Pediatric Cytomegalovirus Infection Treatment & Management

  • Author: Mark R Schleiss, MD; Chief Editor: Russell W Steele, MD   more...
 
Updated: Apr 19, 2010
 

Medical Care

Medical care of cytomegalovirus (CMV) consists of good nutritional support, vigorous supportive care for end-organ syndromes (particularly pneumonia in immunocompromised patients), and specific antiviral therapy in select circumstances.

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Surgical Care

Some children with congenital cytomegalovirus require orthopedic interventions (cerebral palsy) and gastrostomy placement for enteral nutrition.

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Consultations

Depending on the patient and associated risk factors, cytomegalovirus disease is encountered by obstetricians, pediatricians, infectious disease specialists, oncologists, critical care physicians, and other health care providers. Appropriate consultations with surgeons, developmental specialists, pathologists, otolaryngologists, ophthalmologists, neurologists, and gastroenterologists may be necessary.

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Contributor Information and Disclosures
Author

Mark R Schleiss, MD  American Legion Chair of Pediatrics, Professor of Pediatrics, Division Director, Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota Medical School

Mark R Schleiss, MD is a member of the following medical societies: American Pediatric Society, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, and Society for Pediatric Research

Disclosure: Nothing to disclose.

Specialty Editor Board

David Jaimovich, MD  Chief Medical Officer, Joint Commission International and Joint Commission Resources

David Jaimovich, MD is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Leslie L Barton, MD  Professor Emerita of Pediatrics, University of Arizona College of Medicine

Leslie L Barton, MD is a member of the following medical societies: American Academy of Pediatrics, Association of Pediatric Program Directors, Infectious Diseases Society of America, and Pediatric Infectious Diseases Society

Disclosure: Nothing to disclose.

Robert W Tolan Jr, MD  Chief, Division of Allergy, Immunology and Infectious Diseases, The Children's Hospital at Saint Peter's University Hospital; Clinical Associate Professor of Pediatrics, Drexel University College of Medicine

Robert W Tolan Jr, MD is a member of the following medical societies: American Academy of Pediatrics, American Medical Association, American Society for Microbiology, American Society of Tropical Medicine and Hygiene, Infectious Diseases Society of America, Pediatric Infectious Diseases Society, Phi Beta Kappa, and Physicians for Social Responsibility

Disclosure: GlaxoSmithKline Honoraria Speaking and teaching; MedImmune Honoraria Speaking and teaching; Merck Honoraria Speaking and teaching; Sanofi Pasteur Honoraria Speaking and teaching; Baxter Healthcare Honoraria Speaking and teaching; Novartis Honoraria Speaking and teaching

Chief Editor

Russell W Steele, MD  Head, Division of Pediatric Infectious Diseases, Ochsner Children's Health Center; Clinical Professor, Department of Pediatrics, Tulane University School of Medicine

Russell W Steele, MD is a member of the following medical societies: American Academy of Pediatrics, American Association of Immunologists, American Pediatric Society, American Society for Microbiology, Infectious Diseases Society of America, Louisiana State Medical Society, Pediatric Infectious Diseases Society, Society for Pediatric Research, and Southern Medical Association

Disclosure: Nothing to disclose.

References

  1. Goodpasture EQ, Talbot FB. Concerning the nature of "protozoan-like" cells in certain lesions of infancy. Am J Dis Child. 1921;21:415.

  2. Weller TH, Hanshaw JB. Virological and clinical observation of cytomegalic inclusion disease. N Engl J Med. 1962;266:1233.

  3. Weller TH. The cytomegaloviruses: ubiquitous agents with protean clinical manifestations. I. N Engl J Med. Jul 22 1971;285(4):203-14. [Medline].

  4. Schleiss MR, McVoy MA. Overview of congenitally and perinatally acquired cytomegalovirus infections: recent advances in antiviral therapy. Expert Rev Anti Infect Ther. 2004;2 (3):389-403. [Medline].

  5. Kimberlin DW, Lin CY, Sanchez PJ. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr. 2003;143(1):16-25. [Medline].

  6. Ho M. Epidemiology of cytomegalovirus infections. Rev Infect Dis. Sep-Oct 1990;12 Suppl 7:S701-10. [Medline].

  7. Dworsky M, Yow M, Stagno S, et al. Cytomegalovirus infection of breast milk and transmission in infancy. Pediatrics. Sep 1983;72(3):295-9. [Medline].

  8. Hamele M, Flanagan R, Loomis CA, Stevens T, Fairchok MP. Severe morbidity and mortality with breast milk associated cytomegalovirus infection. Pediatr Infect Dis J. Oct 30 2009;[Medline].

  9. Fowler KB, Pass RF. Risk factors for congenital cytomegalovirus infection in the offspring of young women: exposure to young children and recent onset of sexual activity. Pediatrics. 2006;118:e286-92. [Medline].

  10. [Guideline] Kaplan JE, Masur H, Holmes KK. Guidelines for preventing opportunistic infections among HIV-infected persons--2002. Recommendations of the U.S. Public Health Service and the Infectious Diseases Society of America. MMWR Recomm Rep. Jun 14 2002;51(RR-8):1-52. [Medline]. [Full Text].

