Congenital and Perinatal Cytomegalovirus Infection

The signs and symptoms of CMV infection vary with age, route of transmission, and immunocompetence of the patient.

Congenital Infection.
Symptomatic congenital CMV infection was originally termed cytomegalic inclusion disease. Only 5% of all congenitally infected infants have severe cytomegalic inclusion disease, another 5% have mild involvement, and 90% are born with subclinical, but still chronic, CMV infection. The characteristic signs and symptoms of clinically manifested infections include intrauterine growth restriction, prematurity, hepatosplenomegaly and jaundice, blueberry muffin–like rash, thrombocytopenia and purpura, and microcephaly and intracranial calcifications. Other neurologic problems include chorioretinitis, sensorineural hearing loss, and mild increases in cerebrospinal fluid protein. Symptomatic newborns are usually easy to identify. The most severe symptomatic congenital infections and those resulting in sequelae are more likely to be caused by primary rather than reactivated infections in pregnant women. Reinfection with a different strain of CMV can lead to symptomatic congenital infection. Asymptomatic congenital CMV infection is likely the leading cause of sensorineural hearing loss, which occurs in approximately 7% of all infants with congenital CMV infection, whether symptomatic at birth or not.

Perinatal Infection.
Infections resulting from exposure to CMV in the maternal genital tract at delivery or in breast milk occur despite the presence of maternally derived, passively acquired antibody. Approximately 6–12% of seropositive mothers transmit CMV by contaminated cervical-vaginal secretions and 50% by breast milk to their infants, who usually remain asymptomatic and do not exhibit sequelae. Occasionally, perinatally acquired CMV infection is associated with pneumonitis and sepsis-like syndrome. Premature and ill full-term infants may have neurologic sequelae and psychomotor retardation. However, the risk for hearing loss, chorioretinitis, and microcephaly does not appear to be increased. Premature infants with transfusion-acquired CMV infection have a much greater risk for morbidity.