Wednesday, July 13, 2011

Facts about CMV

Well went on a mission yesterday to find out some information about CMV the virus I caught and what led us down this track. I was hoping not to find any 'good' information which sounds weird I know but makes me feel better about what we did and the course we took. Basically after a while reading and searching, I did feel better and know that Grace really had no chance in her lifetime as a healthy baby, which is what the specialist told us, but I wanted to confirm things for myself I guess as a reassurance. I guess this is all part of me seeking some answers and part of the grief process, have been through the anger and the constant searching for someone/something to blame and that does not help at all. I did refine my search to where I probaly go the virus from and once again that really does not help in anyway, it is just me being me and searching out for answers.

Transmission of CMV can occur at any stage of pregnancy, and severe
damage to the developing fetus occurs when CMV
circulates in the mothers blood, and reaches the uterus
to infect the placenta and the baby. Placental and fetal
infections frequently cause stillbirths, or maldevelopment
of the fetus, depending on the time of infection. The virus
damages host cells by entering the cell with specific
surface viral proteins that bind to particular host

Cytomegalovirus (CMV) is an opportunistic pathogen
that can cause infection at any time during the course of
a lifetime and constitutes an important cause of
intrauterine infection and death in newborns

Cytomegalovirus (CMV) is a common viral infection that usually causes no symptoms or mild flu-like symptoms in infected children and adults. CMV is a member of the herpes virus family. It is most common in young children. About half of pregnant women have had CMV in the past and most do not need to be concerned about it during pregnancy (1). However, an infected woman can pass the virus on to her baby during pregnancy and breastfeeding. Most infected babies have no serious problems from the virus (1, 2). In a minority of cases, though, infected newborns develop serious illness or lasting disabilities, or even die.

How is CMV spread?
CMV can be passed from person to person through contact with infected body fluids, such as saliva, mucus, urine and blood. It also can be transmitted sexually or through infected blood products.
Pregnant women can pass the virus to their babies before or during birth. Breastfeeding moms can pass the virus to their baby through breastmilk. However, babies who become infected from breastfeeding rarely have any serious problems from the virus (1, 2).
Up to 20 percent of babies with CMV symptoms die (3, 4). About 80 to 90 percent of survivors develop serious disabilities, such as mental retardation, cerebral palsy, or vision and hearing loss
Which women are at highest risk of passing CMV on to their babies?
A woman who contracts CMV for the first time during pregnancy has about a 1-in-3 chance of passing the virus on to her fetus (1). A woman can pass CMV on to her baby at any stage of pregnancy. However, studies suggest that babies are more likely to develop serious complications when their mother is infected in the first 20 weeks of pregnancy

Like other viruses in the herpes family, CMV stays in the body after symptoms disappear. Occasionally the disease reactivates. However, only about 1 percent of fetuses become infected when their mother has a recurrent infection (1, 5). When these babies do become infected, they rarely develop any serious CMV-related problems
How can a pregnant woman help prevent CMV infection?
Women can help reduce their risk of CMV by practicing careful hygiene. This is especially important for women with young children at home or those who work with young children (such as child care workers). As many as 70 percent of children between 1 and 3 years of age who attend day care may have the virus in body fluids and can pass it on to their families or caretakers (2).
To help prevent CMV, pregnant women should (1):
• Wash their hands thoroughly after any contact with urine, nasal secretions and saliva of young children, including after changing diapers, wiping noses or drool, and picking up toys
• Avoid kissing young children on the mouth or cheek
• Avoid sharing food, drinking glasses and eating utensils with young children
Pregnant health care workers who may be in contact with infected patients, including newborns, also should practice good hygiene. They should follow the universal precautions recommended in medical settings for handling potentially contaminated materials. Medical or child care workers may want to get tested before pregnancy to see if they have had CMV in the past. If they have already had CMV, they have little cause for concern during pregnancy. Child care workers who have never been infected (or have not been tested), should try to limit close contact with children younger than 2½ years of age (1). Routine screening for all pregnant women is not recommended

Tests and treatments
Pregnant women who have previously been infected with CMV, do not necessarily have immunity against future CMV infections. However, the unborn baby is less likely to be affected if their mother has been previously infected. Testing for CMV during pregnancy is difficult. A blood test for IgG and IgM antibodies may show 'positive' shortly after being infected, with the IgM disappearing several months later (the IgG antibody stays positive forever). If you test positive only for IgG, but not IgM, that means your infection happened more than several months ago. If you test positive for IgG and IgM, then your infection was more recent. A single high IgG level (or titre) does not show if the infection is new (primary), or a re-infection (secondary), but a rising titre shows the infection has been recent. It takes about 24-36 hours to get results. A current infection may also be detected through laboratory testing of a urine or saliva sample.

There are no treatments or vaccinations available for CMV.

Clinical Case
A twenty-seven-year-old primigravid woman had an ultrasound examination at twenty-four weeks gestation because her uterus was smaller than expected for dates. Of note, the placenta was moderately thickened, measuring 4.8 cm in diameter. The amniotic fluid volume was in the low-normal range. The estimated fetal weight was in the 15th percentile for gestational age, and the fetal bowel was highly echogenic.

No other abnormalities were noted. Upon detailed questioning, the patient indicated that she had had a prolonged “flu-like” illness at approximately fourteen weeks’ gestation. No treatment had been administered for this illness. The patient presently works as a pre-school teacher.

What is the most likely explanation for the ultrasound findings noted above? What are the most appropriate steps in the evaluation of this patient?
If fetal infection is confirmed, the stage of pregnancy at which it occurred, viral load in the amniotic fluid and evidence of fetal abnormality or growth retardation on ultrasound examination may aid in considering termination of pregnancy.?

Of the approximately 40% of fetuses that become infected, 10% of
neonates show symptoms of congenital CMV infections after primary
maternal infection at birth. The brain, eyes, liver, spleen, blood,
and skin are at risk for problems. Long-term effects may include
sensorineural hearing loss, mental retardation, developmental delay,
and visual impairment. Of the remaining 90% with asymptomatic (no
evidence of disease at birth) congenital infection, 5-15% are at risk
to develop some of the long-term effects.

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