Congenital cytomegalovirus infection: current strategies and future perspective

INTRODUCTION: Cytomegalovirus is the most common cause of congenital infections in humans and it produces considerable morbidity in newborns. AIMS: The present study reviews current concepts on epidemiology, clinical manifestations, diagnosis, treatment, future strategies and prognosis of children with congenital cytomegalovirus infection. RESULTS: Congenital cytomegalovirus infection can be symptomatic or not at birth, but about 10-20% of them all will exhibit neurological damage when followed up. Sensorineural hearing loss is the most frequent long-term consequence and is not manifest invariably at birth or in the neonatal period but in many cases becomes clinically apparent in later childhood. There are growing evidences that newborns with symptomatic congenital cytomegalovirus infection would benefit from treatment with either ganciclovir or valganciclovir, the most widely studied drugs in this setting. It is not yet clear if children with asymptomatic or pauci-symptomatic infection at birth would benefit from treatment. DISCUSSION: Studies evaluating treatment and long-term follow-up of infants with both symptomatic and asymptomatic infection are necessary, in order to definitely evaluate the short and long-term effectiveness and safety of both ganciclovir and valganciclovir and to identify risk factors associated to the development of long-term sequelae. In this way it will be possible to select those children that might benefit for treatment.