Citomegalovírus congénito: atualização e propostas para a prática clínica
DOI:
https://doi.org/10.34631/sporl.3162Resumo
O CMV é a infeção congénita mais frequente em todo o mundo. A sua clínica é muito variável, desde assintomática a sequelas neurológicas graves, que podem estar presentes ao nascimento ou apresentar-se tardiamente ao longo da infância. Apesar da sua prevalência e do impacto negativo das sequelas que ocorrem em 10 a 20% dos casos, o subdiagnóstico do CMV congénito continua a ser uma realidade. A literacia em saúde sobre este tema tende a ser baixa, dificultando as hipóteses de prevenir a aquisição da infeção e de realizar diagnóstico pré e pós-natal. Isto resulta numa perda de oportunidade de tratamento atempado e seguimento especializado com potencial de minimizar o impacto negativo da infeção.
Este documento tem por objetivo simplificar as principais recomendações do atual consenso europeu, “Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European congenital infection initiative (ECCI)”, bem como complementar informação em áreas em que o documento original é menos esclarecedor (ex.: exames de audição), para tornar mais simples e informada a prática clínica diária de quem possa estar menos familiarizado com o CMV congénito.
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1. Leruez-Ville M, Chatzakis C, Lilleri D, Blazquez-Gamero D, Alarcon A, Bourgon N. et al. Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection. Lancet Reg Health Eur. 2024 Apr 1:40:100892. doi: 10.1016/j.lanepe.2024.100892.
2. Moutsopoulou RA, Markou A, Lianou A, Leontari K, Iliodromiti Z, Boutsikou T. et al Congenital cytomegalovirus infection: from silent threat to vaccine horizon. Vaccines (Basel). 2025 Aug 30;13(9):929. doi: 10.3390/vaccines13090929.
3. Pesch MH, Anderson C, Mowers E. Improving obstetric provider congenital cytomegalovirus knowledge and practices. Infect Dis Obstet Gynecol. 2020 Nov 8:2020:8875494. doi: 10.1155/2020/8875494
4. Castillo K, Hawkins-Villarreal A, Valdés-Bango M, Guirado L, Scazzocchio E, Porta O. et al. Congenital cytomegalovirus awareness and knowledge among health professionals and pregnant women: an action towards prevention. Fetal Diagn Ther. 2022;49(5-6):265-272. doi: 10.1159/000525528.
5. Monteiro S, Gonçalves A, Torrão MM, Costa V, Almeida A. Knowledge of cytomegalovirus and available prevention strategies in pregnancy: a cross-sectional study in Portugal. J Matern Fetal Neonatal Med. 2023 Dec;36(1):2183754. doi: 10.1080/14767058.2023.2183754.
6. Rodríguez-Muñoz MF, Martín-Martín C, Kovacheva K, Olivares ME, Izquierdo N, Pérez-Romero P. et al. Hygiene-based measures for the prevention of cytomegalovirus infection in pregnant women: a systematic review. BMC Pregnancy Childbirth. 2024 Feb 29;24(1):172. doi: 10.1186/s12884-024-06367-5.
7. Leruez-Ville M, Ville Y. Fetal cytomegalovirus infection. Best Pract Res Clin Obstet Gynaecol. 2017 Jan:38:97-107. doi: 10.1016/j.bpobgyn.2016.10.005.
8. Eventov-Friedman S, Manor H, Bar-Oz B, Averbuch D, Caplan O, Lifshitz A. et al. Saliva real-time polymerase chain reaction for targeted screening of congenital cytomegalovirus infection. J Infect Dis. 2019 Oct 22;220(11):1790-1796. doi: 10.1093/infdis/jiz373.
9. Fernandes C, Marques A, de Jesus Chasqueira M, Braz MC, Ferreira AR, Neto AS. et al. Saliva pools for screening of human cytomegalovirus using real-time PCR. Eur J Pediatr. 2021 Apr;180(4):1067-1072. doi: 10.1007/s00431-020-03842-x.
10. Almeida S, Gouveia P, Jorge A, Fortuna A, Binda S, Barbi M. et al. Diagnosing congenital cytomegalovirus infections using archived dried blood spots: a 15-year observational study, Portugal. J Clin Virol. 2023 Aug:165:105516. doi: 10.1016/j.jcv.2023.105516.
