Table 2 Comparison of case reports about congenital cytomegalovirus infections due to non-primary maternal infection

Previously immune mother for CMV

Yes, for all

Fetal ultrasonography

Not reported

subependymal cysts

normal

normal

Amniocentesis

none

CMV PCR 8.96 log GEq/ml

none

none

Term at birth

30 weeks

At term

At term

At term

gender

male

female

female

male

Apgar

1/1/3

8/8/10

6/6/7

1/4/9

Clinic at birth

petechial rash, generalized edema, hepatosplenomegaly

Extensive petechiae, hepatosplenomegaly, jaundice

mild respiratory distress, hepatosplenomegaly, petechiae, facial dysmorphic features, axial hypotonia.

bradycardia, apnea, hypotonia, mild hypoxic ischemic encephalopathy

Seizures

yes

no

no

yes

Thrombocytopenia

yes

yes

yes

yes

Suspected early onset sepsis

yes

no

yes

yes

Echocardiography

cardiomegaly and left ventricular hypertrophy

Not reported

Not reported

severe cardiac failure with an ejection fraction of 33% and signs suggestive of cardiomyopathy

Cerebral MRI

day 52 of life: extensive areas of encephalomalacia supratentorial bilateral with reduction of the brain parenchyma, pronounced dilatation of the ventricular system, evidence of massive intraventricular hemorrhage.

day 5 of life: bilateral subependymal cysts, mild dilatation of both lateral ventricles, white matter hyperintensities

widened symmetrical ventricles, subependymal germinolytic cysts, periventricular pseudocysts and micro-bleeding sequelae against the anterior horn of the lateral ventricles and at the occipital horn of the right lateral ventricle.

bilateral ventricular hemorrhage, presence of ischemic-hemorrhagic spots in the frontal white matter, periventricular hyper echogenicity

Cerebral ultrasonography

brain edema, calcification bilaterally, hyperechogenic foci in both sides of the ventricular wall, asymmetric ventriculomegaly

Not reported

bilateral germinolytic cysts with pronounced symmetric periventricular flaring, striatal vasculopathy, moderate dilatation of the ventricles

bilateral intraventricular hemorrhage with mild ventricular dilatation (grade III)

Treatment

ganciclovir IV 6 weeks

ganciclovir IV 3 weeks, then oral valganciclovir 3 weeks

ganciclovir IV 3 day then oral valganciclovir for 6 months

ganciclovir IV for 2 weeks, then oral valganciclovir for a total of 6 months.

Follow up

Not reported

4.5 years of age: normal neurological development but severe hearing loss on the right side.

4 months of age: central motor disorder with axial hypotonia and poor head control, hearing loss on the right side.

9 months of age: normal developmental outcome