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2019

ANUÁRIO DO HOSPITAL
DONA ESTEFÂNIA

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CONGENITAL CMV INFECTION: EARLY TREATMENT...LATER BENEFITS!

Sofia Carneiro1, Jose Pedro Vieira2, Luisa Monteiro3, Carla Conceição4, Maria Joao Brito1

1 - Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
2 - Pediatric Neurology, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
3 - Pediatric Otorhinolaryngology, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal
4 - Neurorradiology Department, Hospital Dona Estefânia, Centro Hospitalar de Lisboa Central, EPE, Lisbon, Portugal

Divulgação:
Poster – 34th ESPID – European Society Of Paediatrics Infectious Diseases – Brighton, UK, 10-14 May, 2016

Resumo:
Introduction: Congenital cytomegalovirus (CMV) infection is common worldwide. Seroconversion rates during pregnancy range from 1-7%. It is the leading cause of nonhereditary sensorineural hearing loss (SNHL) and can cause other long-term neurodevelopmental disabilities.
Case Report: Female newborn with maternal seroconversion to CMV in first trimester of gestation. Morphological ultrasound showed brain cystic lesions and periventricular calcifications. PCR for CMV was positive in amniocentesis fluid. In the second day of life, PCR for CMV was positive in urine. Physical examination was unremarkable. Neonatal hearing screening showed bilateral SNHL, moderate (50 dB) in left ear (LE) and severe (80 dB) in right ear (RE). On D11, she had 580 copies/mL in blood and 4053983 copies/mL in urine, moderate thrombocytopenia, normal transaminases and no cholestasis. Brain ultrasounds neonatal showed mild ventriculomegaly and thalamus striated vasculitis and brain MRI showed multifocal white matter lesions. EEG and ophtalmologic evaluation were normal. Ganciclovir was started, resulting in a decrease of the blood viral load in blood and urine and platelets count normalized. At D18 she started oral valganciclovir. At 1st month, blood viral load was negative, urine viral load was 391464 copies/mL and she showed improvement in serial brain ultrasounds. After 6 months of therapy with no side effects, she showed a total recovery of LE hearing and at 12 months she achieved an adequate neurodevelopment
Conclusion Documented maternal seroconversion is useful for optimal approach, allowing early diagnosis and treatment. Early anti-viral treatment has been shown to improve long-term audiologic and neurodevelopmental outcomes. Valganciclovir seems to be a good alternative to ganciclovir due to its efficacy and few side effects. These infants should have long-term follow-up because they are at risk of delayed manifestations of CMV.

Palavras Chave: CMV, Congenital, Valganciclovir