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Old 09-09-2012
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Arrow Gyrus Daily Questions; Pediatrics #35

A 2-year-old boy is being followed for congenital cytomegalovirus (CMV) infection. He is deaf and developmentally delayed. The child’s mother informs you that she has just become pregnant and is concerned that the new baby will be infected. Which of the following is true?


a. The mother has antibodies to CMV that are passed to the fetus
b. The mother’s infection cannot become reactivated
c. The likelihood that the new baby will become clinically ill is approximately 80%
d. Termination of pregnancy is advised
e. The new infant should be isolated from the older child
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Old 09-09-2012
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antibodies passed to fetus, I think...
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A. The mother has antibodies to CMV that are passed to the fetus
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Vertical transmission from mother to fetus or neonate occurs mainly during the viremia of a primary infection. However, because the result of primary infection is predisposition to a residual lifelong latency, fetal infection can occur with reactivation. Transplacental infection rate is 50% with maternal primary infections regardless of the pregnancy trimester, but < 1 % with recurrent infections.
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The answer is a.

Cytomegalic inclusion disease is the most common congenital viral infection. In the United States, 20 to 90% of women of childbearing age have serologic evidence of a past infection with CMV. Symptomatic congenital disease usually occurs when a mother has a primary CMV infection in the first trimester of pregnancy. Many of these babies die, and those who survive are severely affected. In the event of reactivation of CMV infection during pregnancy, maternal IgG, passed transplacentally, protects the infant from serious infection. Although most infants infected during this secondary maternal infection are asymptomatic, about 10% of them eventually manifest hearing and neurologic problems. Some recommend keeping a child with congenital CMV infection away from susceptible pregnant (or about to become pregnant) women because CMV excretion can persist for months to years; at the very least, good hand washing practices should be instituted. If infected shortly after birth, the younger sibling will probably be asymptomatic since he or she has maternal IgG in the circulation. CMV is primarily an occult infection. Of toddlers in day-care centers, 20 to 80% acquire CMV and shed it in saliva and urine for years. The “gold,” or criterion, standard for diagnosis is a urine viral culture for CMV.


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