Zytomegalie-Infektion des Fetus: Von der Forschung zur Klinik

Zusammenfassung

Das humane Zytomegalievirus (hCMV) ist die häufigste Ursache kongenitaler Infektionen. Weltweit sind 0,2 - 2,3 % aller Neugeborenen mit dem hCMV infiziert. Das hCMV mit einem aus doppelsträngiger DNA bestehenden Genom gehört zur Gruppe der Herpesviren. Die genaue Pathogenese einer hCMV-Infektion ist noch weit gehend unklar, wobei chromosomale Schädigung, Beeinflussung der Immunantwort und Modulation der Apoptose eine wichtige Rolle spielen. Die postnatale Übertragung erfolgt durch Schmier- und Tröpfcheninfektion, Urin, Speichel, Genitalsekrete, Blut, Blutprodukte sowie Muttermilch. Die perinatale Infektion wird durch infizierte Sekrete bei der Passage durch den Geburtskanal erworben. Pränatal infizierte Neugeborene sind bei Geburt ca. zu 10 % symptomatisch und weisen in etwa 5 % die klassischen Stigmata der kongenitalen hCMV-Erkrankung bzw. eines oder mehrere dieser Symptome auf (neurologische Auffälligkeiten, Frühgeburt, Hepatosplenomegalie, Pneumonie, Petechien, Hörverlust, Chorioretinitis). Für die Therapie steht heute vor allem das Ganciclovir bzw. Foscarnet oder Aciclovir zur Verfügung. Synthetische Antisenseoligonukleotide sind wahrscheinlich eine neue Alternative zu den antiviralen Mitteln, wobei deren klinischer Einsatz noch unklar ist. Impfstoffe sind z. Z. in klinischer Erprobung.

Abstract

The cytomegalovirus (hCMV) is the most frequent cause of congenital infections with symptoms at birth and long-term damages. Worldwide 0.2 - 2.3 % of all newborns are infected with hCMV. The hCMV has a dsDNA genome and belongs to the herpes viruses. The exact pathogenesis of hCMV infection is still unknown, although chromosal damage, the influence of the immune response and modulation of apoptosis have been suggested. The primary infection is usually unnoticed during childhood. The majority of the infections are asymptomatic in adolescence, although uncharacteristic symptoms like malaise, tiredness, fever and lymphoadenopathy can occur. Postnatal transmission can occur through urine, saliva, genital secretion, blood, blood products as well as mother's milk. Perinatal infection is mostly acquired during birth. Infected newborns are approximately 10 % symptomatic and show in 5 % of such cases the classic stigmata of a congenital hCMV infection or several of these symptoms (e.g. neurological symptoms, premature birth, hepatosplenomegaly, pneumonia, petechia, hearing loss, chorioretinitis). For treatment of a hCMV infection either ganciclovir or foscarnet/aciclovir can be used. Synthetic antisense oligonucleotides are probably a new alternative to antiviral medications, but the clinical use is still unclear. Two developed vaccines are undergoing clinical testing.

Schlüsselwörter

Zytomegalie (hCMV) - molekularbiologische Grundlagen - fetale Symptomatik - Diagnose - Therapie

Key words

Cytomegalovirus (hCMV) - molecular biology - fetal symptoms - diagnosis - therapy

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