Cytomegalovirus (CMV) infection is a congenital infection (congenital) that is widespread in the world and is the most common type of infection with different clinical forms. The fetus can become infected due to a new (primary) maternal infection or recurrent (recurrent/reactivated) maternal infection.
The tendency for fetal infection and the risk associated with sequels (sequelae) and tissue damage is higher after primary infection. Although most congenital CMV infections are asymptomatic (asymptomatic) when the baby is born, CMV infection can cause sensorineural hearing loss (hearing loss due to nerves), mental retardation, and neurological deficits (nerve damage)
CMV is a complex of the Herpesviridae DNA virus family. The virus lacks the enzyme thymidine-kinase, so it is resistant to antiviral agents that depend on the action of the enzyme. This virus is called cytomegalovirus because there are inclusion objects in the intranuclear and intracytoplasmic which appear with symptomatic disease.
Epidemiology of Cytomegalovirus Infection
Congenital CMV infection occurs in about 0.2-2.5% of all live births. Infections are more frequent in less developed countries and in groups with low socioeconomic populations. Primary or recurrent infections in the mother during pregnancy will cause congenital CMV infection.
About 1-4% of women get primary CMV infection during pregnancy, and about 10% of sero-positive pregnant women have reactivation during their pregnancy. Transmission to the fetus after primary infection is around 40%, where transmission after recurrent infection is only 1-3%.
Clinical Forms of Cytomegalovirus Infection
The clinical form of CMV infection is around 90% asymptomatic when the baby is born. However, there are classic triangles of CMV infection, namely jaundice (yellowish babies in 62% of cases of CMV infection), peteki (spots of bleeding in the skin due to rupture of blood vessel capillaries in 58% of cases of CMV infection), and hepatosplenomegaly (enlargement of liver and spleen in 50% case of CMV infection).
Other clinical manifestations include oligohydramnios, polyhydramnios, prematurity, intrauteirin growth retardation, hypotonia (poor muscle size in children), poor breastfeeding ability, lethargy, temperature instability, cerebral ventriculomegaly (width of the brain ventricles that contain brain fluid), microcephaly (poor size of the child’s head) smaller than it should be), intracranial calcification, usually a periventricular distribution, ‘blueberry muffin’ points, and chorioretinitis (inflammation of certain parts of the eye organ).
Infants with symptomatic CMV infection can be at greater risk for developing congenital malformations such as inguinal hernia (bowel drop to the scrotum) in males, palate with high arches, damage to enamel formation in teeth, hydrocephalus (hydrocephalus head enlarged due to fluid in the brain that is too much), thumb deformity, and clubfoot (flat soles). Some babies can develop hepatitis, pneumonia, osteitis, and intracranial hemorrhage.