Öz
GİRİŞ: Prematürelerde postnatal CMV (sitomegalovirüs) enfeksiyonu en sık enfekte anne sütü alımı ile
kazanılmaktadır. Diğer bulaş yolları perinatal dönemde genital sekresyonlar ve kan transfüzyonudur.
Tanı postnatal 3. haftadan sonra idrar, kan ve sekresyonlarda PCR ya da kültür ile virüsün izole
edilmesine dayanmaktadır. Term olgularda enfeksiyon çoğunlukla asemptomatiktir. Prematürelerde
CMV ilişkili klinik bulgu ve sepsise neden olabilir. Prematüre olgularda CMV ilişkili sepsis az sayıda
bildirilmiştir.
OLGU SUNUMU: Olgularımızın her ikisi de 1000 gr altında prematüre idi. C/S ile doğmuşlardı.
Premature formulası ile beslenmişler, lökosit filtresi kullanılarak çoklu eritrosit süspansiyonu
transfüzyonu almışlardı. İzlemlerinin 2. ayında birinci olguda beslenme intoleransı ve splenomegali,
ikinci olguda oksijen ihtiyacında artma ve invaziv ventilasyon ihtiyacı gelişti. Laboratuvar bulgularında
her iki olguda karaciğer fonksiyon testlerinde yükselme, kolestaz, trombositopeni ve akut faz yüksekliği
saptandı. Kan CMV IgM ve CMV DNA PCR pozitif bulundu. Gansiklovir başlandı. Birinci olgunun 2,
ikinci olgunun altı hafta sonunda klinik ve laboratuvar bulguları düzeldi. İzlemlerinde nörolojik sekel
ya da işitme kaybı gelişmedi.
TARTIŞMA: Prematürelerde, 3. haftadan sonra gelişen sepsis nedeni olarak postnatal CMV
enfeksiyonu akılda tutulmalıdır.
ABSTRACT
INTRODUCTION: Postnatal CMV (cytomegalovirus) infection in the premature infants is most often
transmitted with infected breast milk. The other routes of transmission are blood transfusion and genital
secretions. Diagnosis is made by PCR or viral culture of urine, blood, or other body secretions after the
first 3 weeks of life. It is mostly asymptomatic in term infants. CMV infection may cause sepsis and
many clinical signs in premature infants. There are a few reports of premature infants with CMV sepsis
in the literature.
CASE REPORTS: Both of our cases were premature infants weighing less than 1000 g and born with
ceaserean section. Since both of the mothers did not have breast milk, infants were fed with premature
formula. They were transfused with erythrocyte suspension more than once. The first case has developed
feeding intolerance and splenomegaly, the second case had increased oxygen demand and invasive
mechanical ventilation support at the end of the second month of life. Laboratory findings showed
cholestasis, thrombocytopenia, elevated transaminases and acute phase reactants. Blood CMV IgM and
CMV DNA PCR were positive in both cases. Ganciclovir treatment was started. The first case had
improvement in clinical and laboratory findings in 2 weeks, the second case had improvement in 6th
week of the treatment. None of the patiens developed neurological sequelae or hearing loss.
CONCLUSİON: We aimed to remind that postnatal CMV infection should be suspected in preterm
infants who developed sepsis later than fist 3 weeks of life.
Anahtar Kelimeler
Kaynakça
- 1. Stagno S, Britt B. Cytomegalovirus. İn: Remington JS, Klein JO, Wilson CB, Baker CJ. İnfectious Disease of the Fetus and Newborn İnfant. Elsevier Saunders: Philadelphia, 2006, pp740-81.
- 2. Lanzieri TM, Dollard SC, Josephson CD, Schmid DS, Bialek SR. Breast milk -acquired cytomegalovirus infection and disease in VLBW and premature infants. Pediatrics 2013;133:1937-45.
- 3. Smith D, Lu Q, Yuan S, Goldfinger D, Fernando LP, Ziman A. Survey of current practice for prevention of transfusion-transmitted cytomegalovirus in the United States: leucoreduction vs. cytomegalovirus-seronegative. Vox Sang. 2010; 98 :29-36.
- 4. Vallejo JG, Englund JA, Garcia-Prats JA, Demmler GJ. Ganciclovir treatment of steroidassociated cytomegalovirus disease in a congenitally infected neonate. Pediatr Infect Dis J. 1994;13: 239-41.
- 5. Johnston M, Landers S, Noblşe L, Szucs K, Viehmann L. Breastfeeding and the use of human milk. Pediatrics. 2012;129: 827-41.
