Determination of risk factors, evaluation of diagnostic methods, treatment response and prognosis in patients diagnosed with congenital citomegalovirus infection

Objective: Congenital Cytomegalovirus (CMV) infection is the most common cause of intrauterine infections worldwide. It shows a wide clinical course ranging from asymptomatic to sequelae such as neurodevelopmental retardation and sensorineural hearing loss. It is an increasingly important health problem, especially for societies with high seroprevalence, due to the lack of vaccination and the serious financial burden of treatment and care services. The aim of this study is to evaluate the patients followed up with the diagnosis of Congenital Cytomegalovirus (cCMV) infection in the Pediatric Infectious Diseases Clinic of Çukurova University Faculty of Medicine. Materials and Methods: In this study, pediatric patients aged 0-1 years were evaluated retrospectively in Çukurova University Faculty of Medicine Balcalı Hospital Pediatric Infectious Diseases Clinic between January 1, 2010 and December 31, 2021 (data from January 01, 2020 to December 31, 2021). prospectively collected). In this study, demographic, epidemiological and clinical characteristics, biochemical, serological and virological results, treatment approaches, treatment responses and prognoses of pediatric patients followed up with the diagnosis of cCMV infection were evaluated. Results: Eighty patients with congenital cytomegalovirus infection were analyzed. Prematurity was found in 18 (%22.8) patients and small of gestational age was found in 27 (%33.8) patients. The fact that 47 (%58.8) of the patients were born as the first child and 39 (% 48.8) from the first pregnancy showed that primiparity was a risk factor. In order of frequency, the symptoms and findings detected in the patients are jaundice, hepatosplenomegaly, anemia, thrombocytopenia, hydrocephalus and microcephaly. CMV IgM was positive in 64 (%80) of the patients, and CMV-DNA PCR was positive in all of them. It was observed that prenatal maternal serology study was performed in only 1 (%1.7) of 17 (%21.3) patients with fetal ultrasonography anomaly. Infection-related anomaly was detected in the postnatal period in % 57 of the patients without fetal ultrasonography findings. Mild CMV infection was present in 24 (%30) and moderate/severe cCMV infections in 56 (%70) patients, and central nervous system anomaly was found in 18 (%22.5) patients. Of the patients, 37 (%46.3) received iv ganciclovir alone, 12 (%15) received oral valganciclovir alone, and 21 (%26.2) consecutive therapy. While hematological, respiratory and gastrointestinal findings decreased with treatment, neurodevelopmental disorders continued (p<0.001). At the end of the 12-month follow-up, 2 (%2.5) of the patients had sensorineural hearing loss, 39 (%48.8) had infection-related morbidity (p=0.012) and 5 (%6.3) were mortal. Conclusion: Congenital CMV infection should be followed carefully in terms of neurodevelopmental disorders and infection-related sequelae. Since there is no active vaccination program against infection, early diagnosis of the disease through social education and screening studies is important for effective treatment. Keywords: Congenital cytomegalovirus, diagnosis, prognosis, risk factors, treatment