1
|
Tomobe Y, Tomotaki H, Ogata T, Moriuchi M, Kawai M. A case of atypical congenital cytomegalovirus infection with intraventricular hemorrhage. Pediatr Int 2022; 64:e14906. [PMID: 35092630 DOI: 10.1111/ped.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Yutaro Tomobe
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroko Tomotaki
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tsutomu Ogata
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masako Moriuchi
- Department of Pediatrics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Masahiko Kawai
- Department of Pediatrics, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| |
Collapse
|
2
|
Pinto C, Malik P, Desai R, Shelar V, Bekina-Sreenivasan D, Satnarine TA, Lavado LK, Singla R, Chavda D, Kaul S, Datta S, Shah S, Patel UK. Post-Hemorrhagic Hydrocephalus and Outcomes Amongst Neonates With Intraventricular Hemorrhage: A Systematic Review and Pooled Analysis. Cureus 2021; 13:e18877. [PMID: 34804726 PMCID: PMC8599435 DOI: 10.7759/cureus.18877] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 10/13/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Intraventricular hemorrhage (IVH) is a common cause of morbidity and mortality in preterm neonates. IVH leads to complications such as posthemorrhagic hydrocephalus (PHH), which commonly occurs in neonates with a more severe degree of IVH. Hence, we aimed to evaluate the characteristics and outcomes of PHH in neonates with IVH. Methods We performed a systematic review of cases reported from January 1978 to December 2020 through the PubMed database, using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and the keywords 'intraventricular hemorrhage,' 'cerebral intraventricular hemorrhage,' and 'newborn.' A total of 79 articles were considered for analysis, and data on neonatal and maternal characteristics and outcomes were collected. The analysis was performed by using the χ2 test, Wilcoxon rank-sum test, and multivariate logistic regression model. Results We analyzed a total of 101 IVH cases, 54.5% were male and 62.4% preterm. Thirteen point nine percent (13.9%) presented with grade I, 35.6% grade II, and grade III respectively, and 8% grade IV IVH. Among the 59 (58.4%) neonates with PHH, 33.6% had resolved PHH and 24.8% had unresolved. In adjusted regression analysis, we found that neonates with resolved PHH have lower odds of having neurodevelopmental delay (OR:0.15, 95%CI:0.03-0.74; p=0.02) and death (OR:0.9;95%CI:0.01-0.99; p=0.049) as compared to unresolved PHH. Conclusion Our study showed that neonates with resolved PHH have a statistically significant lower risk of neurodevelopmental delay (NDD) and mortality. Future studies should be planned to evaluate the role of treatment and its effect on outcomes in IVH neonates with PHH as a complication.
Collapse
Affiliation(s)
- Candida Pinto
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Preeti Malik
- Pathology, Montefiore Medical Center, Wakefield Campus, Bronx, USA
- Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| | - Rutikbhai Desai
- Internal Medicine, University of North Carolina Cardiology at Nash, Rocky Mount, USA
| | - Vrushali Shelar
- Internal Medicine, Saratov State Medical University, Saratov, RUS
| | | | - Travis A Satnarine
- Neonatal Intensive Care Unit, Port of Spain General Hospital, Port of Spain, TTO
| | | | - Ramit Singla
- Pediatric Neurology, Children's Hospital of Michigan, Detroit, USA
| | - Devraj Chavda
- Pediatric Neurology, State University of New York Downstate Medical Center, Brooklyn, USA
| | - Surabhi Kaul
- Pediatric Neurology, Mercyone North Iowa, Mason City, USA
| | - Shae Datta
- Neurology, NYU Langone Health, New York, USA
| | - Shamik Shah
- Neurology, Stormont Vail Health, Topeka, USA
| | - Urvish K Patel
- Neurology and Public Health, Icahn School of Medicine at Mount Sinai, New York, USA
| |
Collapse
|
3
|
Capasso L, Coppola C, Vendemmia M, Salomè S, Esposito V, Colinet C, Porfito C, Raimondi F. Severe fetal intracranial hemorrhage: Congenital Cytomegalovirus infection may play a role? A case report and review of literature. IDCases 2021; 25:e01188. [PMID: 34189037 PMCID: PMC8217671 DOI: 10.1016/j.idcr.2021.e01188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 04/02/2021] [Accepted: 06/10/2021] [Indexed: 10/27/2022] Open
Abstract
Cytomegalovirus (CMV) is the most common cause of congenital infection, with a wide spectrum of clinical manifestations and different grade of severity. We report the case of a male baby born at term with an early prenatal diagnosis of severe intracranial hemorrhage (ICH), with no other evident risk factors. Urine and blood sample were tested for CMV-DNA, and diagnosis of congenital CMV infection was established. This case describes intracranial hemorrhage as uncommon although possible sign of early fetal CMV infection. Considering that pathogenic factors cannot be defined in 25 % of term neonates with ICH, this case report highlights the importance of CMV screening in pregnant women and in term infants with prenatal ICH of unknown origin.
