PDF(Pubmed)
Abstract：
BACKGROUND: Congenital cytomegalovirus (cCMV) infection, resulting from non-primary maternal infection or reactivation during pregnancy, can cause serious fetal abnormalities, complications in the immediate neonatal period, and severe sequelae later in childhood. Maternal non-primary cytomegalovirus infection in pregnancy is transmitted to the fetus in 0.5-2% of cases (1).
METHODS: An African full term male newbornwas delivered by emergency caesarean section. Due to signs of asphyxia at birth and clinical moderate encephalopathy, he underwent therapeutic hypothermia. Continuous full video-electroencephalography monitoring showed no seizures during the first 72 h, however, soon after rewarming, he presented refractory status epilepticus due to an intracranial hemorrhage, related to severe thrombocytopenia. The patient also presented signs of sepsis (hypotension and signs of reduced perfusions). An echocardiography revealed severe cardiac failure with an ejection fraction of 33% and signs suggestive of cardiomyopathy. Research for CMV DNA Polymerase Chain Reaction (PCR) on urine, blood, cerebrospinal fluid, and nasopharyngeal secretions was positive.The mother had positive CMV IgG with negative IgM shortly before pregnancy. Serology for CMV was therefore not repeated during pregnancy, but CMV DNA performed on the Guthrie bloodspot taken at birth yielded a positive result, confirming the intrauterine transmission and congenital origin of the infection. The baby was discharged in good general condition and follow up showed a normal neurodevelopmental outcome at 9 months.
CONCLUSIONS: Although uncommon, congenital cytomegalovirus infection should be included in the differential diagnosis of intraventricular hemorrhage and cardiomyopathy. Furthermore, this case highlights the possible severity of congenital cytomegalovirus infection, even in cases of previous maternal immunity.
METHODS: An African full term male newbornwas delivered by emergency caesarean section. Due to signs of asphyxia at birth and clinical moderate encephalopathy, he underwent therapeutic hypothermia. Continuous full video-electroencephalography monitoring showed no seizures during the first 72 h, however, soon after rewarming, he presented refractory status epilepticus due to an intracranial hemorrhage, related to severe thrombocytopenia. The patient also presented signs of sepsis (hypotension and signs of reduced perfusions). An echocardiography revealed severe cardiac failure with an ejection fraction of 33% and signs suggestive of cardiomyopathy. Research for CMV DNA Polymerase Chain Reaction (PCR) on urine, blood, cerebrospinal fluid, and nasopharyngeal secretions was positive.The mother had positive CMV IgG with negative IgM shortly before pregnancy. Serology for CMV was therefore not repeated during pregnancy, but CMV DNA performed on the Guthrie bloodspot taken at birth yielded a positive result, confirming the intrauterine transmission and congenital origin of the infection. The baby was discharged in good general condition and follow up showed a normal neurodevelopmental outcome at 9 months.
CONCLUSIONS: Although uncommon, congenital cytomegalovirus infection should be included in the differential diagnosis of intraventricular hemorrhage and cardiomyopathy. Furthermore, this case highlights the possible severity of congenital cytomegalovirus infection, even in cases of previous maternal immunity.
摘要：
背景：先天性巨细胞病毒（cCMV）感染，由于非原发性母体感染或怀孕期间的再激活，会导致严重的胎儿畸形,新生儿期的并发症，和严重的后遗症在儿童后期。孕妇非原发性巨细胞病毒感染在0.5-2％的病例中传播给胎儿（1）。
方法：一名非洲足月男性新生儿通过紧急剖腹产分娩。由于出生时窒息和临床中度脑病的迹象，他接受了治疗性体温过低。连续的全视频脑电图监测显示在最初的72小时内没有癫痫发作，然而,复温后不久，他因颅内出血而出现难治性癫痫持续状态,与严重血小板减少有关。患者还表现出败血症的体征(低血压和灌注减少的体征)。超声心动图显示严重的心力衰竭，射血分数为33％，迹象提示心肌病。尿液CMVDNA聚合酶链反应（PCR）的研究，血,脑脊液,鼻咽部分泌物呈阳性。母亲在怀孕前不久CMVIgG阳性，IgM阴性。因此，在怀孕期间不再重复CMV的血清学检查，但是出生时在Guthrie血斑上进行的CMVDNA产生了阳性结果，确认宫内传播和感染的先天性起源。婴儿在良好的一般情况下出院，随访显示9个月时神经发育正常。
结论：虽然不常见，先天性巨细胞病毒感染应纳入脑室内出血和心肌病的鉴别诊断。此外，该病例突出了先天性巨细胞病毒感染的可能严重程度，即使在以前的母亲免疫力的情况下。
方法：一名非洲足月男性新生儿通过紧急剖腹产分娩。由于出生时窒息和临床中度脑病的迹象，他接受了治疗性体温过低。连续的全视频脑电图监测显示在最初的72小时内没有癫痫发作，然而,复温后不久，他因颅内出血而出现难治性癫痫持续状态,与严重血小板减少有关。患者还表现出败血症的体征(低血压和灌注减少的体征)。超声心动图显示严重的心力衰竭，射血分数为33％，迹象提示心肌病。尿液CMVDNA聚合酶链反应（PCR）的研究，血,脑脊液,鼻咽部分泌物呈阳性。母亲在怀孕前不久CMVIgG阳性，IgM阴性。因此，在怀孕期间不再重复CMV的血清学检查，但是出生时在Guthrie血斑上进行的CMVDNA产生了阳性结果，确认宫内传播和感染的先天性起源。婴儿在良好的一般情况下出院，随访显示9个月时神经发育正常。
结论：虽然不常见，先天性巨细胞病毒感染应纳入脑室内出血和心肌病的鉴别诊断。此外，该病例突出了先天性巨细胞病毒感染的可能严重程度，即使在以前的母亲免疫力的情况下。
