Cytomegalovirus (Cytomegalovirus, CMV) is a DNA virus from
the herpes virus family. It is the most common perinatal infection. It is a
very common infection, and more than half of people get it. It can also be transmitted
from any body fluid such as urine, saliva, tears, semen, milk, and by sexual
intercourse and blood transfusions. It can be passed on to the baby during
pregnancy or with breastfeeding.
When CMV infection is first passed, this is called primary infection.
After this first infection, the virus remains in the body and becomes latent,
that is, it becomes silent, it can be activated again and again in the future.
These recurrent infections are also called recurrent infections. It can be
passed both in the form of first (primary) and recurrent (recurrent) infections
during pregnancy.
The infection is most often passed with no symptoms or mild
symptoms, fever, malaise, sore throat, joint pain, swelling in the lymph nodes.
The first
(pregnancy) CMV infection in pregnancy:
Mothers who have never had a CMV infection before pregnancy
will get this infection for the first time during 1-4% pregnancy. 20-40% of the
infection passes to the baby from the mothers who had CMV infection for the
first time in pregnancy and one tenth of the babies who have passed this
infection are affected. In affected babies, eyes, liver, spleen and brain are
the main affected organs. A condition called cytomegalic inclusion disease
(congenital cytomegalovirus infection) occurs in the baby. Microcephaly (the
head is smaller than normal), calcifications in the brain, growth in the liver
and spleen, vision and hearing problems, mental retardation, developmental
retardation, jaundice, petechia and death can be seen. Although a small number
of babies are normal after birth, problems such as mental retardation and
hearing problems occur in the long term.
Apart from these problems, there is insufficient evidence
that CMV infection can cause miscarriage or death in the uterus.
Recurrent
(recurrent) CMV infection during pregnancy:
Although it is more common than primary infection, the risk
of affecting the baby is lower. Secondary infection in pregnancy passes to the
baby at the rate of 1-2%. Although the risk of infection affecting the baby is
less than perimer infection, the effects can occur in the short or long term.
If the person has been found to have had CMV infection before
the pregnancy and it is found that he had CMV infection again during pregnancy,
it is understood that this infection is a recurrent infection and the risk of
affecting the baby is low.
The risk of infection in the early stages of pregnancy
affecting the baby is higher than the infection in the late period. In both
primary and recurrent infections, although the baby appears initially
unaffected, 5-10% may have long-term effects.
How does the infection pass through to the baby and the risk
of the baby to be affected is not yet clear.
Diagnosis:
If the CMV IgM antibody in the mother's blood is positive,
the disease is newly passed. If the CMV IgG antibody is positive, it is past.
CMV IgM antibody is positive in 75% of primary infections, positive in 10% of
recurrent infections. Therefore, a 4-fold increase in the IgG titer is more
useful in diagnosing a recent infection. IgM disappears again at different
times after infection.
Since the virus is excreted in various body fluids during
infection, the virus can be isolated from the mother's urine, but this method
is also not very sensitive and useful.
Diagnosis of infection in the fetus can be made from fetal
blood, amniotic fluid, chorionic villus by virus culture or PCR DNA isolation.
Or, IgM antibody can be checked from fetus blood. The sensitivity and
specificity of these methods are not known precisely and demonstration of infection
in the fetus does not provide information about the severity of the disease in
the fetus. Only one-fourth of the fetuses diagnosed with these methods develop
a problem after birth, and three-quarters do not have a problem.
Apart from these diagnostic methods, it will be useful to
investigate the anomalies in the baby with detailed ultrasonography.
What to do
if an infection is passed during pregnancy?
Although the primary (first) infection experienced during
pregnancy is more likely to affect the baby than recurrent (recurrent)
infection, the result is that both babies are at a lower risk, but the affected
babies may have serious problems. In addition, it is difficult to diagnose both
clinical and laboratory infections of both primary and recurrent infections.
Since the infection is mostly experienced with mild symptoms, it is difficult
to recognize it by looking at the complaints and symptoms.
In case of infection during pregnancy, the family and the
doctor should decide whether the pregnancy should continue or not by discussing
the risks mentioned above.
There is no vaccine or treatment related to CMV. Hygiene,
etc. of people who have not previously encountered CMV. they need to be careful
to reduce their chances of exposure to this infection, paying attention to the
rules.
General
recommendations to protect against CMV infection:
- After contact with young children, hands should be washed
with soap and child secretions including urine and saliva should be avoided.
- Nursery, class, etc. should be avoided as much as possible.
- If the child goes to the nursery, the hygienic rules must
be followed, and after contact with the child's secretions, cleaning with water
and soap (eg after changing diapers).
- Kissing children on the lips or cheeks should be avoided.
- Food and drinks of children should not be shared, fork,
spoon etc. they use. should not be used without washing.
- Blood transfusion should be done with CMV (-) blood.
- Condoms should be used.
Findings in
CMV infection:
- Microcephaly
- Intracerebral calcification
- Ventriculomegaly
- Chorioretinitis
- Hearing problems
- IUGR (CMV is the most common infection that causes IUGR.)
- Oligohydramnios
- Hidrops fetalis
- Hyperechogenic intestine
- heart block
- Acid
- Pleural Effusion
- Renal dysplasia
- Hepatosplenomegaly
- Psychomotor retardation
- Mental retardation
-URINARY TRACT INFECTIONS IN PREGNANCY
-DYSENTERY AND DIARRHEA IN PREGNANCY
-MUMPS IN PREGNANCY
-MEASLES IN PREGNANCY
