PERINATAL CYTOMEGALOVIRUS-INFECTION - A C LINICAL, VIROLOGICAL, AND THERAPEUTIC APPROACH WITH REFERENCE TO 3 CASE-REPORTS

Although most cytomegalovirus (CMV) infections are inapparent, severe forms responsible for permanent neurologic sequelae can occur in immun ocompromised Individuals, fetuses, and neonates, Three severe cases in neonates managed in an intensive care unit are reported. A 28-week ge stational age infant was born with lethal multivisceral CMV infection, A neonate with systemic fetal-onset CMV infection developed severe ne urosensory disabilities, A one-month-old with CMV encephalitis had a f avorable outcome under ganciclovir therapy. The epidemiology of CMV in fection and modes of transmission of the CMV to the fetus and neonate are reviewed. The spectrum of clinical presentations ranges from asymp tomatic infection to disseminated plurivisceral infections. Some patie nts develop focal CMV infection manifesting as hepatitis, encephalitis , or thrombocytopenic purpura. In utero infection with the CMV can be responsible for delayed sensory impairment, of which the most common f orm is hearing loss. The virologic diagnosis rests on demonstration of the CMV (e.g., detection of nucleic acids using in situ hybridation o r PCR) or on indirect diagnostic methods. Ganciclovir and foscarnet ar e the two antiviral drugs currently available for the treatment of CMV infection. Both drugs are well tolerated in neonates. Additional phar macokinetic data on these two agents would be of assistance for refini ng indications in the neonatal period.