Leruez-Ville Marianne, Ville Yves
Université Paris Descartes, Sorbonne Paris Cité, hôpital Necker-enfants malades, laboratoire de virologie, 75015 Paris, France.
université Paris Descartes, Sorbonne Paris Cité, hôpital Necker-enfants malades, service d'obstétrique et médecine fœtale, 75015 Paris, France.
Presse Med. 2014 Jun;43(6 Pt 1):683-90. doi: 10.1016/j.lpm.2014.02.016. Epub 2014 May 1.
Cytomegalovirus is the main cause of neurosensorial deficit due to a congenital infection. Fetal infection may follow a maternal primary infection or a maternal secondary infection. The diagnosis of maternal primary infection remains tricky because the interpretation of IgG avidity test may be difficult. The diagnosis of maternal secondary infections is impossible with usual routine assays. The virological diagnosis of fetal infection is very reliable with a sensitivity over 90% and a specificity next to 100%. In the context of a proven intrauterine infection, the negative predictive value of ultrasound coupled with fetal brain RMI is over 85%. No antenatal treatment is yet validated, two treatments (hyperimmune therapy and antival therapy) are under evaluation. Six months treatment course with valganciclovir improves audiologic and neurodevelopmental outcomes of symptomatic neonates.
巨细胞病毒是先天性感染导致神经感觉功能缺损的主要原因。胎儿感染可能继发于母体原发性感染或母体继发性感染。母体原发性感染的诊断仍然棘手,因为IgG亲和力试验的解读可能存在困难。常规检测方法无法诊断母体继发性感染。胎儿感染的病毒学诊断非常可靠,敏感性超过90%,特异性接近100%。在已证实宫内感染的情况下,超声联合胎儿脑RMI的阴性预测值超过85%。尚无经证实有效的产前治疗方法,两种治疗方法(超免疫疗法和抗病毒疗法)正在评估中。缬更昔洛韦六个月的治疗疗程可改善有症状新生儿的听力和神经发育结局。