42%), and neurologic disease consisting of microcephaly and intracranial calcifications (42%). Conclusions: The prevalence of congenital CMV infection was similar to that reported in other studies of highly immune populations. Infants with asymptomatic congenital CMV infection may have diseases of the central nervous system that are not clinically evident at birth. Patients infected by CMV and who are symptomatic at birth have a multisystem disease, and the differential diagnosis of any newborn with clinical abnormalities in the hepatobiliary, hematopoietic and central nervous systems should include congenital CMV infection. CMV is an important agent of these abnormalities, and most symptomatic patients were identified after the neonatal period, which makes diagnosis more difficult.
ResultsThe prevalence of congenital CMV infection was 2.6% and the prevalence of CMV antibodies in mothers was 95%. In the first group, none of the 5 newborns congenitally infected presented clinically apparent disease at birth, although one had intracranial calcifications. In the second group, CMV was a cause of congenital disease in 12 children (5.9%). Of these, 10 (83%) were diagnosed after the neonatal period. Clinical findings included hepatosplenomegaly (75%), jaundice with direct hyperbilirubinemia (42%), and neurologic disease consisting of microcephaly and intracranial calcifications (42%). Conclusions: The prevalence of congenital CMV infection was similar to that reported in other studies of highly immune populations. Infants with asymptomatic congenital CMV infection may have diseases of the central nervous system that are not clinically evident at birth. Patients infected by CMV and who are symptomatic at birth have a multisystem disease, and the differential diagnosis of any newborn with clinical abnormalities in the hepatobiliary, hematopoietic and central nervous systems should include congenital CMV infection. CMV is an important agent of these abnormalities, and most symptomatic patients were identified after the neonatal period, which makes diagnosis more difficult.
ConclusionsThe prevalence of congenital CMV infection was similar to that reported in other studies of highly immune populations. Infants with asymptomatic congenital CMV infection may have diseases of the central nervous system that are not clinically evident at birth. Patients infected by CMV and who are symptomatic at birth have a multisystem disease, and the differential diagnosis of any newborn with clinical abnormalities in the hepatobiliary, hematopoietic and central nervous systems should include congenital CMV infection. CMV is an important agent of these abnormalities, and most symptomatic patients were identified after the neonatal period, which makes diagnosis more difficult.
Determinar a prevalência da infecção congênita por citomegalovírus (CMV), bem como avaliar o papel desse agente como causa de doença congênita e descrever as principais manifestações clínicas dessa doença em crianças atendidas em hospital universitário de Ribeirão Preto.
Casuística e métodosPara determinação da prevalência da infecção congênita, foram estudados 189 recém-nascidos e suas mães, constituindo um primeiro grupo de estudo. Para avaliação da importância do CMV na etiologia da doença congênita e descrição das manifestações clínicas da citomegalovirose congênita, foram incluídos outros 130 recém-nascidos e 74 lactentes com clínica sugestiva de infecção congênita, constituindo um segundo grupo. O diagnóstico laboratorial foi realizado pelo isolamento viral na urina em cultura de fibroblastos humanos, pela detecção do DNA viral na urina através da reação de amplificação gênica catalizada pela polimerase e pela reação de imunofluorescência para pesquisa de IgM e IgG específicos anti-CMV.
ResultadosA prevalência da infecção congênita foi de 2,6%, e 95% das mães tinham IgG anti-CMV. Todas as crianças infectadas do primeiro grupo eram assintomáticas ao nascimento, porém em uma evidenciaram-se calcificações intracranianas ao exame radiológico. No segundo grupo de estudo, CMV foi detectado na urina de 12 (5,9%) das crianças com apresentação clínica compatível com doença congênita. Destas, em 10 (83%), o diagnóstico foi realizado após o período neonatal. Os achados clínicos incluíram a hepatoesplenomegalia (75%), icterícia neonatal com hiperbilirrubinemia direta (42%) e anormalidades neurológicas caracterizadas por microcefalia e calcificações intracranianas (42%).
ConclusõesObservou-se uma prevalência de infecção congênita por CMV similar à encontrada nos estudos realizados em populações de soroprevalência elevada para CMV. Crianças com citomegalovirose assintomática podem ter acometimento do SNC, clinicamente imperceptível ao nascimento, e crianças sintomáticas apresentam doença multissistêmica. O diagnóstico diferencial de qualquer recém-nascido com anormalidades, incluindo envolvimento hepático, hematopoético e neurológico, deve incluir pesquisa para citomegalovirose congênita. Os CMV mostraram ser agentes importantes na etiologia dessas afecções, e a grande maioria das crianças sintomáticas foram identificadas após o período neonatal, dificultando um diagnóstico definitivo.
