1. Proposed diagnostic and management algorithm for maternal and congenital CMV infection.
Proposed diagnostic and management algorithm for maternal and congenital CMV infection. The presence of high-avidity CMV IgG antibodies before 16 weeks of gestation excludes primary infection; however, nonprimary infection is still a possibility. Indications for prenatal testing in nonprimary infections are less clear, and decisions should be made on case-by-case basis when sonographic findings are suggestive of congenital infection. Baseline investigations for newborns with symptomatic congenital CMV infection should include complete blood count, liver function tests, CMV real-time PCR (blood and urine), audiometry, ophthalmology screen, and cranial US/CT/MRI. A low CMV DNA blood viral load in the first month of life can predict a normal development in asymptomatic newborns. Since the cutoff values for amniotic fluid viral load measurements were derived from a few studies and have not been validated with international standards, they may not be generalizable.
Sheetal Manicklal et al. Clin. Microbiol. Rev. 2013; doi: /CMR