Abnormal Development - Cytomegalovirus: Difference between revisions
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* '''Prenatal diagnosis of congenital cytomegalovirus infection in 115 cases''': a 5 years' single center experience<ref name="PMID28207161"><pubmed>28207161</pubmed></ref> "The objective of this study is to investigate the diagnostic value of invasive prenatal diagnosis (PD) of congenital cytomegalovirus (CMV) infection from amniotic fluid (AF) and fetal blood (FB). A retrospective study was conducted on 115 pregnancies with CMV primary infection. A total of 111 AF and 106 FB samples were investigated for various virological and non-virological markers. Detailed ultrasound examinations were performed at time of PD. Overall sensitivity of CMV PCR in FB (75.6%; 95%CI 60-87) and AF (72.7%; 95%CI 57-85) was comparable. In women with amniocentesis >8 weeks between seroconversion and PD, we did not observe significant differences between amniocentesis performed ≥17 + 0 (sensitivity 90.9%; 95%CI 71-99) and ≥20 + 0 gestational weeks (sensitivity 90.0%; 95%CI 68-99). Virological markers in FB were higher in symptomatic compared with asymptomatic fetuses (p < 0.05). ...Optimal timing of amniocentesis in women with primary infection in early gestation should be reevaluated in a prospective study. Analysis of FB markers may be beneficial in the individual management of pregnant women with confirmed congenital CMV infection." | |||
* '''Clinical Implications for Children Born With Congenital Cytomegalovirus Infection Following a Negative Amniocentesis'''<ref name="PMID27114380"><pubmed>27114380</pubmed></ref> "Recently, congenital cytomegalovirus (cCMV) infection was reported irrespective of a negative amniotic fluid prenatal analysis for cytomegalovirus (CMV). The question of whether this phenomenon represents low sensitivity of the test or late development of fetal infection (after amniocentesis) was discussed, but not answered. However, if late transmission is the rule, then infants born with cCMV after negative amniocentesis would be expected to carry better prognosis than those who tested positive. Data of all infants with cCMV infection, followed in 2 pediatric centers from 2006 to 2015, were reviewed. Infant outcome after birth of symptomatic vs asymptomatic disease was compared with infants born after a negative amniocentesis (study group) and those with a positive amniocentesis (control group).Amniocentesis was performed in 301 pregnancies of our cohort of infants with cCMV and was negative for CMV in 47 (15.6%). There were fewer symptomatic cCMV neonates in the study group than in the control group (4.3% vs 25%; P < .001). Hearing impairment at birth was also less frequent in the study group (2.2% vs 17.4%; P = .012). None of the children in the study group had neurologic sequelae at long-term follow up, compared with 13 (14.1%) in the control group (P < .001). Although negative amniocentesis does not exclude cCMV, infants with cCMV born after a negative amniocentesis seldom present with mild clinical symptoms or cerebral ultrasound features at birth. These children also have a very good long-term outcome. Our findings support the theory of a late development of fetal infection, after the time of the amniocentesis." | * '''Clinical Implications for Children Born With Congenital Cytomegalovirus Infection Following a Negative Amniocentesis'''<ref name="PMID27114380"><pubmed>27114380</pubmed></ref> "Recently, congenital cytomegalovirus (cCMV) infection was reported irrespective of a negative amniotic fluid prenatal analysis for cytomegalovirus (CMV). The question of whether this phenomenon represents low sensitivity of the test or late development of fetal infection (after amniocentesis) was discussed, but not answered. However, if late transmission is the rule, then infants born with cCMV after negative amniocentesis would be expected to carry better prognosis than those who tested positive. Data of all infants with cCMV infection, followed in 2 pediatric centers from 2006 to 2015, were reviewed. Infant outcome after birth of symptomatic vs asymptomatic disease was compared with infants born after a negative amniocentesis (study group) and those with a positive amniocentesis (control group).Amniocentesis was performed in 301 pregnancies of our cohort of infants with cCMV and was negative for CMV in 47 (15.6%). There were fewer symptomatic cCMV neonates in the study group than in the control group (4.3% vs 25%; P < .001). Hearing impairment at birth was also less frequent in the study group (2.2% vs 17.4%; P = .012). None of the children in the study group had neurologic sequelae at long-term follow up, compared with 13 (14.1%) in the control group (P < .001). Although negative amniocentesis does not exclude cCMV, infants with cCMV born after a negative amniocentesis seldom present with mild clinical symptoms or cerebral ultrasound features at birth. These children also have a very good long-term outcome. Our findings support the theory of a late development of fetal infection, after the time of the amniocentesis." | ||
