Congenital cytomegalovirus infection

Acute congenital form: general characteristics

If fetal infection with Cytomegalovirus occurs in the later stages of pregnancy, classic true malformations do not develop in the child. Instead, various fetopathies occur—pathological conditions of the fetus that lead to severe functional disorders and marked intrauterine growth restriction. Manifestation of the disease in such cases occurs literally from the first days of the infant's life and proceeds as a severe, acute infectious process.

In the clinical presentation from the first days, general infectious syndrome and associated trophic disorders are prominent:

• Marked lethargy and elevated body temperature (fever) are observed.
• The child refuses food, shows a poor appetite, and has frequent regurgitation, which inevitably leads to inadequate weight gain.
• Tissue turgor decreases, and dyspeptic disorders develop, manifested by unstable stools.

Multiorgan involvement

The congenital form is characterized by a generalized process involving multiple organs and systems.

In the hepatobiliary system and blood, enlargement of the liver and spleen (hepatosplenomegaly) is observed against the background of hypochromic anemia. Jaundice develops, which is of mixed genesis, combining both hepatic and hemolytic components.

Hemorrhagic syndrome often becomes dominant in the clinical picture. The main cause of bleeding is thrombocytopenia. The syndrome manifests as cutaneous hemorrhages in the form of petechiae and ecchymoses, as well as gastrointestinal bleeding (a typical sign is "coffee-ground" vomiting).

In addition, the following are affected:

• Respiratory system: interstitial pneumonia develops.
• Central nervous system (CNS): inflammation of the meninges and brain substance (meningoencephalitis) occurs, as well as hydrocephalus.
• Gastrointestinal tract and kidneys: enteritis, colitis, and nephritis are diagnosed. Profound structural changes of a fibrotic or polycystic type occur in the pancreas.

Course and outcomes of the disease

The acute generalized process in congenital cytomegalovirus infection is often complicated by secondary bacterial flora. This causes an extremely high risk of death in the first weeks of the patient's life.

If the child survives, severe residual effects develop:

1. Gross neurological deficits.
2. Marked neurodevelopmental delay.
3. Hypertensive-hydrocephalic syndrome.
4. Specific calcification of brain tissues—periventricular calcification.

Note: It is worth noting that in addition to the generalized form, milder variants of the infection are also possible: isolated involvement of only a single organ, as well as an abortive or completely asymptomatic course.

Clinical syndromes (por vremeni manifestatsii) / Clinical syndromes (by time of manifestation)

To facilitate the systematization of clinical manifestations, congenital cytomegalovirus infection is usually divided into two main syndromes depending on when the first symptoms appear:

• "Manifest cytomegalovirus syndrome" is relatively rare (in only 10–15% of cases). It includes all the severe acute multiorgan symptoms described above, which appear immediately after the infant's birth.
• "Latent cytomegalovirus syndrome" is diagnosed in the vast majority of cases. In the neonatal period, this form is completely asymptomatic. However, as the child grows at later stages, delayed severe lesions of the CNS and sense organs are detected. These include intellectual disability, various speech disorders, sensorineural hearing loss, and eye damage (chorioretinitis, which ultimately leads to irreversible optic atrophy).

Class and exam questions

What else to study on this topic

• Mechanisms of thrombocytopenia development in intrauterine viral infections
• Differential diagnosis of jaundice of mixed genesis in newborns
• Pathogenesis and radiological diagnosis of periventricular calcification
• Interstitial pneumonia: features of the course in viral lesions
• Methods for early diagnosis of latent cytomegalovirus syndrome

Other topics from the section «Chapter 12. Infectious and parasitic diseases»

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