Emel OKULU, Dilek KAHVECİOĞLU, Saadet ARSAN, Serdar ALAN, Atila KILIÇ, Adem KARBUZ, Erdal İNCE, Begüm ATASAY

Aşırı Düşük Doğum Ağırlıklı Bebekte Kazanılmış Sitomegalovirüs Enfeksiyonu Aquired Cytomegalovirus Infection of Extremely Low Birth Weight Infant

Anne sütü, özellikle prematürelerde kazanılmış sitomegalovirüs (CMV) enfeksiyonu için majör kaynaktır ve anne sütünden kazanılan CMV enfeksiyonu seropozitif anne bebeklerinde görülmektedir. Türkiyede annelerin çoğunluğunun seropozitif olmasına karşın prematüre bebeklerde yaşamı tehdit eden akkiz CMV enfeksiyonu yalnızca vaka sunumları şeklinde çok az olguda bildirilmektedir. Preterm semptomatik anne sütü kaynaklı CMV enfeksiyonunun tedavisi klinik bulguların ağırlığına göre yapılmalıdır. Postnatal 111. gününde menenjit-sepsis tanısı alan, anne sütünden kazanılan CMV enfeksiyonu tanımlanan ancak yaşamı tehdit eden çoklu organ yetmezliği gelişmemesi nedeniyle antiviral tedavi verilmeyen prematüre bir bebek literatür bilgileri eşliğinde sunulmuştur. Preterm bebeklerde etken saptanmayan sepsis kliniği, açıklanamayan trombositopeni, karaciğer enzim yüksekliği ve direkt bilirübinemi varlığında kazanılmış CMV enfeksiyonu akla getirilmelidir. (Güncel Pediatri 2013; 11: 138-41)

Aquired Cytomegalovirus Infection of Extremely Low Birth Weight Infant

Breast milk is a major source for acquired cytomegalovirus infection especially in premature infants and acquired CMV infection occurs in infants whose mothers were seropositiveCMV. Although most of mothers of premature infants are seropositive in Turkey, acquired life-threatening breast milk acquired CMV infection was reported occasionally. Treatmentpreterm with symptomatic breast milk acquired CMV infection should be done accordingthe severity of clinical signs. In this report, a preterm case with a diagnosis of breast milk- acquired CMV meningitis and sepsis without multiorgan failure on the 111th day of life, who did not require antiviral therapy was presented and discussed in the context of the acquired CMV literature. In preterm babies, when there is sepsis with no apparent causes, unexplained thrombocytopenia, elevated liver transaminases and direct hyperbilirubinemia acquired CMV infection should be suspected. (Journal of Current Pediatrics 2013; 11: 138-41) Key words: Preterm infant, aquired cytomegalovirus infectious for of to

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1. Hamprechet K, Maschamann J, Vochem M, Dietz K, Speer CP, Jahn G. Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding. Lancet 2001;357:513-8.
2. Schleiss MR. Role of breast milk in acquisition of cytomegalovirus infection: recent adveances. Curr Opin Pediatr 2006;18:48-52.
3. Hamprechet K, Maschamann J, Vochem M, Jahn G, Poets CF, Goelz R. Cytomegalovirus transmission to preterm infants during lactation. J Clin Virol 2008;41:198-205.
4. Meier J, Lienicke U, Tschirch E, Kruger DH, Wauer RR, Prosch S. Human cytomegalovirus reactivation during lactation and mother-to-child transmission in preterm infants. J Clin Microbiol 2005;43:1318-24.
5. Schleiss MR. Vertically transmitted herpesvirus infections. Herpes 2003;10:4-11.
6. Stagno S, Reynolds DW, Pass RF, Alford CA. Breast milk and the risk of cytomegalovirus infection. N Engl J Med 1980;302:1073-6.
7. Dworsky M, Yow M, Stagno S, Pass RF, Alford C. Cytomegalovirus infection of breast milk and transmission in infancy. Pediatrics 1983;72:295-9.
8. Miron D, Brosilow S, Felszer K, Reich D, Halle D, Wachtel D, et al. Incidence and clinical manifestations of breast milk- acquired Cytomegalovirus infection in low birth weight infants. J Perinatol 2005;25:299-303.
9. Bryant P, Morley C, Garland S, Curtis N. Cytomegalovirus transmission from breast milk in prematüre babies: does it matter. Arch Dis Child Fetal Neonatal Ed 2002;87:75-7.
10. Yeager AS, Palumbo PE, Malachowski N, Ariagno RL, Stevenson DK. Sequelae of maternally derived cytomegalovirus infections in prematüre infants. J Pediatr 1983;102:918-22.
11. Vollmer B, Seibold-Weiger K, Schmitz-Salue C, Hamprecht K, Goelz R, Krageloh-Mann I, et al. Postnatally acquired cytomegalovirus infection via breast milk: effects on hearing and development in preterm infants. Pediatr Infect Dis J 2004;23:322-7.
12. Çizmeci Z, Durmaz R, Tekerekoğlu MS, Özerol İH. Doğurganlık çağındaki kadınlarda rubella ve sitomegalovirus antikorlarının araştırılması. İnönü Üniversitesi Tıp Fakültesi Dergisi 2003;10:129-31.
13. Forsgren M. Cytomegalovirus in breast milk: reassessment of pasteurization and free-thawing. Pediatr Res 2004;56:526-8.
14. Hamprecht K, Maschmann J, Müller D, Dietz K, Besenthal I, Goelz R, et al. Cytomegalovirus (CMV) inactivation in breast milk: reassessment of pasteurization and freeze-thawing. Pediatr Res 2004;56:529-35.
15. Takahashi R, Tagawa M, Sanjo M, Chiba H, Ito T, Yamada M, et al. Severe postnatal cytomegalovirus infection in a very premature infant. Neonatology 2007;92:236-9.