Collapse
Affiliation(s)
- Letizia Capasso
- Neonatology and NICU, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Clara Coppola
- Neonatology and NICU, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Maria Vendemmia
- Neonatology and NICU, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Serena Salomè
- Neonatology and NICU, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Valentina Esposito
- Neonatology and NICU, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Chiara Colinet
- Neonatology and NICU, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Carolina Porfito
- Neonatology and NICU, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| | - Francesco Raimondi
- Neonatology and NICU, Department of Translational Medical Sciences, University Federico II, Naples, Italy
| |
Collapse
|
4
|
Rasile M, Lauranzano E, Mirabella F, Matteoli M. Neurological consequences of neurovascular unit and brain vasculature damages: potential risks for pregnancy infections and COVID-19-babies. FEBS J 2021; 289:3374-3392. [PMID: 33998773 PMCID: PMC8237015 DOI: 10.1111/febs.16020] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/11/2021] [Accepted: 05/13/2021] [Indexed: 01/08/2023]
Abstract
Intragravidic and perinatal infections, acting through either direct viral effect or immune-mediated responses, are recognized causes of liability for neurodevelopmental disorders in the progeny. The large amounts of epidemiological data and the wealth of information deriving from animal models of gestational infections have contributed to delineate, in the last years, possible underpinning mechanisms for this phenomenon, including defects in neuronal migration, impaired spine and synaptic development, and altered activation of microglia. Recently, dysfunctions of the neurovascular unit and anomalies of the brain vasculature have unexpectedly emerged as potential causes at the origin of behavioral abnormalities and psychiatric disorders consequent to prenatal and perinatal infections. This review aims to discuss the up-to-date literature evidence pointing to the neurovascular unit and brain vasculature damages as the etiological mechanisms in neurodevelopmental syndromes. We focus on the inflammatory events consequent to intragravidic viral infections as well as on the direct viral effects as the potential primary triggers. These authors hope that a timely review of the literature will help to envision promising research directions, also relevant for the present and future COVID-19 longitudinal studies.
Collapse
Affiliation(s)
- Marco Rasile
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy.,IRCCS Humanitas Clinical and Research Center, Rozzano, Italy
| | | | - Filippo Mirabella
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Michela Matteoli
- IRCCS Humanitas Clinical and Research Center, Rozzano, Italy.,CNR Institute of Neuroscience, Milano, Italy
| |
Collapse
|
5
|
Gaur P, Ffrench-Constant S, Kachramanoglou C, Lyall H, Jan W. Is it not time for international guidelines to combat congenital cytomegalovirus infection? A review of central nervous system manifestations. Clin Radiol 2020; 75:644.e7-644.e16. [PMID: 32216960 DOI: 10.1016/j.crad.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
Cytomegalovirus (CMV) is the most commonly transmitted virus in utero with a prevalence of up to 1.5%. The infection has potentially debilitating and devastating consequences for the infected fetus, being a leading cause for neurological disability worldwide. Once acquired, it often goes undetected with only an assumed 10% of infected neonates displaying the classic clinical or imaging features. Viral DNA polymerase chain reaction (PCR) of saliva or urine obtained within the first 21 days of life is required to make the diagnosis. As the majority of infected neonates are initially asymptomatic, diagnosis is often delayed. An abnormal routine neonatal hearing test and characteristic antenatal cranial ultrasound imaging findings may raise the suspicion of congenital CMV (cCMV) in the asymptomatic group. Ultimately, the aim is to facilitate early diagnosis and timely treatment. In this article, we highlight diagnostic and treatment challenges of the commonest congenital infection, we present the current available central nervous system imaging severity grading systems, and highlight the need for an internationally agreed diagnostic grading system that can aid treatment decision-making.