  11. Colugnati FA, Staras SA, Dollard SC, Cannon MJ. Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infect Dis. 7:71. [Medline].

  12. Torpy JM, Burke AE, Glass RM. JAMA patient page. Cytomegalovirus. JAMA. Apr 14 2010;303(14):1440. [Medline].

  13. Fowler KB, Dahle AJ, Boppana SB, Pass RF. Newborn hearing screening: will children with hearing loss caused by congenital cytomegalovirus infection be missed?. J Pediatr. Jul 1999;135(1):60-4. [Medline].

  14. Barton LL, Mets MB. Congenital lymphocytic choriomeningitis virus infection: decade of rediscovery. Clin Infect Dis. Aug 1 2001;33(3):370-4. [Medline].

  15. Gleaves CA, Smith TF, Shuster EA, Pearson GR. Comparison of standard tube and shell vial cell culture techniques for the detection of cytomegalovirus in clinical specimens. J Clin Microbiol. Feb 1985;21(2):217-21. [Medline].

  16. Demmler GJ, Buffone GJ, Schimbor CM, May RA. Detection of cytomegalovirus in urine from newborns by using polymerase chain reaction DNA amplification. J Infect Dis. Dec 1988;158(6):1177-84. [Medline].

  17. [Best Evidence] Pass RF, Zhang C, Evans A, Simpson T, Andrews W, Huang ML, et al. Vaccine prevention of maternal cytomegalovirus infection. N Engl J Med. Mar 19 2009;360(12):1191-9. [Medline].

  18. Schleiss MR. Cytomegalovirus vaccines and methods of production (WO20009049138): the emerging recognition of the importance of virus neutralization at the epithelial/endothelial interface. Expert Opin Ther Pat. Apr 2010;20(4):597-602. [Medline].

  19. Boppana SB, Rivera LB, Fowler KB, Mach M, Britt WJ. Intrauterine transmission of cytomegalovirus to infants of women with preconceptional immunity. N Engl J Med. May 3 2001;344(18):1366-71. [Medline].

  20. Adler SP. Cytomegalovirus and child day care. Evidence for an increased infection rate among day-care workers. N Engl J Med. Nov 9 1989;321(19):1290-6. [Medline].

  21. Chou SW. Acquisition of donor strains of cytomegalovirus by renal-transplant recipients. N Engl J Med. May 29 1986;314(22):1418-23. [Medline].

  22. Demmler GJ. Congenital cytomegalovirus infection and disease. Adv Pediatr Infect Dis. 1996;11:135-62. [Medline].

  23. Demmler GJ. Congenital cytomegalovirus infection treatment. Pediatr Infect Dis J. Nov 2003;22(11):1005-6. [Medline].

  24. Kovacs A, Schluchter M, Easley K, et al. Cytomegalovirus infection and HIV-1 disease progression in infants born to HIV-1-infected women. Pediatric Pulmonary and Cardiovascular Complications of Vertically Transmitted HIV Infection Study Group. N Engl J Med. Jul 8 1999;341(2):77-84. [Medline].

  25. Plotkin SA. Vaccination against cytomegalovirus, the changeling demon. Pediatr Infect Dis J. Apr 1999;18(4):313-25; quiz 326. [Medline].

  26. Schleiss M, Stanberry L. Herpesvirus infections of the neonatal CNS: Similarities and differences between HSV and CMV. Herpes. 1997;4:74.

  27. Schleiss, MR. Prospects for development and potential impact of a vaccine against congenital cytomegalovirus (CMV) infection. J. Pediatr. 151:564-70. [Medline].

  28. Stagno S, Pass RF, Dworsky ME, et al. Congenital cytomegalovirus infection: The relative importance of primary and recurrent maternal infection. N Engl J Med. Apr 22 1982;306(16):945-9. [Medline].

  29. Tabata T, McDonagh S, Kawakatsu H, Pereira L. Cytotrophoblasts infected with a pathogenic human cytomegalovirus strain dysregulate cell-matrix and cell-cell adhesion molecules: a quantitative analysis. Placenta. 2007;28:527-37. [Medline].

  30. Yow MD. Congenital cytomegalovirus disease: a NOW problem. J Infect Dis. Feb 1989;159(2):163-7. [Medline].

  31. Zhang C, Buchanan H, Andrews W, Evans A, Pass RF. Detection of cytomegalovirus infection during a vaccine clinical trial in healthy young women: seroconversion and viral shedding. J Clin Virol. Mar 2006;35(3):338-42. [Medline].

 
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Epidemiology patterns of congenital cytomegalovirus infection. Approximately 10% of cases of congenital cytomegalovirus occur in women with primary infection during pregnancy, and 90% of these infants have neurological sequelae. Although preexisting immunity (eg, maternal recurrent infection) protects against severe disease, approximately 15% of these infants have sequelae, particularly sensorineural hearing loss.
Cranial CT scan of infant born with symptomatic congenital cytomegalovirus infection. Neurological involvement is evident, manifest as ventriculomegaly and periventricular calcifications.
 
 
 
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