Cytomegalovirus (CMV)& the newborn
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What is the most common source of congenital infection in newborns?
Cytomegalovirus - CMV
How does CMV affect a newborn
Hearing loss and intellectual disability
CMV is a member of ____________family?
CMV virus is susceptible to inactivation to what?
soap, heat, disinfectant, & dehydration
CMV virus can be found where?
breastmilk, saliva, urine, blood, cervical excretions, and semen
Symptoms of CMV?
None in person w/ normal immune system. If Sx do occur they are mild to flu-like. More serious in fetus, person w/ HIV or person w/ transplant and on immunosuppressive therapy
What are the 3 time periods that transmission of CMV can occur?
- 1. In utero
- 2. At birth
- 3. After birth
When does disability occur?
Any time in utero, but most severe is in the 1st trimester.
Newborn Sx of CMV are?
- Transient: Jaundice, seizures, hepatosplenomegaly, petechiae.
- Permanent: microcephaly, motor disability, hearing and vision loss, MR, learnimg disabilities, epilepsy, death.
- About 18% of congenitally infected children, including many who were asymptomatic at birth, eventually experience permanent sequelae.'
Most common form of disability of CMV?
- sensorineural hearing loss.
- Symptomatic newborns tend to exhibit hearing loss earlier and with greater severity than asymptomatic children. Often, hearing loss in children with congenital CMV is progressive in nature and can fluctuate during childhood.
What is the single most important recommendation that a PCM do for a child exposed to CMV?
Yearly hearing screenings
If hearing loss is detected, what are the options?
- speech and language therapy,
- hearing aids,
- cochlear implants
Test used to detect CMV?
- IgG - primary infection
- The presence of CMV IgM and low-avidity IgG in a single specimen indicates the occurrence of a primary CMV infection within the past few months.
Prenatal diagnostic tests for fetal CMV infection include?
- viral culture
- quantitative polymerasechain reaction (PCR) analysis of maternal blood,urine, and amniotie fluid
- magnetic resonance imaging (MRI) scans can be used to help detect obvious abnormalities consistent with a congenital CMV infection (such as microcephaly, hepatosplenomegaly, and cystic or calcified lesions in the brain).
What is considered infectious from an infant with CMV?
- Nasal secretions
- surfaces contaminated with secretions are considered potentially infectious
What are the preferred specimens for CMV culture?
- urine or saliva.
- Blood has not historically been used for diagnosing CMV infection because viral loads are significantly lower in blood than in urine and saliva.
The best predictors for the development of disabilities?
- presence of clinical symptoms at birth
- highCMV viral load
What are the hygiene guidelines for pregnant women:
- Avoid exposure to children's urine and saliva that may contain CMV by:
- • Washing hands frequently with soap and water, especially after diaper changes, feeding, wiping nose ordrool, and handling children's toys.
- • Not sharing cups, plates, utensils, food, or toothbrushes.
- • Not sharing towels or washcloths.
- • Not putting a child's pacifier in your mouth.
- • Cleaning toys, countertops, and other surfaces that come in contact with children's urine or saliva.
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