Collapse
Affiliation(s)
- P Gaur
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - S Ffrench-Constant
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - C Kachramanoglou
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - H Lyall
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - W Jan
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
| |
Collapse
|
6
|
Bhattacharya D, Anil Kumar BN, Panigrahi I, Kaur A. Congenital Cytomegalovirus Infection Masquerading as Antenatal Ventriculomegaly With Intraventricular Hemorrhage in a Term Neonate. Neurohospitalist 2019; 10:55-57. [PMID: 31839867 DOI: 10.1177/1941874419846044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Intraventricular hemorrhage is an uncommon manifestation of congenital cytomegalovirus (CMV) infection and has been described in preterm neonates. We discuss a term neonate, who was referred because of intracranial hemorrhage and hydrocephalous detected in the antenatal ultrasound. She had cholestatic jaundice, hepatitis, and thrombocytopenia, with positive polymerase chain reaction for CMV. Neuroimaging revealed reduced sulcation, mildly enlarged ventricles, and multiple periventricular cysts, along with residual hemorrhage in occipital horn of left lateral ventricle. She was started on ganciclovir, following which there was improvement in platelet count, jaundice, as well as transaminase levels.
Collapse
Affiliation(s)
- Deepanjan Bhattacharya
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - B N Anil Kumar
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Inusha Panigrahi
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| | - Anupriya Kaur
- Department of Pediatrics, Postgraduate Institute of Medical Education & Research, Chandigarh, India
| |
Collapse
|
7
|
Sobolewska-Pilarczyk M, Pawlak-Osinska K, Drewa S, Smok B, Pawlowska M. Intraventricular haemorrhage as the first manifestation of congenital Cytomegalovirus infection. Indian J Med Microbiol 2018; 36:279-281. [PMID: 30084424 DOI: 10.4103/ijmm.ijmm_18_11] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Congenital Cytomegalovirus infection (CCMV) is the most common intrauterine infection. Early diagnosis of CCMV is hindered by three factors: There is no screening programme for CMV infection in pregnant women; a high percentage of infections in neonates are asymptomatic; the clinical signs of CCMV infection are uncharacteristic. The aim of this article is to analyse the clinical picture and course of CCMV treatment in a 3-week-old newborn, analyse adverse events in 14-week-long antiviral therapy and also assess intraventricular bleeding as an early indicator for the diagnosis of CCMV.
Collapse
Affiliation(s)
- Malgorzata Sobolewska-Pilarczyk
- Department of Pediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum N. Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Pawlak-Osinska
- Department of Patophysiology of Hearing and Balance System, Collegium Medicum N. Copernicus University, Bydgoszcz, Poland
| | - Sylwia Drewa
- T. Browicz Provincial Hospital for Infectious Diseases in Bydgoszcz, Bydgoszcz, Poland
| | - Beata Smok
- Department of Pediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum N. Copernicus University, Bydgoszcz, Poland
| | - Małgorzata Pawlowska
- Department of Pediatric Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum N. Copernicus University, Bydgoszcz, Poland
| |
Collapse
|
8
|
Putbrese B, Kennedy A. Findings and differential diagnosis of fetal intracranial haemorrhage and fetal ischaemic brain injury: what is the role of fetal MRI? Br J Radiol 2016; 90:20160253. [PMID: 27734711 DOI: 10.1259/bjr.20160253] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Ventriculomegaly (VM) is a non-specific finding on fetal imaging. Identification of the specific aetiology is important, as it affects prognosis and may even change the course of current or future pregnancies. In this review, we will focus on the application of fetal MRI to demonstrate intracranial haemorrhage and ischaemic brain injury as opposed to other causes of VM. MRI is able to identify the specific aetiology of VM with much more sensitivity and specificity than ultrasound and should be considered whenever VM is identified on obstetric ultrasound. Advances in both fetal and neonatal MRI have the potential to shed further light on mechanisms of brain injury and the impact of chronic hypoxia; such information may guide future interventions.