- 6. Dworsky M, Stagno S, Pass RF, Cassady G, Alford C Persistence of cytomegalovirus in human milk after storage. J Pediatr. 1982; 101:440-3.
- 7. Friis H, Andersen HK. Rate of inactivation of cytomegalovirus in raw banked milk during storage at -20 degrees C and pasteurisation. Br Med J (Clin Res Ed).1982;285:1604-5.
- 8. Luchtman-Jones L, Schwartz AL,Wilson DB. The blood and the hematopoietic system. In:Martin RJ, Fanaroff AA, Walsch WC(eds). Fanaroff and Martin’s Neonatal Perinatal Medicine Diseases of the Fetus and Infant. 8th ed.Vol 2. Philadelphia: Mosby Elsevier, 2006,pp 1287-1356.
- 9. Maschmann J, Hamprecht K, Dietz K, Jahn G, Speer CP. Cytomegalovirus infection of extremely low-birth weight infants via breast milk. Clin Infect Dis 2001;33: 1998-2003.
- 10. Mussi-Pinhata MM, Yamamoto AY, do Carmo Rego MA, Pinto PC, da Motta MS, Calixto C. Perinatal or early-postnatal cytomegalovirus infection in preterm infants under 34 weeks gestation born to CMV-seropositive mothers within a high-seroprevalence population. J Pediatr 2004;145:685-8.
- 11. Hamprecht K, Maschmann J, Vochem M, Dietz K, Speer CP, Jahn G. Epidemiology of transmission of cytomegalovirus from mother to preterm infant by breastfeeding. Lancet. 2001;357:513-8.
- 12. Jim WT, Shu CH, Chiu NC, Chang JH, Hung HY, Peng CC et. al. High cytomegalovirus load and prolonged virus excretion in breast milk increase risk for viral acquisition by very low birth weight infants. Pediatr Infect Dis J. 2009; 28: 891-4.
- 13. Alan S, Okulu E, Karbuz A, Kahvecioğlu D, Kılıç A, Atasay B et.al. Aşırı Düşük Doğum Ağırlıklı Bebekte Kazanılmış Sitomegalovirüs Enfeksiyonu. Güncel Pediatri. 2013; 11.
- 14. Mehler K, Oberthuer A, Lang-Roth R, Kribs A. High rate of symptomatic cytomegalovirus infection in extremely low gestational age preterm infants of 22-24 weeks' gestation after transmission via breast milk. Neonatology. 2014;105: 27-32.
- 15. Tran L, Ferris M, Norori J, Stark M, Craver R, Dowd S, Penn D. Necrotizing enterocolitis and cytomegalovirus infection in a premature infant. Pediatrics. 2013;131: 318-22.
- 16. Unlüsoy Aksu A, Sarı S, Karabulut R, Ekinci O, Dalgıç B. Jejunal stricture in a premature infant: Is cytomegalovirus the causative pathogen or a superinfection? Turk J Gastroenterol. 2013; 24: 273-6.
- 17. Mark R. Schleiss and Janna C. Patterson. Viral ınfections of the fetus and newborn and human immunodeficiency virus infection during pregnancy. In: Chrıstıne AG, Sherin U. Devaskar. Eds. Avery's dıseases of the newborn, 2011, pp 468-512.
- 18. Nijman J, Gunkel J, de Vries LS, van Kooij BJ, van Haastert IC, Benders MJ et.al. Reduced occipital fractional anisotropy on cerebral diffusion tensor imaging in preterm infants with postnatally acquired cytomegalovirus infection. Neonatology. 2013;104:143-50.
- 19. Goelz R, Meisner C, Bevot A, Hamprecht K, Kraegeloh-Mann I, Poets CF. Long-term cognitive and neurological outcome of preterm infants with postnatally acquired CMV infection through breast milk. Arch Dis Child Fetal Neonatal Ed. 201; 98:430-3.
- 20. Nijman J, van Zanten BG, de Waard AK, Koopman-Esseboom C, de Vries LS, VerboonMaciolek MA. Hearing in preterm infants with postnatally acquired cytomegalovirus infection. Pediatr Infect Dis J. 2012;1: 1082-4. 21. Wakabayashi H, Mizuno K, Kohda C, Negoro T, Maekawa C, Sawato S et.al. Low HCMV DNA copies can establish infection and result in significant symptoms in extremely preterm infants: a prospective study. Am J Perinatol 2012; 29:377-82.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Bölüm | Olgu |
| Yazarlar | |
| Yayımlanma Tarihi | 1 Nisan 2018 |
| Yayımlandığı Sayı | Yıl 2018 Cilt: 16 Sayı: 1 |