Unidade de Infeciologia Pediátrica, Hospital Dona Estefânia, Centro Hospitalar Universitário de Lisboa Central, Lisboa
- 36th Annual Meeting of theESPID; Malmo; 15-18 junho 2018.Poster com apresentação
Resumo:
Background: Congenital cytomegalovirus (CMV) is one of the major causes of sensorineural hearing loss and neurodevelopmental abnormalities in developed countries. Antiviral therapy of children reduces the risk of long-term disabilities. However, absence of guidelines regarding prevention, diagnostic methods and therapeutic strategies may difficult this approach. Also, the large variable genetic background of CMV genotypes, may hamper its comprehension and vaccine prevention.
Case Presentation Summary: Wepresent three cases of congenital CMV, with different severity, that underwent treatment with valganciclovir 15mg/kg/dose for 6 months. A 39-week female neonate, 2930g, with first-trimester CMV seroconversion, confirmed with amniocentesis. Postnatal neurosonography revealed ventriculomegaly, calcifications and thalamostriate vasculopathy. Thrombocytopenia and bilateral moderate sensorioneural hearing loss were detected. Follow-up evidenced normal neurodevelopment with profound right hearing loss and normal left hearing. A 37-week female neonate, 1765g, with growth restriction detected after third-trimester CMV seroconversion. After birth, hepatitis was detected with progressive transaminases normalization. Neuroimaging with MRI was normal. Follow-up revealed normal neurodevelopment with no sensory deficit. A 39-week female neonate, 2865g, with second-trimester CMV seroconversion, confirmed with amniocentesis. Postnatal neurosonography demonstrated mild thalamostriate vasculopathy with rare calcifications. No clinical or analytical manifestation were detected at birth. However, follow-up revealed postnatal hearing deficit. All cases showed good response to valganciclovir with progressive decrease in serum and urine CMV titters. No adverse reaction was recorded.
Learning Points/Discussion: Recent expert consensus recommends therapy with valganciclovir in neonates with moderate to severe manifestations of congenital CMV. However, literature is unclear whether mild to asymptomatic cases should undergo the same treatment, making this an off-label approach. Increasing knowledge on defined CMV genotypes, may define viral markers for prediction of clinical severity, possibly affecting future decision on pregnancy interruption or valganciclovir therapy.
Palavras Chave: Congenital infection; Cytomegalovirus; Geneticpolymorphisms; valganciclovir.