Collapse
Affiliation(s)
- Bryn Putbrese
- Department of Radiology and Imaging Sciences, University of Utah Health Care, Salt Lake City, UT, USA
| | - Anne Kennedy
- Department of Radiology and Imaging Sciences, University of Utah Health Care, Salt Lake City, UT, USA
| |
Collapse
|
9
|
Samedi VM, Skappak C, Jantzie L, Trevenen C, Kamaluddeen M, Ekwalanga P, Al Awad EH. Comparison of Presentation, Course, and Outcome of Congenital and Acquired Cytomegalovirus Infection in Twins. AJP Rep 2016; 6:e1-5. [PMID: 26929859 PMCID: PMC4737621 DOI: 10.1055/s-0035-1563387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/29/2015] [Indexed: 12/03/2022] Open
Abstract
Background Cytomegalovirus (CMV) is one of the most common causes of serious viral intrauterine infections. It is universally distributed among the human population with an average incidence of 0.15 to 2%. Indeed, at least half of the women in the reproductive age have evidence of prior CMV infection. Epidemiology and Pathogenicity However, it is not a usual practice to screen asymptomatic pregnant woman or neonates for CMV. Even if a mother developed a primary CMV infection during pregnancy, up to 90% of the newborns with congenital CMV will be asymptomatic at the time of birth. Only 5 to 7% of the infected babies will be acutely symptomatic, and the typical clinical presentation includes intrauterine growth restriction, microcephaly, various cutaneous manifestations (including petechiae and purpura), hematological abnormalities (particularly resistant thrombocytopenia), hepatosplenomegaly, chorioretinitis, hepatitis, etc. In contrast, acquired CMV infection is extremely unlikely to cause any serious sequelae for the infant. Cases We present a case of congenital and acquired CMV infection in twins with a focus of dissimilarity in presentation, clinical course, and outcome.
Collapse
Affiliation(s)
| | - Christopher Skappak
- Department of Family Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Lindsay Jantzie
- Department of Family Medicine, University of Calgary, Alberta, Calgary, Canada
| | - Cynthia Trevenen
- Department of Pathology and Laboratory Medicine, University of Calgary, Alberta, Calgary, Canada
| | | | - Pauline Ekwalanga
- Department of Obstetrics and Gynecology, University of Calgary, Alberta, Calgary, Canada
| | | |
Collapse
|
10
|
Halawa S, McDermott L, Donati M, Denbow M. TORCH screening in pregnancy. Where are we now? An audit of use in a tertiary level centre. J OBSTET GYNAECOL 2014; 34:309-12. [PMID: 24476395 DOI: 10.3109/01443615.2013.872609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This audit was performed in the obstetrics and gynaecology department of a tertiary referral hospital, to investigate the use and results of TORCH screening. St Michael's Hospital delivers approximately 6,000 women from South Bristol a year and receives tertiary referrals from the South West of England and South Wales. It was found that 739 patients over a 6-year period from April 2006 to January 2012 underwent testing. The majority's indication (21%) was polyhydramnios. Three patients had evidence of primary CMV infection in pregnancy on serology, two for fetal indications (polyhydramnios and echogenic bowel) and one following a miscarriage. There were no confirmed cases of gestational toxoplasma or rubella. Routine testing for toxoplasma and rubella infection as part of the TORCH screening in cases of fetal or obstetric abnormality should thus be discontinued in our population.
Collapse
Affiliation(s)
- S Halawa
- Department of Obstetrics and Gynaecology
| | | | | | | |
Collapse
|