Secondary cytomegalovirus infections: How much do we still not know? Comparison of children with symptomatic congenital cytomegalovirus born to mothers with primary and secondary infection

Fabiola Scaramuzzino; Michela Di Pastena; Sara Chiurchiu; Lorenza Romani; Maia De Luca; Giulia Lucignani; Donato Amodio; Annalisa Seccia; Pasquale Marsella; Teresa Grimaldi Capitello; Daniela Longo; Paolo Palma; Laura Lancella; Stefania Bernardi; Paolo Rossi; Francesca Ippolita Calo Carducci

doi:10.3389/fped.2022.885926

Secondary cytomegalovirus infections: How much do we still not know? Comparison of children with symptomatic congenital cytomegalovirus born to mothers with primary and secondary infection

Front Pediatr. 2022 Jul 19:10:885926. doi: 10.3389/fped.2022.885926. eCollection 2022.

Authors

Fabiola Scaramuzzino¹, Michela Di Pastena², Sara Chiurchiu³, Lorenza Romani³, Maia De Luca³, Giulia Lucignani⁴, Donato Amodio^{5

6}, Annalisa Seccia⁷, Pasquale Marsella⁷, Teresa Grimaldi Capitello², Daniela Longo⁴, Paolo Palma^{5

6}, Laura Lancella³, Stefania Bernardi³, Paolo Rossi^{1

6}, Francesca Ippolita Calo Carducci³

Affiliations

¹ Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
² Clinical Psychology Unit, Department of Neuroscience, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
³ Immunological and Infectious Disease Unit, Academic Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁴ Neuroradiology Unit, Imaging Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁵ Clinical Immunology and Vaccinology Unit, Academic Department of Paediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.
⁶ Chair of Pediatrics, Department of Systems Medicine, University of Rome "Tor Vergata", Rome, Italy.
⁷ Audiology and Otosurgery Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy.

Abstract

Congenital cytomegalovirus (cCMV) infection can follow primary and secondary maternal infection. Growing evidence indicate that secondary maternal infections contribute to a much greater proportion of symptomatic cCMV than was previously thought. We performed a monocentric retrospective study of babies with cCMV evaluated from August 2004 to February 2021; we compared data of symptomatic children born to mothers with primary or secondary infection, both at birth and during follow up. Among the 145 babies with available data about maternal infection, 53 were classified as having symptomatic cCMV and were included in the study: 40 babies were born to mothers with primary infection and 13 babies were born to mothers with secondary infection. Analyzing data at birth, we found no statistical differences in the rate of clinical findings in the two groups, except for unilateral sensorineural hearing loss (SNHL) which was significantly more frequent in patients born to mother with secondary infection than in those born to mother with primary infection (46.2 vs. 17.5%, P = 0.037). During follow up, we found a higher rate of many sequelae (tetraparesis, epilepsy, motor and speech delay, and unilateral SNHL) in the group of children born to mothers with secondary infection, with a statistical difference for tetraparesis and unilateral SNHL. Otherwise, only children born to mothers with primary infection presented bilateral SNHL both at birth and follow up. Our data suggest that the risk of symptomatic cCMV and long-term sequelae is similar in children born to mother with primary and secondary CMV infection; it is important to pay appropriate attention to seropositive mothers in order to prevent reinfection and to detect and possibly treat infected babies.

Keywords: CMV; congenital cytomegalovirus infection; pregnancy; secondary infection; sequelae; symptoms.