A Neonate with Reduced Cytomegalovirus DNA Copy Number and Marked Improvement of Hearing in the Treatment of Congenital Cytomegalovirus Infection

Role of Valganciclovir in Children with Congenital CMV Infection: A Review of the Literature

BACKGROUND

Cytomegalovirus (CMV) is the most common agent of congenital infection in humans. It is a main cause of neurodevelopmental delay and sensorineural hearing loss in infancy. Since the 2000s, a number of studies have used Valganciclovir as a therapy for children with congenital CMV infection.

METHODS

In order to evaluate the efficacy of Valganciclovir in preventing clinical sequelae and its possible side effects, we performed a review of the published literature. This search was completed via PubMed for manuscripts published from January 2007 to December 2021, combining the MeSH words "Valganciclovir", "Congenital", and "Cytomegalovirus".

RESULTS

A total of 27 articles were included (12 retrospective studies, 4 prospective studies, 1 randomized controlled trial, and 10 case reports). The clinical features were similar to those already described in the literature. The therapeutic protocols used were very different between the various studies included and neonatal antiviral treatments were only moderately effective. The therapy proved to be well-tolerated.

CONCLUSIONS

The quality of the included studies and the sample size were limited due to the rarity of the disease. The use of different therapeutic protocols in terms of starting dates, doses, and durations made it impossible to compare and correctly evaluate the efficacy of the treatments. Randomized controlled trials are needed to establish the correct effective dose with the fewest side effects and the most efficient duration of therapy.

Imbalance of acquired immunity factors in newborns with cytomegaloviral infection depending on the severity of the disease

OBJECTIVE

to assess the imbalance of the parameters of the immune status at the time of manifestation of CMVI in newborns in order to predict the development of a severe form of the disease.

METHODS

133 newborns with CMVI were examined. Depending on the severity of the condition, all children were divided into two groups: 1 - CMVI, severe form - 60 people (45.1%); 2 - CMVI, moderate form - 73 people (54.9%). An immunological examination was carried out, including the determination of T and B lymphocytes, as well as intercellular interaction between them. Using the "classification trees" method, we compared two differentiated approaches to the prediction of severe CMVI: based on a study of the relationships between T-lymphocytes (CD3+), T-helpers (CD4+), the content of cytotoxic lymphocytes (CD8+) and B lymphocytes (CD20+) and by studying the interaction of co-stimulation molecules CD28, CD3 + CD28 +, CD3-CD28 +, CD3 + CD28-.

RESULTS

In this study, it was demonstrated that the "standard immunogram", limited to the definition of CD3+, CD4+, CD8+, CD20+ lymphocytes, shows less information in predicting the development of a severe form of the disease in this patient population than the combination of markers, including CD3 + CD28-, CD20 + CD40 +.

FINDINGS

A model for predicting a severe form of cytomegalovirus infection in newborns based on the analysis of the content of CD 28 costimulation molecules has a higher information content, which makes it possible to start specific therapy on time.