11. Paixão P, Almeida S, Gouveia P, Vilarinho L, Vaz Osório R. Prevalence of human cytomegalovirus congenital infection in Portuguese newborns. Euro Surveill. 2009 Mar 5;14(9):13-5. doi:10.2807/ese.14.09.19135-en.
12. Dollard S, Dreon M, Hernandez-Alvarado N, Amin M, Wong P, Lanzieri T. et al. Sensitivity of dried blood spot testing for detection of congenital cytomegalovirus infection. JAMA Pediatr. 2021 Mar 1;175(3):e205441. doi: 10.1001/jamapediatrics.2020.5441.
13. Penella A, Miller J, Rochat R, Demmler-Harrison G. Utility of dried blood spots for the diagnosis of congenital cytomegaloviruses within the first 21 days of life in a single center. Int J Neonatal Screen. 2023 Aug 4;9(3):44. doi: 10.3390/ijns9030044.
14. Chung PK, Schornagel F, Oudesluys-Murphy AM, de Vries LS, Soede W, van Zwet E. et al. Targeted screening for congenital cytomegalovirus infection: clinical, audiological and neuroimaging findings. Arch Dis Child Fetal Neonatal Ed. 2023 May;108(3):302-308. doi: 10.1136/archdischild-2022-324699.
15. Fowler KB, McCollister FP, Sabo DL, Shoup AG, Owen KE, Woodruff JL. et al. A targeted approach for congenital cytomegalovirus screening within newborn hearing screening. Pediatrics. 2017 Feb;139(2):e20162128. doi: 10.1542/peds.2016-2128.
16. Melamed R, Shemer-Avni Y, Shany E, Kurtzman L, Gorali R, Landau D. Targeted and universal screening in term and preterm infants for congenital CMV infection. Infect Dis (Lond). 2020 Oct;52(10):730-735. doi: 10.1080/23744235.2020.1779342.
17. Schleiss MR, Blázquez-Gamero D. Universal newborn screening for congenital cytomegalovirus infection. Lancet Child Adolesc Health. 2025 Jan;9(1):57-70. doi: 10.1016/S2352-4642(24)00237-2.
18. Manicklal S, Emery VC, Lazzarotto T, Boppana SB, Gupta RK. The “silent” global burden of congenital cytomegalovirus. Clin Microbiol Rev. 2013 Jan;26(1):86-102. doi: 10.1128/CMR.00062-12.
19. Chasqueira MJ, Fernandez C, Marques A, Rodrigues L, Marçal M, Tuna M. et al. Pooling saliva sample as an effective strategy for the systematic CMV screening of newborns—a multicentric prospective study. Pediatr Infect Dis J. 2023 Dec 1;42(12):1117-1120. doi: 10.1097/INF.0000000000004096
20. Swanson EC, Schleiss MR. Congenital cytomegalovirus infection: new prospects for prevention and therapy. Pediatr Clin North Am. 2013 Apr;60(2):335-49. doi: 10.1016/j.pcl.2012.12.008.
21. Rubinacci V, Shears A, Karagiannidou S, Blázquez-Gamero D. Update on congenital cytomegalovirus: antenatal and postnatal management. Pediatr Infect Dis J. 2025 Jun 30;44(9):e333-e337. doi: 10.1097/INF.0000000000004894.
22. Kimberlin DW, Jester PM, Sánchez PJ, Ahmed A, Arav-Boger R, Michaels MG. et al. Valganciclovir for symptomatic congenital cytomegalovirus disease. N Engl J Med. 2015 Mar 5;372(10):933-43. doi: 10.1056/NEJMoa1404599.
23. Kimberlin DW, Lin CY, Sánchez PJ, Demmler GJ, Dankner W, Shelton M. et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr. 2003 Jul;143(1):16-25. doi: 10.1016/s0022-3476(03)00192-6.
24. Demmler-Harrison GJ, Miller JA; Houston Congenital Cytomegalovirus Longitudinal Study Group. Maternal cytomegalovirus immune status and hearing loss outcomes in congenital cytomegalovirus-infected offspring. PLoS One. 2020 Oct 9;15(10):e0240172. doi: 10.1371/journal.pone.0240172.
25. Foulon I, De Brucker Y, Buyl R, Lichtert E, Verbruggen K, Piérard D. et al. Hearing loss with congenital cytomegalovirus infection. Pediatrics. 2019 Aug;144(2):e20183095. doi: 10.1542/peds.2018-3095
26. Lanzieri TM, Chung W, Flores M, Blum P, Caviness AC, Bialek SR. et al. Hearing loss in children with asymptomatic congenital cytomegalovirus infection. Pediatrics. 2017 Mar;139(3):e20162610. doi: 10.1542/peds.2016-2610.
