Awareness and knowledge of congenital cytomegalovirus infection among pregnant women and the general public: a web-based survey in Japan

BACKGROUND@#The best approach to reduce congenital cytomegalovirus infection (cCMVi) is to practice behaviors that reduce cytomegalovirus (CMV) transmission during pregnancy. Expanding awareness and knowledge of CMV is expected to result in increased practice of preventative behaviors. To this end, it is necessary to understand current awareness and knowledge of CMV.@*METHODS@#This web-based cross-sectional survey assessed the awareness and knowledge of cCMVi among pregnant women and the general public in Japan. Participants aged 20-45 years (pregnant and non-pregnant women, and men) were identified from a consumer panel. Study outcomes (all participants) included awareness of cCMVi and other congenital conditions. Among those aware of cCMVi, outcomes included knowledge of CMV transmission routes, long-term outcomes of cCMVi, and behaviors to prevent CMV transmission during pregnancy. Outcomes limited to pregnant women included the practice of preventative behaviors and opinion on how easy it is to implement these behaviors. The data of the pregnant group (pregnant at the time of the survey) were compared with those of the general group (non-pregnant women and men).@*RESULTS@#There were 535 participants in the pregnant group and 571 in the general group. Awareness of cCMVi was generally low (pregnant, 16.1%; general, 10.2%). Pregnant participants were significantly more aware of most congenital conditions than those in the general group, including cCMVi (P = 0.004). Knowledge about CMV/cCMVi was limited; there were no significant differences between the two groups for 24 of the 26 knowledge questions. A small proportion (one third or less) of pregnant women practiced behaviors to prevent the transmission of CMV, though most (73.3-95.3%) pregnant women who were aware of cCMVi considered such behaviors easy to implement.@*CONCLUSIONS@#Awareness and knowledge of CMV/cCMVi is low among pregnant women in Japan; the level of knowledge is similar to that among the general public. This needs to be improved. Most pregnant women considered behaviors to prevent CMV transmission easy to perform, which indicates that effectively educating pregnant women regarding the long-term outcomes of cCMVi, CMV transmission routes, and preventative behaviors will contribute to a reduced incidence of cCMVi.@*TRIAL REGISTRATION@#UMIN Clinical Trials Registry, UMIN000041260 .

Diagnostic Clues for Congenital Cytomegalovirus Infection: Association with Newborn Hearing Screening Tests

PURPOSE: To investigate clinical markers for the diagnosis of congenital cytomegalovirus (CMV) infection and determine the correlation between abnormal newborn hearing screening results and asymptomatic congenital CMV infection. METHODS: Medical records of newborns with congenital CMV infection, born at Cheil General Hospital & Women's Healthcare Center from July 2008 to June 2018, were retrospectively reviewed. Infants with congenital CMV infection were classified into “symptomatic,” “asymptomatic,” and “asymptomatic with isolated abnormal automated auditory brainstem response (AABR)” groups. Clinical data were analyzed based on this classification. RESULTS: Among the 59,424 live births, congenital CMV infection was found in 25 neonates, including 19 symptomatic (0.03%) infants, two asymptomatic, and four asymptomatic with isolated abnormal AABR. Diagnostic clues for the identification of congenital CMV infection were intrauterine growth restriction (IUGR), including microcephaly in 10 infants (40.0%), abnormal AABR in four (16.0%), initial complicated signs in four (16.0%), and abnormal findings on brain ultrasonography in three (12.0%). Other less common markers included petechiae, abnormal findings on antenatal ultrasonography, and co-twin with CMV infection. During the recent 10 years, 53,094 of 59,424 newborns (89.3%) had AABR for hearing screening and 493 (0.9%) did not pass. Among them, 477 (96.8%) were screened for CMV, and results were positive for seven (1.5%). Among the seven infants, four had asymptomatic congenital CMV infection. Overall, 0.8% of the newborns with abnormal AABR (four of 477 infants) were diagnosed as having asymptomatic congenital CMV infection. CONCLUSION: The incidence of symptomatic congenital CMV infection was 0.03%, and 0.8% of infants who failed in the newborn hearing screening tests had asymptomatic congenital CMV infection. The most common clinical marker to diagnose congenital CMV infection was IUGR, including microcephaly, and the second isolated marker was abnormal AABR.

Intraventricular haemorrhage as the first manifestation of congenital Cytomegalovirus infection

Congenital Cytomegalovirus infection (CCMV) is the most common intrauterine infection. Early diagnosis of CCMV is hindered by three factors: There is no screening programme for CMV infection in pregnant women; a high percentage of infections in neonates are asymptomatic; the clinical signs of CCMV infection are uncharacteristic. The aim of this article is to analyse the clinical picture and course of CCMV treatment in a 3-week-old newborn, analyse adverse events in 14-week-long antiviral therapy and also assess intraventricular bleeding as an early indicator for the diagnosis of CCMV.

