Long-term Outcomes of Congenital Cytomegalovirus Infection in Sweden and the United Kingdom
Long-term Outcomes of Congenital Cytomegalovirus Infection in Sweden and the United Kingdom
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DOI：
10.1093/cid/cit018
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发表时间：
2013-05-01
影响因子：
11.8
通讯作者：
Peckham, Catherine S.
中科院分区：
文献类型：
--
作者：
Townsend, Claire L.;Forsgren, Marianne;Peckham, Catherine S.
背景。先天性巨细胞病毒（CMV）是神经系统问题，特别是感音神经性听力损失的重要原因，但有关长期后遗症和非原发性孕产妇感染影响的数据有限。我们报告了两项大型前瞻性研究关于儿童结局的最新发现。方法。 1977 年至 1986 年间，瑞典马尔默和英国伦敦的孕妇被纳入其中，并对新生儿进行了 CMV（尿液或唾液病毒培养）筛查。病例和匹配对照接受定期、详细的发育评估，直至至少 5 岁。结果。在超过 50 000 名筛查中发现了 176 名先天性感染婴儿（马尔默：76 名[4.6/1000 名出生婴儿]；伦敦：100 名[3.2/1000 名出生婴儿]）；选择了 214 个对照。 11% 的 CMV 感染新生儿 (19/176) 出现症状，且症状大多较轻微；只有 1 名新生儿出现神经系统症状。随访时，7% (11/154) 的婴儿被分类为轻度、5% (7/154) 中度、6% (9/154) 重度神经系统后遗症。 161 名对照者中的 4 名（2%）有轻度损伤。在出生时有症状的儿童中，42% (8/19) 有后遗症，而无症状婴儿的这一比例为 14% (19/135) (P =.006)。所有中度/重度结果均在 1 岁时确定； 6 名儿童在 2-5 岁时首次发现轻度后遗症，3 名儿童在 6-7 岁时首次发现后遗症。在 16 名中度/重度结果的儿童中，2 名的母亲患有确诊病例，7 名推测为非原发性感染。结论。通过人群筛查发现患有先天性 CMV 的儿童中，有 11% 的儿童在 1 岁时出现中度或重度后果；这个年龄之后检测到的所有损伤都是轻微的。非原发性感染在很大程度上加重了儿童先天性巨细胞病毒疾病的负担。
Background. Congenital cytomegalovirus (CMV) is an important cause of neurological problems, particularly sensorineural hearing loss, but data on long-term sequelae and the impact of nonprimary maternal infection are limited. We report updated findings on childhood outcomes from 2 large prospective studies.Methods. Pregnant women in Malmo, Sweden, and London, United Kingdom, were included between 1977 and 1986, and newborns were screened for CMV (virus culture of urine or saliva). Cases and matched controls underwent regular, detailed developmental assessments up to at least age 5 years.Results. One hundred seventy-six congenitally infected infants were identified among >50 000 screened (Malmo: 76 [4.6/1000 births]; London: 100 [3.2/1000 births]); 214 controls were selected. Symptoms were recorded in 11% of CMV-infected neonates (19/176) and were mostly mild; only 1 neonate had neurological symptoms. At follow-up, 7% of infants (11/154) were classified as having mild, 5% (7/154) moderate, and 6% (9/154) severe neurological sequelae. Four of 161 controls (2%) had mild impairment. Among children symptomatic at birth, 42% (8/19) had sequelae, versus 14% (19/135) of the asymptomatic infants (P =.006). All moderate/severe outcomes were identified by age 1; mild sequelae were first identified at age 2-5 years in 6 children, and age 6-7 years in 3. Among the 16 children with moderate/severe outcomes, 2 had mothers with confirmed and 7 with presumed nonprimary infection.Conclusions. Moderate or severe outcomes were reported in 11% of children with congenital CMV identified through population screening, all by 1 year; all impairment detected after this age was mild. Nonprimary infections contributed substantially to the burden of childhood congenital CMV disease.