27. Kettler M, Shoup A, Moats S, Steuerwald W, Jones S, Stiell SC. et al. American Academy of Audiology position statement on early identification of cytomegalovirus in newborns. J Am Acad Audiol. 2023 Mar;34(3-04):84-89. doi: 10.1055/s-0043-1768036.
28. Salomè S, Giannattasio A, Malesci R, Marciano E, Dolce P, Portella G. et al. The natural history of hearing disorders in asymptomatic congenital cytomegalovirus infection. Front Pediatr. 2020 May 5:8:217. doi: 10.3389/fped.2020.00217.
29. Pinninti S, Christy J, Almutairi A, Cochrane G, Fowler KB, Boppana S. Vestibular, gaze, and balance disorders in asymptomatic congenital cytomegalovirus infection. Pediatrics. 2021 Feb;147(2):e20193945. doi: 10.1542/peds.2019-3945.
30. Bernard S, Wiener-Vacher S, Van Den Abbeele T, Teissier N. Vestibular disorders in children with congenital cytomegalovirus infection. Pediatrics. 2015 Oct;136(4):e887-95. doi: 10.1542/peds.2015-0908.
31. Chebib E, Maudoux A, Benoit C, Bernard S, Van Den Abbeele T, Teissier N. et al. Audiovestibular consequences of congenital cytomegalovirus infection: greater vulnerability of the vestibular part of the inner ear. Ear Hear. 2022 Nov-Dec;43(6):1730-1739. doi: 10.1097/AUD.0000000000001240.
32. Bigelow RT, Agrawal Y. Vestibular involvement in cognition: visuospatial ability, attention, executive function, and memory. J Vestib Res. 2015;25(2):73-89. doi: 10.3233/VES-150544.
33. Dhondt C, Maes L, Van Acker E, Martens S, Vanaudenaerde S, Rombaut L. et al. Vestibular follow-up program for congenital cytomegalovirus based on 6 years of longitudinal data collection. Ear Hear. 2023 Nov-Dec;44(6):1354-1366. doi: 10.1097/AUD.0000000000001377
34. Loos E, Gerdsen M, Hazen M, Cushing SL, Gordon KA, Perez-Fornos A. et al. Bilateral vestibular hypofunction in children. Int J Pediatr Otorhinolaryngol. 2025 Sep:196:112506. doi: 10.1016/j.ijporl.2025.112506.
35. Gerdsen M, Hundscheid TM, Boudewyns A, Van Rompaey V, Van De Berg R, Widdershoven JCC. Vestibular assessment in children with sensorineural hearing loss: diagnostic accuracy and proposal for a diagnostic algorithm. Front Neurol. 2024 Feb 1:15:1349554. doi: 10.3389/fneur.2024.1349554.
36. Bartlett AW, McMullan B, Rawlinson WD, Palasanthiran P. Hearing and neurodevelopmental outcomes for children with asymptomatic congenital cytomegalovirus infection: a systematic review. Rev Med Virol. 2017 Sep 6. doi: 10.1002/rmv.1938.
37. Novelli M, Natale F, Di Norcia A, Boiani A, Temofonte S, Calandriello F. et al. Early neurodevelopmental outcomes in children with asymptomatic congenital CMV infection. Ital J Pediatr. 2022 Dec 26;48(1):203. doi: 10.1186/s13052-022-01387-3.
38. Preterm follow-up guideline development group. Guideline for Growth, Health and Developmental Follow-Up for Children Born Very Preterm. Melbourne: Centre of Research Excellence in Newborn Medicine; 2024. Available from: https://www.crenewbornmedicine.org.au/media/0aabcrcx/25062024_preterm_followup_guideline.pdf
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Direitos de Autor (c) 2026 Ana Jardim, Constança Oom, Inês Moreira, Luisa Monteiro, Margarida Madail, Madalena Tuna, Inês Tovim, Maria Inês Linhares, Teresa Castelo, Carla Marques, Rita Valsassina, Maria Luísa Martins, Paulo Paixão, Sara Letras

Este trabalho encontra-se publicado com a Licença Internacional Creative Commons Atribuição-CompartilhaIgual 4.0.