Correlation with neonatal congenital cytomegalovirus infection,maternal primary infection and secondary infection / 中国免疫学杂志

Objective:To explore the correlation with neonatal congenital cytomegalovirus infection,maternal primary infection and secondary infection.Methods: 48 neonates with congenital CMV infection were assigned to infection group with their mothers.And the other 30 couples without congenital CMV infection were assigned to negative group with their mothers.The level of CMV-IgM/IgG and affinity of CMV-IgG in peripheral blood were tested by CLIA,and CMV-DNA in mother′s milk,peripheral blood and urine of the newborn was tested by fluorescent quantitation PCR.We also analyzed the differences of the test results between the two groups and performed a retrospective analysis to compare the levels of CMV-IgG of the mother with early pregnancy with the result of this test.Results: In the infection group,the level of CMV-IgG in peripheral blood and CMV-DNA in milk was significantly higher than those in the negative group,the difference was statistically significant(P0.05).Conclusion: It is a high-risk factor for neonatal congenital cytomegalovirus infection that CMV-IgG level of the pregnant women is promted by the reactivation or reinfection of cytomegalovirus.It is important to monitor CMV-IgM/IgG during pregnancy.

Analysis the correlation factors of neonatal lenticulostriate vasculopathy / 实用医学杂志

Objective To investigate the correlation factors of neonatal lenticulostriate vasculopathy. Method Four hundred and forty-seven newborns from Guangdong Women and Children Hospital were enrolled in this study. Clinical data of the newborns were obtained . Brain ultrasound studies of lenticulostriate artery were performed on the newborns. The logistic regression was performed for screening the correlation factors of neonatal lenticulostriate vasculopathy (P < 0.05). Results Results of the univariate logistic regression reveal the correlation factors tcontributing to LSV include congenital cytomegalovirus infection、neonatal asphyxia、congenital heart disease (CHD),hypertensive disorder in pregnancy (P < 0.05, respectively). Multivariate logistic regression analysis was performed on these factors. The congenital cytomegalovirus infection, neonatal asphyxia, CHD,hypertensive disorder in pregnancy were significantly associated with LSV (P < 0.05). Conclusion The congenital cytomegalovirus infection,neonatal asphyxia,CHD,hypertensive disorder in pregnancy are the correlation factors of neonatal lenticulostriate vasculopathy. LSV could be a predictive marker for the future development of neuropsychiatric disorders. The brain ultrasound studies of lenticulostriate artery is suggested to be performed on all infants with the correlation factors.

New progress of the study of congenital cytomegalovirus infection / 中华实用儿科临床杂志

Human Cytomegalovirus (HCMV) is one of the biggest viruses belonging to the β human herpesvirus family,which has a high infection rate around the world.HCMV is the most common cause of congenital virus infection,it has infected about 1％ of all births around worldwide,and it often leads to the subsequent neurologic sequelae,which bring great influence on children's healthy growth.The primary causes of the high morbidity of congenital HCMV infection are the lack of the low toxicity and high efficiency antivirus drugs and vaccines,as well as the lower public awareness to congenital HCMV infection.The current situation,diagnosis and treatment,precaution and long-term follow-up of congenital CMV infection were summarized.

Clinical Features and Neurodevelopmental Outcomes of Infants with Congenital Cytomegalovirus Infection: Single NICU Experience

PURPOSE: To assess the clinical features, hearing loss and neurodevelopmental outcomes of infants with congenital cytomegalovirus (CMV) infection and to discover significant brain magnetic resonance imaging (MRI) findings that predict poor neurodevelopmental outcomes. METHODS: The medical records of 31 infants who were diagnosed with congenital CMV infection at the Neonatal Intensive Care Unit of Asan Medical Center between 2002 and 2012 after CMV was isolated from their urine within the second week of their life were retrospectively reviewed. The long-term neurodevelopmental outcomes of the infants were monitored using the Bayley Scale of Infant Development II, the Korean Infants' Development Screening Test and the Wechsler Scale of Intelligence, as appropriate. RESULTS: The infants' mean gestational age was 36.3+/-3.2 weeks and their mean birth weight was 2,395+/-715 g. Microcephaly were detected in three of them (9.7%), and petechiae and hepatosplenomegaly were detected in one (3.2%). Ten infants (32.2%) and nine infants (29.0%) showed preterm and intrauterine growth retardation, respectively. Of the 27 infants with whom long-term follow-up was possible, six (22.2%) showed developmental disabilities. The brain MRI findings, which included ventriculomegaly, periventricular calcification, polymicrogyria, microcephaly and cerebellar hypoplasia, were correlated with the poor neurodevelopmental outcomes, but no correlation was found between the presence of periventricular cysts and that of white matter disease. Of the infants who survived, six (20.0%) had sensorineural hearing loss at the median age of 30.6 months. CONCLUSION: Congenital cytomegalovirus infection is one of the most frequent causes of intrauterine viral fetal infection and need to be distinguished if congenital infection is suspected. On the follow up observation, the hearing loss was observed in 20% of the patients. A long term neurological observation is required for the patients who had unusual impression on MRI.