* '''Neuro-Imaging Findings in Infants with Congenital Cytomegalovirus Infection: Relation to Trimester of Infection'''<ref name="PMID25790782"><pubmed>25790782</pubmed></ref> "Demographic and clinical data were collected in infants with cCMV infection (1992-2013). Trimester of infection, neuro-imaging results and outcome were reviewed. Cerebral abnormalities were categorized into none, mild (lenticulostriate vasculopathy, germinolytic cysts, high signal intensity on T2-weighted images) and severe (migrational disorder, ventriculomegaly, cerebellar hypoplasia). Results were statistically analysed. RESULTS: Thirty-six infants were eligible for analysis. cUS was performed in all and cranial MRI in 20 infants. Migrational disorders were only diagnosed using MRI (p < 0.01). In 17 infants trimester of infection was ascertained. Seven out of 10 infants infected during the first trimester had severe abnormalities on cUS (5 confirmed on MRI) and adverse sequelae; 3 had no/mild abnormalities on cUS/MRI and normal outcome. Two out of 3 infants infected during the second trimester with no/mild abnormalities on cUS/MRI had normal outcome; 1 with mild cUS and MRI abnormalities developed sensorineural hearing loss. Four infants infected during the third trimester with no/mild abnormalities on cUS/MRI had normal outcome. CONCLUSION: Infants with a first trimester cCMV infection are most at risk of severe cerebral abnormalities and neurological sequelae. MRI, and not cUS, enables an early diagnosis of migrational disorders, which can improve prediction of outcome." | * '''Neuro-Imaging Findings in Infants with Congenital Cytomegalovirus Infection: Relation to Trimester of Infection'''<ref name="PMID25790782"><pubmed>25790782</pubmed></ref> "Demographic and clinical data were collected in infants with cCMV infection (1992-2013). Trimester of infection, neuro-imaging results and outcome were reviewed. Cerebral abnormalities were categorized into none, mild (lenticulostriate vasculopathy, germinolytic cysts, high signal intensity on T2-weighted images) and severe (migrational disorder, ventriculomegaly, cerebellar hypoplasia). Results were statistically analysed. RESULTS: Thirty-six infants were eligible for analysis. cUS was performed in all and cranial MRI in 20 infants. Migrational disorders were only diagnosed using MRI (p < 0.01). In 17 infants trimester of infection was ascertained. Seven out of 10 infants infected during the first trimester had severe abnormalities on cUS (5 confirmed on MRI) and adverse sequelae; 3 had no/mild abnormalities on cUS/MRI and normal outcome. Two out of 3 infants infected during the second trimester with no/mild abnormalities on cUS/MRI had normal outcome; 1 with mild cUS and MRI abnormalities developed sensorineural hearing loss. Four infants infected during the third trimester with no/mild abnormalities on cUS/MRI had normal outcome. CONCLUSION: Infants with a first trimester cCMV infection are most at risk of severe cerebral abnormalities and neurological sequelae. MRI, and not cUS, enables an early diagnosis of migrational disorders, which can improve prediction of outcome." |
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P35.1 Congenital cytomegalovirus infection
Introduction
Human cytomegalovirus (HCMV, Greek, cyto = "cell", megalo = "large") or Human Herpesvirus 5 (HHV-5) is a member of the herpes virus family. A viral infection that causes systemic infection and extensive brain damage and cell death by necrosis. Cytomegalovirus is the leading cause of congenital viral infection, with a range of incidence between 0·5–3% of live births worldwide. Approximately 30% of maternal infections during pregnancy can result in congenital infection. Neonates with congenital or perinatal cytomegalovirus infection can be asymptomatic and infection can also be transmitted postnatally from mother to infant by breastfeeding.
HCMV infection is ranked as one of the most common infections in adults, with the seropositive rates ranging from 60–99% globally. In Western countries, adults with advanced AIDS prior to the introduction of highly active antiretroviral therapy (HAART) this virus also a cause of blindness (CMV retinitis) and death in patients.
Congenital cytomegalovirus infection is also a cause of non-hereditary congenital sensorineural hearing loss.[2]
Some Recent Findings
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More recent papers |
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This table allows an automated computer search of the external PubMed database using the listed "Search term" text link.
