Congenital Cytomegalovirus Infection: Management Update

Asma Khalil; Chrissie Jones; Yves Villec

Disclosures

Curr Opin Infect Dis. 2017;30(3):274-280. 

In This Article

Antenatal Screening

Because routine CMV screening does not meet several of the criteria for an effective screening test, not least the fact that there is no effective preventive treatment, in most countries it is not recommended outside of the research setting.[10,11] Currently, therefore, serological testing for CMV is offered only to women with influenza-like symptoms during pregnancy or in whom ultrasound detects fetal abnormalities suggestive of possible CMV infection. It is important to acknowledge a number of arguments that support routine screening during pregnancy: first, congenital CMV infection is more common than Down's syndrome, which also has no treatment; second, if prevention is to be given an opportunity to be effective then screening is necessary; third, the symptoms and ultrasound features lack specificity; fourth, severe cases are more likely to be diagnosed, giving women the option of possible termination if infection is identified and investigated. Focusing on a different setting, a UK cost analysis of targeted screening using salivary swabs integrated within the newborn hearing screening programme, with subsequent treatment for congenital CMV-related SNHL in otherwise asymptomatic infants, resulted in an estimated cost per case that compares favourably with other screening programmes.[12] Despite some compelling reasons for antenatal screening, congenital CMV does not adequately fulfil the criteria for the implementation of a screening programme.

Prenatal diagnosis of CMV infection is challenging and options for prevention and treatment are limited. The current approach to the antenatal management of congenital CMV is illustrated in Fig. 1.

Figure 1.

Proposed approach to the antenatal management of congenital cytomegalovirus infection.

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