Elsevier

Journal of Clinical Virology

Volume 97, December 2017, Pages 59-63
Journal of Clinical Virology

Full length article
Neonatal and long-term ophthalmological findings in infants with symptomatic and asymptomatic congenital cytomegalovirus infection

https://doi.org/10.1016/j.jcv.2017.11.001Get rights and content

Highlights

  • Ocular involvement is common in symptomatic congenital CMV infection.

  • Ophthalmological findings are often associated with other signs of CNS involvement.

  • A close ophthalmological follow-up might be appropriate for symptomatic infants.

  • Asymptomatic infants seem to have a low risk of long-term ocular sequelae.

  • Both primary and non-primary infections may lead to ocular involvement.

Abstract

Background

Congenital cytomegalovirus (cCMV) infection is responsible of a high burden of neurosensory impairment in children.

Objectives

To report incidence and consequences of ophthalmological abnormalities in infants with cCMV infection and better define their long-term ophthalmological management.

Study design

Infants with cCMV infection were enrolled in a 6-year follow-up. Infants were classified as symptomatic or asymptomatic based on complete clinical, laboratory and instrumental evaluations. All infants underwent funduscopic evaluation in neonatal period, and yearly complete ophthalmological evaluation, including funduscopic, motility and visual acuity assessments.

Results

Forty-eight infants were enrolled, 18/48 (37.5%) symptomatic and 30/48 (62.5%) asymptomatic. Mean duration of follow-up was 34.9 ± 22.2 vs. 34.8 ± 20.1 months (P = 0.98). Funduscopic abnormalities were identified in neonatal period in 7/18 (39%) symptomatic infants and in none of the infants without other clinical and instrumental abnormalities at birth (P < 0.001); chorioretinal scars were the most common finding (5/18 cases, 28%). Strabismus was detected in 1/18 (5.5%) symptomatic infants during the first years of life. Visual impairment at last follow-up evaluation was suspected or detected in 4/18 (22%) symptomatic infants and in none of the asymptomatic infants at birth (P = 0.01). Ophthalmological abnormalities were associated with other signs of central nervous system (CNS) involvement (P<0.001). No correlation was found with the type of maternal infection.

Conclusions

Ophthalmological abnormalities were common in symptomatic infants though often not associated with long-term visual impairment, and correlated with the presence of CNS involvement. Neonatal and periodical ophthalmological evaluations throughout childhood seem prudential for symptomatic babies. No ophthalmological abnormalities were detected in asymptomatic infants, who might therefore undergo more deferred evaluations.

Section snippets

Background

Congenital cytomegalovirus (CMV) infection is the most common congenital viral infection, with an estimated incidence of 0.6-2% of all live births [1], [2]. It contributes to a high burden of disease and is recognized as the leading non-genetic cause of sensorineural hearing loss (SNHL) in children [3], [4], [5], [6].

Ocular abnormalities and visual impairment have been reported in a high percentage of symptomatic infants with congenital CMV (cCMV) infection, whereas they are considered uncommon

Objectives

The aim of this study was to evaluate ophthalmological findings and visual function in the neonatal period and during a long-term follow-up in infants with cCMV infection. The ocular involvement in relation to type and timing of maternal infection was also explored.

Study design

All infants with cCMV infection referred to the Outpatient Clinic of the Neonatal Division of St. Orsola-Malpighi Hospital, Bologna, Italy between January 2006 and December 2015 were enrolled in a prospective observational study.

Infants were identified because of suspected/confirmed maternal CMV infection during pregnancy or because of the presence of symptoms consistent with cCMV infection at birth.

Data regarding timing and type (primary vs. non-primary) of maternal infection, neonatal and

Results

Forty-eight infants with cCMV infection were enrolled, including 18/48 (37.5%) symptomatic and 30/48 (62.5%) asymptomatic infants (Table 1).

In the symptomatic group 11/18 infants (61%) were born to mothers with a primary CMV infection, diagnosed during the first trimester of pregnancy in 6/11 (55%) cases and during the second trimester in the other 5/11 (45%) cases. Instead, 5/18 (28%) infants were born to mothers with a non-primary CMV infection. For two infants, maternal serology during

Discussion

Natural history studies of cCMV infection reported variable rates of long-term morbidity, up to 60% in symptomatic infants [3], [5], [15], [16]. The long-term prognosis of cCMV infection however remains a matter of speculation for some aspects; first, since in most countries a systematic neonatal screening program for cCMV does not exist, the rate of sequelae might differ from what currently accepted, because it is likely that most asymptomatic patients are missed, and thus not enrolled in

Funding

None.

Competing interests

None declared.

Ethical approval

The findings presented in this study are not experimental investigations, as the proposed protocol overlaps with the clinical management of babies, and performed at physician’s discretion. Infant’s parents or guardians had given consent to utilize collected data.

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