Konnatale CMV-Infektionen

Zusammenfassung

Während effektive Präventionsstrategien zu einem deutlichen Rückgang der meisten vertikalen Infektionen geführt haben (Röteln, HIV, Hepatitis B, Lues, B-Streptokokken), dürften jedes Jahr in Deutschland mehrere Tau-send Kinder mit einer konnatalen Zytomegalie-Virus (CMV)-Infektion auf die Welt kommen, von denen schätzungsweise 90 % jedoch nicht diagnostiziert werden. Während in Mitteleuropa jeweils rund die Hälfte der konnatalen CMV-Infektionen Kinder betrifft, deren Mütter ihre CMV-Erstinfektion entweder in der Schwangerschaft oder bereits vor der Schwangerschaft durchgemacht haben, erreicht der Anteil fetaler CMV-Infektionen bei prägravider mütterliche CMV-Infektion in Ländern mit höheren durchschnittlichen Familiengrößen über 90 %. Die Transmissions-rate steigt mit der Schwangerschaftsdauer an, während die fetale Erkrankungsschwere abnimmt. Bei Erkrankungen vor allem im ersten und zweiten Trimenon kann es zu Hydrops fetalis, hämolytischer Anämie und Gehirnfehlbildungen kommen. Ist die Erkrankung bei Geburt noch in einem floriden Stadium, bietet sich das Bild eines „blueberry muffin“-Babys mit extramedullären Hämatopoiese-Herden in der Haut. Auch bei Geburt asymptomatisch erscheinende Kinder mit konnataler CMV-Infektion können im Laufe des ersten Lebensjahres einen sensorineuralen Hörverlust erleiden (zweithäufigste Ursache nicht syndromalen Hörverlustes nach Connexin-26-Mutationen). Der hypothetische Wert einer pränatalen spezifischen ImmunglobulinGabe wird gegenwärtig in zwei randomisierten Multicenterstudien geprüft, die Behandlung wird dennoch vielerorts von den Krankenkassen übernommen. Bei Neugeborenen mit symptomatischer CMV-Infektion lässt sich ein konsekutiver Hörverlust durch Behandlung mit Ganciclovir bzw. dem oral applizierbaren Valganciclovir in vielen Fällen verhindern, Aussagen zu Neugeborenen mit asymptomatischer konnataler CMV-Infektion sind mangels Screenings derzeit nicht möglich.

Summary

The rate of most vertically transmitted infections (rubella, HIV, hepatitis B, syphilis, group B streptococci) has declined substantially following the institution of effective preventive measures. In contrast, several thousand infants are born each year in Germany with congenital cytomegalovirus (CMV) infection, approximately 90 % of them undiagnosed. In central European countries, congenital CMV infections are equally divided between infants of mothers who had their first CMV infection before or during pregnancy, while maternal pre-pregnancy CMV infections are found in more than 90 % of congenital CMV infections in southern countries featuring large families. Rates of transmission increase during pregnancy while the severity of fetal symptoms decrease. Infections during the first and second trimester of pregnancy may result in fetal hydrops, hemolytic anemia and brain malformations. Infants born while the disease is in its active stage may present as “blueberry muffin babies” indicating extramedullary hematopoiesis in the skin. Infants with or without symptoms at birth may develop severe sensorineural hearing loss. Congenital CMV infections are the second most common cause of non-syndromic hearing loss in children (after connexin-26 mutations). Two randomized controlled trials are currently establishing whether the rate of transmission and severity of fetal symptoms of mothers with their first CMV infection during pregnancy may be reduced by maternal administration of CMV-specific immunoglobulin. In infants born with symptomatic congenital CMV infection, the rates of hearing loss are significantly reduced by administration of ganciclovir or its orally available prodrug, valganciclovir. Recommendations for asymptomatically infected infants have to await the results of future trials.

Schlüsselwörter

Zytomegalie-Virus - CMV - Valganciclovir

Keywords

Congenital cytomegalovirus infection - CMV - valganciclovir

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