Dietrich Monika L, Schieffelin John S
Department of Pediatrics, Tulane University School of Medicine, New Orleans, LA.
Ochsner J. 2019 Summer;19(2):123-130. doi: 10.31486/toj.18.0095.
Congenital cytomegalovirus (cCMV) is the leading cause of nongenetic congenital hearing loss in much of the world and a leading cause of neurodevelopmental disabilities. Infected babies can be born to women who are seropositive and seronegative prior to pregnancy, and the incidence is approximately 0.6%-0.7% in the United States. Symptoms vary from mild to severe, and hearing loss can be delayed in onset and progressive. We reviewed the literature to summarize the epidemiology, clinical manifestations, diagnosis, treatment, and future directions of cCMV. The best way to diagnose the infection is with polymerase chain reaction of urine or saliva within 3 weeks after birth, followed by a repeat confirmatory test if positive. Moderately to severely symptomatic neonates should be treated for 6 months with valganciclovir, and some practitioners also choose to treat infants who have isolated hearing loss only. Treatment is not recommended for asymptomatic infants. All infected infants should be screened for hearing loss and neurodevelopmental sequelae. Universal and targeted screening may be cost effective. Currently, no vaccine is commercially available, although multiple candidates are under study. Congenitally acquired cytomegalovirus is found in all communities around the world with a disease burden that is greater than many other well-known diseases. Advances are being made in prevention and treatment; however, improved awareness of the disease among clinicians and patients is needed.
先天性巨细胞病毒（cCMV）是世界上许多地区非遗传性先天性听力损失的主要原因，也是神经发育障碍的主要原因。感染的婴儿可能出生于孕期血清学阳性和阴性的女性，在美国发病率约为0.6%-0.7%。症状从轻度到重度不等，听力损失可能起病延迟且呈进行性。我们回顾了文献以总结cCMV的流行病学、临床表现、诊断、治疗及未来方向。诊断感染的最佳方法是在出生后3周内对尿液或唾液进行聚合酶链反应检测，若结果为阳性则需重复进行确诊试验。中度至重度症状的新生儿应使用缬更昔洛韦治疗6个月，一些医生也会选择仅对孤立性听力损失的婴儿进行治疗。不建议对无症状婴儿进行治疗。所有感染婴儿均应进行听力损失和神经发育后遗症筛查。普遍筛查和针对性筛查可能具有成本效益。目前尚无商业化疫苗，不过有多种候选疫苗正在研究中。全球所有社区都存在先天性获得性巨细胞病毒感染，其疾病负担超过许多其他知名疾病。在预防和治疗方面正在取得进展；然而，临床医生和患者对该疾病的认识仍需提高。
