Cytomegalovirus (CMV) is the leading cause of congenital
infection in developed countries, affecting 0.3 to 0.6% of all live births in Europe. Primary CMV
infection occurs in 1 to 4% of seronegative women during pregnancy and may be transmitted to the fetus in 40% of cases. Up to 10% of intrauterine CMV
infections result in symptomatic congenital disease at birth. Half of these children and 13% of those born with
asymptomatic infection will develop long-term sequelae, especially neurosensory
hearing loss and
mental retardation. Accurate diagnosis of primary maternal and fetal
infection is now possible using the avidity index of anti-CMV
IgG and virological testing to detect the virus in amniotic fluid. Symptomatic congenital
infection may be preventable using CMV hyperimmune
globulin during pregnancy. The gold standard for diagnosis of
congenital CMV infection is the detection of the virus in urine within the first 2 weeks of life by rapid cell culture techniques (shell vial) or
nucleic acid amplification of
viral DNA (PCR). Retrospective diagnosis can be achieved by detection of
viral DNA by PCR in dried blood spots (Guthrie card) collected on filter paper in the first days of life. Currently available drugs for the treatment of congenital CMV include
ganciclovir and its oral
prodrug valganciclovir. Treatment with intravenous
ganciclovir for six weeks may prevent hearing deterioration in children with symptomatic
congenital CMV infection and central nervous system involvement.
Valganciclovir may be an excellent alternative because of its good bio-availability, providing plasma concentrations similar to those achieved with intravenous
ganciclovir.