A Case of Congenital CMV Infection associated with Incontinentia Pigmenti

Congenital cytomegalovirus (CMV) infection is one of the most frequent congenital infections in neonates. It can manifest as asymptomatic infection in 90% or symptoms may appear in 10% of the patients. Asymptomatic congenital CMV infection is likely to be a leading cause of sensorineural hearing loss, mental retardation and microcephaly. Incontinentia pigmenti is a rare multisystemic ectodermal disorder, which is characterized by vesicular, verrucous, and pigmented cutaneous lesions, and is frequently associated with various developmental defects of the eyes, CNS, teeth, hair, and nail. It is regarded as an X-linked dominent genetic disorder. We are reporting a case of neonate who presented with delayed development and bilateral hearing loss due congenital CMV infection which was incidentally assoicated with incontinentia pigmenti.

Clinical Features of Congenital Cytomegalovirus Infection in Neonates / 대한주산의학회잡지

OBJECTIVE: Cytomegalovirus(CMV) is the most common cause of congenital infection with diverse clinical features according to the age of hosts. This study was done to evaluate clinical manifestations and complications in congenital CMV infection. METHODS: Between October 2000 and September 2001, 10 cases of congenital CMV infection were diagnosed by urine culture within 2 weeks after birth. Demographic data, clinical and laboratory findings were collected from maternal and newborn hospital records. RESULTS: There were 7 males and 3 females. Average gestational age was 38+0 weeks(34+2-41+1), average birth weight was 2462+/-598.2g(1670-3360) and 5 cases were small for gestational age. Average head circumference was 31.9+/-1.8cm(29-34.3). There were 4 cases of microcephaly, 6 cases of petechiae, 3 cases of leukocytopenia, 6 cases of thrombocytopenia. There was no case showing hepatomegaly, hepatic dysfunction, or pathologic jaundice. 4 cases showed physiologic jaundice. IgM level was elevated in 5 out of 9 cases. Polymerase chain reaction(PCR) was positive in 7 cases. All cases showed germinal matrix hemorrhage and septated cysts on cranial ultrasonography. 1 case showed cerebral calcification. 1 case showed bilateral sensorineural hearing loss on brainstem auditory evoked potentials(BAEP). There was no case showing chorioretinitis on fundoscopy. CONCLUSION: There were diverse clinical manifestations in CMV infection in neonates. All cases showed germinal matrix hemorrhage and septated cysts. When we find these findings, we should consider the possibility of CMV infection. One patient developed bilateral sensorineural hearing loss, so its early detection and follow-up might be necessary.

Diagnosis of Cytomegalovirus Infection in Neonatal and Infantile Periods Using Polymerase Chain Reaction

PURPOSE: The aims of present study were to document the incidence of cytomegalovirus infection in neonatal and infantile periods especially in high-risk patients of associated infection by nested PCR of DNA from leukocytes and to evaluate the effectiveness of nested PCR in the diagnosis of congenital cytomegalovirus infection. METHODS: Genomic DNA was extracted from peripheral leukocytes of 204 neonates and infants during the period from June 1994 to March 1995, and nested PCR was performed. The cases were divided into six groups according to clinical profiles; Group IA-healthy fullterm babies, group IB-fullterm babies with suspected or definite perinatal infection, group IIA-healthy preterm babies, group IIB-preterm babies with suspected or definite perinatal infection, group III-infants with clinical features of viral infection and abnormal liver function tests, group IV-IgM seropositive babies with clinical evidence of cytomegalovirus infection. RESULTS: In group IA(n=70), 2 cases were positive for PCR amplification (2.9%). All of the cases in group IB(n=64), group IIA(n=15), and group IIB(n=20) were negative for cytomegalovirus infection. Only one case(3.3%) among group III(n=30) showed positive reaction, while all of the five cases(100%) in group IV(n=5) were positive. CONCLUSIONS: The incidence of congenital cytomegalovirus infection in our analysis were 1.2% (2/169), and it was similar to that of western countries. Nested PCR was proved to be a both sensitive and specific diagnostic tool in the diagnosis of cytomegalovirus infection and it seems to be useful in the screening of congenital cytomegaloviral infection in the newborn period. Future analysis of samples including non-blood origin from adult women and newborns will be helpful in the epidemiologic analysis of cytomegalovius infection in this period.