Infezione congenita da Citomegalovirus: updates.

Congenital Cytomegalovirus (CMV) infection still represents a disease of great impact on individual and public health in the paediatric age. It has an estimated global prevalence of 0.64%, with the risk of developing permanent sequelae in 20% of patients. It is the leading cause of acquired sensorineural hearing loss and is frequently related to visual and neurodevelopmental impairments. In the majority of cases (85-90%) congenital CMV infection is asymptomatic at birth, with 10-15% of cases presenting symptoms mainly affecting the central nervous system. However, in asymptomatic cases, late onset manifestations are possible even years later, the most frequent one being sensorineural hearing loss. The European Congenital Cytomegalovirus Initiative has recently published a revision of the recommendations on management of congenital CMV infection4, introducing antiviral therapy in pregnancy as an important tool for prevention of vertical transmission. Serological analysis (CMV-IgG and IgM) should be performed as early as possible during pregnancy, in order to start antiviral therapy with valacyclovir in case of primary infection acquired during the first trimester. Moreover, it has been shown that the risk for long-term sequelae for newborns is higher when the infection is acquired during the first trimester of pregnancy, becoming close to zero in case of infection during the second and third trimesters. Pharmacological therapy with valganciclovir is now recommended not only for newborns with moderate to severe manifestations, but also for those presenting isolated sensorineural hearing loss. Treatment should be started within the first month of life. The importance of multidisciplinary follow up until school age is also underlined.