Puliyanda D P, Silverman N S, Lehman D, Vo A, Bunnapradist S, Radha R K, Toyoda M, Jordan S C
Center for Kidney Diseases and Transplantation, Cedars Sinai Medical Center, UCLA School of Medicine, Los Angeles, CA 90048, USA.
Transpl Infect Dis. 2005 Jun;7(2):71-4. doi: 10.1111/j.1399-3062.2005.00089.x.
Congenital cytomegalovirus (CMV) infection occurs in approximately 1% of newborns and is the leading infectious cause of congenital birth defects. Female renal allograft recipients who develop CMV infection during pregnancy are at risk for both graft dysfunction and fetal morbidity. DNA-based analysis of amniotic fluid (AF) from at-risk pregnancies has been suggested as an adjunct/substitute for traditional culture. We have shown that CMV-polymerase chain reaction of AF is a useful diagnostic test for congenital CMV infection. Using this test we diagnosed CMV infection in the fetus of a 30-year-old renal transplant recipient. As termination was not an option for the family, the patient was extensively counseled and treated with oral ganciclovir. This resulted in clearance of the virus from the AF and the delivery of a healthy newborn girl, free of CMV disease. This is the first reported case to our knowledge of successful use of maternal ganciclovir to treat intrauterine CMV infection in a pregnant renal transplant recipient.
先天性巨细胞病毒（CMV）感染约发生于1%的新生儿中，是先天性出生缺陷的主要感染原因。孕期发生CMV感染的女性肾移植受者面临移植肾功能障碍和胎儿发病的风险。有人建议对高危妊娠的羊水（AF）进行基于DNA的分析，作为传统培养方法的辅助手段/替代方法。我们已经表明，羊水的CMV聚合酶链反应是先天性CMV感染的一种有用诊断测试。通过该测试，我们诊断出一名30岁肾移植受者的胎儿感染了CMV。由于终止妊娠对这个家庭来说不是一个选择，因此对该患者进行了广泛的咨询，并给予口服更昔洛韦治疗。这导致病毒从羊水中清除，并分娩出一名健康的新生女婴，未患CMV疾病。据我们所知，这是首例成功使用母体更昔洛韦治疗妊娠肾移植受者子宫内CMV感染的报告病例。
