母亲原发性巨细胞病毒感染后使用伐昔洛韦早期治疗的病例报告。
Case report on early treatment with valaciclovir after maternal primary cytomegalovirus infection.
作者信息
Codaccioni Camille, Vauloup-Fellous Christelle, Letamendia Emmanuelle, Saada Julien, Benachi Alexandra, Vivanti Alexandre J
机构信息
Service de Gynécologie-Obstétrique, Hôpital Antoine Béclère, Université Paris-Sud, Clamart, France.
AP-HP, Hôpital Paul Brousse, Department of Virology, WHO Rubella NRL, Université Paris-Sud, INSERM U1193, Villejuif, 94804, France.
出版信息
J Gynecol Obstet Hum Reprod. 2019 Apr;48(4):287-289. doi: 10.1016/j.jogoh.2019.01.003. Epub 2019 Jan 8.
BACKGROUND
Cytomegalovirus (CMV) is the main cause of congenital viral infections. Current guidelines do not include any recommendation about antenatal treatment. Most studies that evaluate the efficacy of valaciclovir aim to treat infected symptomatic fetus but the benefit of anti-CMV therapy remains unclear.
CASE PRESENTATION
We report the case of cytomegalovirus seroconversion during the second trimester of pregnancy. Early treatment with valaciclovir was introduced, associated with a close monitoring of maternal CMV viremia. The virus was no longer detected in maternal blood soon after the beginning of antiviral therapy. Valaciclovir was stopped at 24 + 5 WG after negative prenatal diagnosis but CMV viremia was still monitored in maternal blood until the end of pregnancy.
CONCLUSION
The neonate was not infected and remained asymptomatic. It suggests that early treatment with valaciclovir 8 g per day could be effective in quickly reducing maternal viral load and lowering the risk of vertical CMV transmission.
背景
巨细胞病毒（CMV）是先天性病毒感染的主要原因。当前指南未包含任何关于产前治疗的建议。大多数评估伐昔洛韦疗效的研究旨在治疗受感染的有症状胎儿，但抗CMV治疗的益处仍不明确。
病例报告
我们报告了一例妊娠中期巨细胞病毒血清学转换的病例。开始使用伐昔洛韦进行早期治疗，并密切监测母体CMV病毒血症。抗病毒治疗开始后不久，母体血液中未再检测到该病毒。产前诊断为阴性后，伐昔洛韦在孕24 + 5周时停用，但仍对母体血液中的CMV病毒血症进行监测直至妊娠结束。
结论
新生儿未被感染且无症状。这表明每天8克伐昔洛韦的早期治疗可能有效快速降低母体病毒载量并降低CMV垂直传播的风险。
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