A PATIENT AFFECTED BY CYTOMEGALO VIRUS
- 30 year old mother referred from Andhra pradesh to our centre (prashanth fertility research centre, chennai) for delivery in view of severe polyhydramnios (excess fluid in the womb).
- Her first baby born preterm at 8 months died at 9 days of life due to infection. Second child is 2 years old and is developmentally delayed.
- She delivered a baby boy after caesarean section at 8 months with a birth weight of 1.7 kg.
- Baby was admitted in our NICU and was on ventilator in view of immature lungs.
- Workup in view of polyhydramnios showed positive titre for cytomegalovirus infection(CMV) which is a viral infection commonly transmitted from mother to the baby during pregnancy or childbirth.
- In the second week of life baby had severe hyponatremia (low salt) for which extensive workup was done as it was severe and persistent.
- After ruling out the common causes ,central nervous system (brain) cause was suspected and MRI of brain was taken which showed changes suggestive of CMV infection.
- To confirm, blood and urine samples were sent which showed lakhs of viral particles.
- Ganciclovir, the antiviral drug was started immediately after which sodium levels in blood got normalized and the baby was sent home on antiviral drug to be continued till blood is cleared of the virus.
- Congenital CMV infection is the most common congenital infection (infection present from the time of birth) worldwide.
- Around 80- 90% of pregnant women are sero positive(CMV antibodies present) for this infection most of them infected before they were pregnant.
- Infected persons are asymptomatic or have only minor symptoms and the virus persists in the body life long.
- The virus spreads from person to person mostly through saliva.
- Young children with CMV infection shed the virus in urine and saliva for more than a year.
- Uninfected women caring for young children are at high risk of acquiring CMV.
- Risk of transmission to the fetus ( baby in the womb) is higher with primary infection (first time infection)
- Congenital CMV infection is the leading cause of hearing loss and can also cause developmental delay, vision problems and fits.
- Congenital CMV infection rates range from 1 to 5 % in areas of high CMV sero prevalance ( 80-90%) .
- At birth 90% of babies are asymptomatic but some of them develop hearing loss later in life.
- 10% are symptomatic with low birth weight, small head, jaundice, fits, eye involvement, hearing loss and feeding problems. Around 70-80% of these symptomatic infants develop late complications like developmental delay, vision and hearing problems.
- This baby was presented because timely diagnosis and treatment helped in achieving almost normal development in this child who is one year old now.
- There is a need to increase awareness of this infection in view of the complications occuring in the baby if the woman contracts infection during pregnancy.
- No vaccine is available for prevention. Therefore education of pregnant women is a most effective prevention strategy, the most important being handwashing after contact with urine and saliva from young children.