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Kinder- und Jugendmedizin 2022; 22(04): 231-244
DOI: 10.1055/a-1847-0107
Schwerpunkt

Vertikale CMV-Transmission

Epidemiologie und Diversität der Übertragungsmuster sowie TherapieoptionenVertical CMV transmissionEpidemiology and diversity of transmission patterns and antiviral therapy options
Klaus Hamprecht
1   Institut für Medizinische Virologie, Universitätsklinikum Tübingen
3   *gemeinsame Autorenschaft
,
Rangmar Goelz
2   Department für Neonatologie, Universitätsklinik für Kinder- und Jugendmedizin, Universitätsklinikum Tübingen
3   *gemeinsame Autorenschaft
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ZUSAMMENFASSUNG

Die vertikale CMV-Transmission umfasst verschiedene Übertragungsmuster wie intrauterine, peri- und postnatale Virustransmission. Risikopatientinnen für eine symptomatische kongenitale CMV-Infektion (cCMV) des Feten und Neugeborenen sind die bei Schwangerschaftsbeginn seronegativen Frauen mit einem Kleinkind unter 3 Jahren, welche die CMV-Primärinfektion (CMV-PI) entweder perikonzeptionell oder im ersten Trimenon erworben haben. Nach derzeitiger Evidenz stellt nur die symptomatische cCMV-Infektion eine antivirale Therapieoption mit Valganciclovir (VGCV) dar. Der CMV-Status des Neugeborenen sollte innerhalb der ersten zwei Lebenswochen zusammen mit ZNS-Bildgebung, Augen- und Hördiagnostik erfolgen. Die Lumbalpunktion hat für die Therapieindikation nur untergeordnete Bedeutung. Die postnatale CMV-Infektion setzt voraus, dass nahezu alle latent CMV-infizierten Mütter (CMV-IgG +/CMV-IgM-/hohe CMV-IgG-Avidität) das Virus meist im ersten Lebensmonat reaktivieren und in die Milch ausscheiden. Die CMV-Reaktivierung während des Stillens ist ein lokaler, selbst limitierter Prozess, der in der Regel eine unimodale Kinetik aufweist. Bei Risikofrühgeborenen kann die postnatale CMV-Infektion zu teilweise schwerer, symptomatischer CMV-Infektion mit Langzeitfolgen führen.

ABSTRACT

Vertical CMV transmission includes intrauterine, perinatal and postnatal CMV transmission patterns. Risk patients for symptomatic congenital CMV infection (cCMV) in Germany are initially seronegative pregnant mothers with an infant below three years of age. The highest risk for the outcome of the newborn infant is the acquisition of the maternal infection either periconceptionally or during the first trimenon. Current evidence for antiviral therapy with Valganciclovir (VGCV) in symptomatically cCMV-infected newborns is given if therapy-onset occurs within 4 weeks after birth. Hearing and retinal diagnostics and CNS imaging methods are of high value for the indication of VGCV therapy, no evidence supports lumbar puncture as a part of routine diagnostic procedure, viral DNA in CSF has only been documented in about 15 % of symptomatically cCMV-infected newborns. Postnatal CMV reactivation of the latently CMV-infected breastfeeding mother may be of risk for very low birthweight preterm infants. CMV reactivation during lactation is a local self-restricted phenomenon with frequencies up to 95 % of all breastfeeding mothers. Postnatal CMV-infection may have considerable consequences for very low birth weight infants with severe symptomatic courses and long-term consequences.

Schlüsselwörter

CMV-Primärinfektion - Virusinfektionen in der Schwangerschaft - kongenitale CMV-Infektion - postnatale CMV-Infektion - antivirale Therapie - Stillen

Keywords

CMV primary infection - pregnancy - congenital CMV infection - postnatal CMV infection - antiviral therapy - breastfeeding


Publication History

Article published online:
17 August 2022

© 2022. Thieme. All rights reserved.

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Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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