What are the other Names for this Condition? (Also known as/Synonyms)

• Congenital CMV
• Congenital CMV Infection
• Neonatal Cytomegaloviral Disease

What is Congenital Cytomegalovirus? (Definition/Background Information)

• The Cytomegalovirus (CMV) belongs to the herpes virus family and is commonly found in most humans. It can spread by a variety of  factors, such as:
  • Sexual contact
  • Through blood transfusions
  • Urine
  • Nose and mouth secretions
  • Occasionally, even breast milk
• In individuals with normal immune system, a CMV infection is generally self-limiting. The infection is easily handled by the body with only mild flu-like symptoms observed, for a short period of time
• A baby in the womb can contract the virus through the placenta, or a newborn may become infected through breast milk, if the mother is infected. This condition is termed as Congenital Cytomegalovirus
• The virus stays in the body for life, after being infected once. But, since it only mildly infects (and sometimes does not infect) healthy women with normal resistance,  they may not be aware of the condition and its transmission to their offspring

Who gets Congenital Cytomegalovirus? (Age and Sex Distribution)

Infected pregnant women can transmit the cytomegalovirus to their offspring, either before birth, or shortly after birth, and this could lead to Congenital Cytomegalovirus.

What are the Risk Factors for Congenital Cytomegalovirus? (Predisposing Factors)

The risk factors of Congenital CMV Infection include:

• Women, who are pregnant and are exposed to the CMV virus
• All individuals with weak immunity, organ/bone marrow transplant recipients, exposed to the virus that spreads through close physical contact, have a great risk
• Individuals on chronic steroid therapy (either low or high dosage), for a diverse set of health issues
• Healthcare workers administering to such affected patients or newborn babies, are at a high risk; CMV spreads through close physical contact
• Chronic alcohol dependence
• Malnourishment, like protein deficiency or kwashiorkor

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Congenital Cytomegalovirus? (Etiology)

• The CMV viruses occur latently in most human-beings (60-80%); but they remain inactive, since a healthy host immunity is strong and resilient
• Congenital Cytomegalovirus may occur, when the fetus is infected while in the womb, or the child is affected immediately after birth during breastfeeding, if the mother is infected
• This contagious disease can also spread by physical contact (such as through saliva, nasal fluids, and urine) from the mother to the child

What are the Signs and Symptoms of Congenital Cytomegalovirus?

Healthy children affected by the virus may hardly show any signs and symptoms of cytomegalovirus infection. Pregnant women, who have signs of any infection, have to be evaluated for CMV. Babies may show indications of the disease, a few months to years after birth; even though they might appear healthy at birth. Common signs of these include hearing and vision problems.

If the virus affects the child while in the womb, its termed Congenital CMV infection and there could be severe indications of the disease, such as:

• Skin rashes
• Enlarged spleen
• Premature birth, low birth weight
• Small head, baby appears small at birth
• Jaundice (yellow eyes), liver function problems
• Pneumonia, lung disorders
• Seizures

Babies, who are born and appear healthy, may stay healthy.

How is Congenital Cytomegalovirus Diagnosed?

Pregnant women can be screened for CMV infection, by performing an amniocentesis, if any fetal abnormalities are noted on the ultrasound scans.

• If flu-like symptoms are noted in healthy pregnant women, then testing for CMV is strongly advised
• Since a diverse set of medical complications and diseases present the same signs and symptoms, a differential diagnosis is often considered

Tests are performed within the first 3 weeks after baby birth, if Congenital Cytomegalovirus Infection is suspected.

• The blood, saliva or urine of the infant is tested for the presence of CMV
• Regular checking of the eyes and ears for sensory problems is recommended, if CMV Infection is confirmed

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Congenital Cytomegalovirus?

Complications due to Congenital CMV Infection are not frequent. However, the infection can affect specific parts of the body and cause permanent defects over time, particularly if the infection was present at birth. These include:

• Seizures
• Babies with small head
• Mental disorders
• Autism
• Attention deficit hyperactivity disorder (ADHD)
• Severe eye problems (irritation, light-sensitivity, loss of vision, inflammation)
• Hearing loss

How is Congenital Cytomegalovirus Treated?

Quick, early diagnosis and appropriate treatment is the key to speedy recovery from severe cases of Congenital Cytomegalovirus Infection.

• Proper medications with nutritional supplementation are normally adequate to aid in recovery, for newborn babies
• Healthy children, usually do not require any treatment, if no symptoms or complications are present. But, children who are weak, or infants with low birth weight, may require constant monitoring and regular screening for eye and ear abnormalities
• The antiviral drug ganciclovir is known to aid treatment of CMV infections. Nevertheless, it may cause serious side effects and hence the drug is administered with extreme caution

How can Congenital Cytomegalovirus be Prevented?

The virus affects a large percentage of the population and this makes it acutely pathologic. However, maintaining basic and careful hygiene and following simple practices (like regular hand washing), reduces the risk of CMV transmission through direct contact.

Some other precautionary steps for pregnant women, so as to reduce the incidence of Congenital Cytomegalovirus Infection, include:

• Washing of hands at regular intervals, with soap and water, before feeding/breastfeeding the baby, after any diaper change, or wiping the baby’s face (of drool), handling baby’s toys
• Wash the pacifier frequently; avoid biting on it, or placing it in your mouth
• Do not allow toys and other items used by kids to be stained with their urine or saliva
• Avoiding the use of commonly shared items for food and drink, with very young children
• Do not allow children to share your toothbrush
• Use of proper disposal techniques when handling tissues, diapers, and other contaminated items; washing of hands thoroughly after disposing them
• Performing actions, such as kissing, hugging in a manner that puts you in direct contact with a child’s eyes, lips, and nose. Pregnant ladies have to be extremely cautious in such cases
• Practicing safe sex (before, or if, you are planning for a child)

What is the Prognosis of Congenital Cytomegalovirus? (Outcomes/Resolutions)

• A child with a healthy immune system recovers fast, with little or no treatment for Congenital Cytomegalovirus
• However, there may be complications in the long-term. There is a risk factor involved for future neurological, aural and visual problems, if the baby had a reduced birth weight, or was born premature or preterm
• If proper and timely treatment is not administered, then in newborn babies with poor health condition or weak immunity, Congenital CMV Infection can be fatal, or cause a lifetime of illness necessitating lifelong medical attention
• It is difficult to treat Congenital Cytomegalovirus effectively, due to the strong side effects of the antiviral drugs (currently available for treatment)

Additional and Relevant Useful Information for Congenital Cytomegalovirus:

New drugs and vaccines against CMV are currently being developed, to decrease the chances of infection in developing babies and in pregnant women.