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Year : 2017  |  Volume : 60  |  Issue : 1  |  Page : 130-131
Congenital cytomegalovirus infection in a neonate born to HIV-infected mother: A case report


Department of Pathology, Grant Government Medical College, Mumbai, Maharashtra, India

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Date of Web Publication14-Feb-2017
 

How to cite this article:
Lanjewar DN, Ramraje SN. Congenital cytomegalovirus infection in a neonate born to HIV-infected mother: A case report. Indian J Pathol Microbiol 2017;60:130-1

How to cite this URL:
Lanjewar DN, Ramraje SN. Congenital cytomegalovirus infection in a neonate born to HIV-infected mother: A case report. Indian J Pathol Microbiol [serial online] 2017 [cited 2017 May 29];60:130-1. Available from: http://www.ijpmonline.org/text.asp?2017/60/1/130/200028


HIV-infected babies may manifest with perinatal coinfections such as tuberculosis, syphilis, and cytomegalovirus (CMV) infection.[1] CMV is the most common congenital viral infection seen in infants of HIV-infected mothers, especially in developing countries.[2],[3] We describe a case of congenital CMV infection in a neonate born to HIV-infected mother.

A near-term male infant, born to a second gravida, was delivered by emergency lower segment cesarean section. The baby had low birth weight (1.230 kg), was 44 cm in length, and had a head circumference of 28 cm and a chest circumference of 26 cm. According to the New Ballard score, the age of the baby was 34 weeks, and Ponderal index was 1.44. On examination, the baby had acrocyanosis and tachypnea (respiratory rate of 68/min) with mild chest retraction. Examination of the cardiovascular and central nervous system did not show any abnormality; liver and spleen were just palpable. On the 2nd day, the baby developed severe tachypnea, tachycardia, and chest retraction and died due to respiratory failure. An autopsy was performed to know the cause of death. At postmortem examination, the thymus was in normal anatomical position and was small in size. The lungs were firm and showed confluent hemorrhagic areas. The heart, liver, spleen, kidneys, gastrointestinal tract, and brain appeared normal. Microscopic examination of the thymus showed changes of precocious involution comprising depletion of lymphocytes and dilated Hassel's corpuscles. Histology of the lung showed CMV infection and hyaline membrane disease. The liver showed CMV infection in hepatocytes and bile duct epithelium. Microscopic examination of the kidneys showed extensive lymphocytic infiltrate in interstitium; tubular lining cells and vascular endothelium showed CMV infection [Figure 1]a and [Figure 1]b. The infected cells were large and had prominent basophilic intra-nuclear inclusions surrounded by clear halo along with intra-cytoplasmic inclusions [Figure 1]c and [Figure 1]d. The presence of extensive lymphocytic infiltrate in the kidney indicates active CMV infection. The heart, spleen, gastrointestinal tract, and brain did not show any pathology.
Figure 1: (a) Microscopic examination of the kidney shows extensive lymphocytic infiltrate in interstitium (H and E; ×100). (b) Cytomegalovirus infection of renal tubular lining cells and vascular endothelium (H and E; ×100); (c and d). The infected cells are large and have prominent basophilic intranuclear inclusions surrounded by clear halo along with intracytoplasmic inclusions (H and E; ×400)

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Neonatal CMV infection is acquired transplacentally or through contaminated birth canal or during the 1st month of life through infected breast milk or due to exposure of high-risk blood products.[4],[5] HIV-CMV coinfections in children are associated with a more severe course of HIV.[3] Since both CMV and HIV viruses are immunosuppressive, they may act additively or synergistically to accelerate disease progression. CMV can cause a varied spectrum of diseases, including gastrointestinal illness, which can be a major cause of death.[1] Other manifestations of congenital CMV infection are microcephaly, intellectual impairment, sensorineural hearing loss, chorioretinitis, and congenital heart disease.[3],[4] Early diagnosis of neonatal CMV infection is important to advocate the right therapy and proper management so as to prevent onset of neurological sequel. The diagnosis of CMV infection in a neonate is done by urine culture, detection of CMV-IgM, detection of CMV antigen in blood, and identification of CMV-DNA by polymerase chain reaction.[4] The µ-capture ELISA is a sensitive and specific technique. It may be used in detection of current/congenital CMV infection in a country with limited resources, like India. A vaccine that prevents CMV infection would be interesting for early life immunization. However, there is no available licensed vaccine for preventing congenital CMV disease although clinical trials are going on in countries like the USA. Vaccination against CMV may be considered in countries with very high rates of sero-positivity to prevent the morbidity associated with congenital infections.[5]

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Conflicts of interest

There are no conflicts of interest.

 
   References Top

1.
Slyker JA, Lohman-Payne BL, Rowland-Jones SL, Otieno P, Maleche-Obimbo E, Richardson B, et al. The detection of cytomegalovirus DNA in maternal plasma is associated with mortality in HIV-1-infected women and their infants. AIDS 2009; 23:117-24.  Back to cited text no. 1
    
2.
Marín Gabriel MA, Fernández Ibieta M, González Tomé MI, Saavedra Lozano J, Barajas Sánchez V, Rojo Conejo P, et al. Congenital cytomegalovirus infection in the infants of HIV-infected mothers. An Pediatr (Barc) 2005; 62:38-42.  Back to cited text no. 2
    
3.
Guibert G, Warszawski J, Le Chenadec J, Blanche S, Benmebarek Y, Mandelbrot L, et al. Decreased risk of congenital cytomegalovirus infection in children born to HIV-1-infected mothers in the era of highly active antiretroviral therapy. Clin Infect Dis 2009; 48:1516-25.  Back to cited text no. 3
    
4.
Bhatia P, Narang A, Minz RW. Neonatal cytomegalovirus infection: Diagnostic modalities available for early disease detection. Indian J Pediatr 2010; 77:77-9.  Back to cited text no. 4
    
5.
Kaye S, Miles D, Antoine P, Burny W, Ojuola B, Kaye P, et al. Virological and immunological correlates of mother-to-child transmission of cytomegalovirus in the Gambia. J Infect Dis 2008; 197:1307-14.  Back to cited text no. 5
    

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Correspondence Address:
Dhaneshwar Namdeorao Lanjewar
Grant Government Medical College, Mumbai, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.200028

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