Ahmet YAĞMUR BAŞ, Nihal DEMİREL, İstemi Han ÇELİK, Sezin ÜNAL, Beyza ÖZCAN, Dilek ULUBAŞ IŞIK

Yenidoğanda Konjenital Sitomegalovirus Enfeksiyonu: Vaka Serisi

Amaç: Sitomegalovirus (CMV) yenidoğanda konjenital enfeksiyonların en yaygın nedenidir. CMV enfeksiyonu semptomatik infantlarda genellikle intrauterin büyüme geriliği, hepatosplenomegali, kolestaz, döküntü, trombositopeni ve mikrosefali ile bulgu veren olan multisistemik bir hastalıktır. Yöntem: Ekim 2012 ve Ocak 2015 yılları arasında, 3. düzey yenidoğan yoğun bakım ünitesinde konjenital CMV tanısı alan olguların verileri retrospektif olarak değerlendirildi. Bulgular: Çalışma süresince 8 olgu konjenital CMV tanısı aldı. Yoğun bakım ünitesine kabul edilen yenidoğanlar arasında konjenital CMV insidansı % 0, 15 olarak belirlendi. Olguların ortalama doğum haftası ve doğum ağırlığı 32, 6 (±4, 2) hafta ve 1591 (±681) gramdı. Altı (%75) olgu premature idi. Olguların tanı anında bulguları trombositopeni, kolestatik hepatit, blue-berry muffin döküntüsü, intrakraniyal kalsifikasyon, mikrosefali, pnömoni and bilateral katarakttı. Beş olguya gansiklovir ile tedavi başlandı. Üç olgu izlemde exitus oldu. Sonuç: Konjenital CMV enfeksiyonu neonatal morbidite ve mortalitenin önemli bir nedenidir. Doktorlar konjenital CMV enfeksiyonunu önleyici yaklaşımların ve doğum sonrası müdahalelerin farkında olmalıdır.

Case Series of Congenital Cytomegalovirus Infection in Neonatal Period

Objective: Cytomegalovirus (CMV) is one of the most common cause ofcongenital infections in the newborn. CMV infection is a multisystem disease,which symptomatic infants generally present with intrauterine growthrestriction, hepatosplenomegaly, cholestasis, rash, thrombocytopenia, andmicrocephaly.Methods: Retrospective chart review was performed for newborns who werediagnosed with congenital CMV infection at tertiary neonatal intensive careunit (NICU) in Turkey, between October 2012 and January 2015.Results: We identified eight cases with congenital CMV infection with anincidence of 0.15 % among admitted neonates. Mean gestational age and birthweight of cases were 32.6 (±4.2) weeks and 1591 (±681) g respectively. Six(75%) cases were premature. The symptoms at presentation were as follows;thrombocytopenia, cholestatic hepatitis, blue-berry muffin rash, intracranialcalcification, microcephaly, pneumonia, and bilateral cataract. Five cases weretreated with ganciclovir. Three of them died in follow-up.Conclusion: Congenital CMV infection is an important cause of neonatalmorbidity and mortality. Physicians should be aware of the preventivemeasures and postnatal interventions of congenital CMV infection.

PDF

___

Griffiths PD, Baboonian C. A prospective study of primary cytomegalovirus infection during pregnancy: final report. Br J ObstetGynaecol. 1984;91:307-15.
Britt W. Cytomegalovirus. In: Remington JS, Klein JO, Wilson CB, et al, eds. Infectious Diseases of the Fetus and Newborn Infant. 7th ed. Philadelphia: Elsevier Saunders; 2011:706–55.
Trincado DE, Rawlinson WD. Congenital and perinatal infections with cytomegalovirus. JPaediatr Child Health.2001;37:187–92.
Williamson WD, Demmler GJ, Percy AK, Catlin FI. Progressive hearing loss in infants with asymptomatic congenital cytomegalovirus infection. Pediatrics. 1992;90:862-6.
Alford CA, Stagno S, Pass RF, Britt WJ. Congenital and perinatal cytomegalovirus infections. Rev Infect Dis. 1990;12 Suppl 7:S745-53.
Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 2007; 17:253.
Clarissa Schreiner Miura, Ernani Miura, Alice Beatriz Mombach, Marisa Chesky. The prevalence of congenital cytomegalovirus infection in newborn infants at an intensive care unit in a public hospital. J Pediatr (Rio J). 2006;82:46-50.
Panhani S, Heinonen K. Screening for congenital cytomegalovirus infection among preterm infants born before the 34th gestational week in Finland. Scand J Infect Dis. 1994;26:375-8.
GunillaMalm, Mona-Lisa Engman. Congenital cytomegalovirus infections. Seminars in Fetal & Neonatal Medicine 2007;12:154e159
Pawłowska, J., Świątkowska, E., Gliwicz, D., Jankowska, I., Kluge, P., Cukrowska, B., et al. The role of cytomegalovirus infection in pathogenesis of neonatal cholestasis. Experimental & Clinical Hepatology 2010; 1: 25-9.
Kadambari S, Williams EJ, Luck S, et al. Evidence based management guidelines for the detection and treatment of congenital CMV. Early Hum Dev; 2011;87:723–8.
Stehel EK, Sanchez PJ. Cytomegalovirus infection in the fetus and neonate. Neo Rev. 2005;6:38–43.
Britt W. Cytomegalovirus. In: Remington JS, Klein JO, Wilson CB, eds. Infectious Diseases of the Fetus and Newborn Infant. 7th ed. Philadelphia: Elsevier Saunders; 2011:706–55.
Özdemir M., Taşbent F. E., Terzi H. A., Çetinkol Y., Uysal E. B., Aşık G., et al. Seroprevalence of Major Viral Pathogens during Pregnancy: A Multicenter Study in Turkey. Adv Clin Med Microbiol 2016; 1:001.
Uyar Y, Balci A, Akcali A, Cabar C. Prevalence of rubella and cytomegalovirus antibodies among pregnant women in northern Turkey. New Microbiol 2008; 31: 451-5.
Picone O, Vauloup-Fellous C, Cordier AG, Parent Du Chatelet I, Senat MV, Frydman R, et al. A 2-year study on cytomegalovirus infection during pregnancy in a French hospital. BJOG 2009; 116:818-23.