Fetal Therapy Unit "U. Nicolini", Children's Hospital Vittore Buzzi, Milan, Italy.
Department of Women Mother and Neonate, Children's Hospital Vittore Buzzi, Milan, Italy.
Fetal Diagn Ther. 2022;49(1-2):36-40. doi: 10.1159/000521711. Epub 2021 Dec 30.
Human cytomegalovirus (HCMV) is the most common congenital infection, especially severe after a maternal primary infection; sequelae in neonates born to mothers experiencing a nonprimary infection have been already reported. Hereby, two cases of severe fetal HCMV disease in seroimmune gravidas referred to our Unit are described.
Case 1: A fetus at 21 weeks' gestation with signs of anemia and brain abnormalities at ultrasound, described at magnetic resonance (MR) imaging as ependymal irregularity and bilateral asymmetric parenchymal thinning; amniotic fluid sample was positive for HCMV although the woman had a previous immunity; after termination of pregnancy, autopsy demonstrated a thicken layer of disorganized neurons on the right cortical plate, while on the left, there was a morphological pattern coherent with polymicrogyria. Case 2: A fetus at 20 weeks' gestation with anemia, moderate atrioventricular insufficiency, hepatosplenomegaly but no major cerebral lesions. Fetal blood was positive for HCMV, although unexpected for prepregnancy maternal immunity, and intrauterine transfusion was needed. A cesarean section at 34 weeks' gestation was performed due to worsening condition of the fetus, who had a birthweight of 2,210 g and needed platelet transfusions, but MR examination and clinical evaluation were normal.
The impact of nonprimary maternal infection on pregnancy outcome is unknown and fetal brain damage in HCMV seroimmune transmitter-mothers can occur as a consequence of maternal reinfection or reactivation for a hypotetic different role of HCMV-primed CD4+ or CD8+ T-cells in fetal brain, with progressive brain lesions coexistent in the first case and with severe unexpected anemia in the second case. A previous maternal HCMV immunity should not exempt to test anemic fetuses for such infection, nor to consider a potential transplacental transmission.
人巨细胞病毒（HCMV）是最常见的先天性感染，尤其是在母体原发感染后更为严重；母体非原发感染后新生儿的后遗症已有报道。本文描述了两例血清学免疫孕妇中严重胎儿 HCMV 疾病的病例。
病例 1：胎儿 21 周时超声检查发现有贫血和脑部异常，磁共振成像（MR）显示室管膜不规则和双侧不对称的实质变薄；尽管该妇女有先前的免疫力，但羊水样本 HCMV 检测呈阳性；妊娠终止后尸检显示右侧皮质板上神经元层增厚且排列紊乱，而左侧表现为符合多小脑回畸形的形态模式。病例 2：胎儿 20 周时出现贫血、中度房室传导阻滞、肝脾肿大，但无明显的脑部病变。胎儿血液 HCMV 检测呈阳性，尽管与妊娠前母体免疫预期不符，但需要宫内输血。由于胎儿病情恶化，在 34 周时进行了剖宫产，出生体重为 2210 克，需要血小板输注，但 MR 检查和临床评估均正常。
非原发母体感染对妊娠结局的影响尚不清楚，HCMV 血清学免疫传递者的胎儿脑损伤可能是由于母体再感染或重新激活引起的，因为 HCMV 激活的 CD4+或 CD8+T 细胞在胎儿脑中有不同的作用，在第一个病例中出现进行性脑损伤，而在第二个病例中出现严重的意外贫血。先前的母体 HCMV 免疫力不应免除对贫血胎儿进行此类感染的检测，也不应忽视潜在的胎盘传播。