More? References | Discussion Page | Journal Searches | 2019 References | 2020 References Search term: Abnormal Development Cytomegalovirus <pubmed limit=5>Abnormal Development Cytomegalovirus</pubmed> |
Older papers |
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Cytomegalovirus Structure
- double-stranded linear DNA virus
- 235 Kb in size
Cytomegalovirus infected spermatozoa nucleus[1]
Full and empty viral capsids | HCMV virions |
Cytomegalovirus Detection
Image shows human embryonic lung infected by cytomegalovirus demonstrated by an immunofluorescent technique. Viral infection causes systemic infection and extensive brain damage and cell death by necrosis.
A combination of tests has been used for prenatal diagnosis and there are some less reliable sonographic features to the infection.
- maternal serum - specific immunoglobulin (IgM) antibodies
- amniotic fluid - viral culture and PCR amplification of CMV DNA.
Cytomegalovirus History
- 1921 - first to suggest that the "cytomegalia" could be due to a viral agent.
- 1950 - demonstrated that infection may occur in utero.
- 1956-57 - several groups independently isolate human CMV strains.
- 1960 - the term "cytomegalovirus" introduced.
Cytomegalovirus Musculoskeletal
A mouse model of effects of cytomegalovirus infection on development has shown induction of micrognathia and other musculoskeletal abnormalities by impacting on signalling pathways, involving FN, NF-kappaB2, RelA, RelB, and Shh and Smad7 proteins. |
Cytomegalovirus induced micrognathia and abnormal skeletogenesis in mouse model.[10] |
Cytomegalovirus Placentitis
Clinical term for the cytomegalovirus infection of the placenta.
A earlier histological study[11] identified fixed connective tissue cells predominantly infected cell type in placental tissue. In addition, endothelial cells, macrophages and in some cases trophoblast infection. While a more recent in vitro study[12] suggests that all villi cell types are likely to be infected.
References
- ↑ 1.0 1.1 <pubmed>21711549</pubmed>| Herpesviridae.
- ↑ <pubmed>22033878</pubmed>
- ↑ 3.0 3.1 <pubmed>23071438</pubmed>| PLoS Pathog.
- ↑ <pubmed>28207161</pubmed>
- ↑ <pubmed>27114380</pubmed>
- ↑ <pubmed>25790782</pubmed>
- ↑ <pubmed>24252374</pubmed>
- ↑ <pubmed>23100477</pubmed>
- ↑ <pubmed>21631642</pubmed>
- ↑ <pubmed>18371224</pubmed>| BMC Dev Biol.
- ↑ <pubmed>8236822</pubmed>
- ↑ <pubmed>21392403</pubmed>
Textbooks
- Medical Microbiology. 4th edition. Baron S, editor. Galveston (TX): University of Texas Medical Branch at Galveston; 1996. Medical Microbiology- Cytomegalovirus | Search Medical Microbiology "Cytomegalovirus"
- Molecular Biology of the Cell. 4th edition. Alberts B, Johnson A, Lewis J, et al. New York: Garland Science; 2002. Viruses Exploit Host Cell Machinery for All Aspects of Their Multiplication
- Disease Control Priorities in Developing Countries. 2nd edition. Jamison DT, Breman JG, Measham AR, et al., editors. Washington (DC): World Bank; 2006. Chapter 20Vaccine-preventable Diseases
Reviews
<pubmed></pubmed> <pubmed></pubmed> <pubmed>21364849</pubmed> <pubmed>21375790</pubmed> <pubmed>18073181</pubmed> <pubmed>17635529</pubmed> <pubmed>16635273</pubmed> <pubmed>12364375</pubmed>
Articles
<pubmed></pubmed> <pubmed></pubmed> <pubmed></pubmed> <pubmed>21072294</pubmed> <pubmed>20388893</pubmed> <pubmed>9042169</pubmed>
Search Pubmed
Search Pubmed: Cytomegalovirus Virus | Congenital Cytomegalovirus Syndrome | Congenital Cytomegalovirus Infection | cytomegalovirus placentitis
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- Centers for Disease Control and Prevention Cytomegalovirus (CMV) and Congenital CMV Infection | testing-diagnosis | The Congenital Disease Mothers Don't Know About
- PubMed Health Congenital cytomegalovirus
- MedlinePlus Congenital cytomegalovirus
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Cite this page: Hill, M.A. (2024, March 29) Embryology Abnormal Development - Cytomegalovirus. Retrieved from https://embryology.med.unsw.edu.au/embryology/index.php/Abnormal_Development_-_Cytomegalovirus
- © Dr Mark Hill 2024, UNSW Embryology ISBN: 978 0 7334 2609 4 - UNSW CRICOS Provider Code No. 00098G