To the content
4 . 2018

Cytomegalovirus enterocolitis in newborns and infants

Abstract

Background. Intestinal CMV infection in infants can be associated with watery diarrhea or neonatal necrotizing enterocolitis (NEC).

Case presentations. Two term infants have had severe watery diarrhea and bloody stool. One of them had NEC additionally. Patients were treated with Ganciclovir, specific intravenous immunoglobulin and completely recovered. In the last case, we considered about CMV and gut malformation as a concomitant disease.

Conclusions. Primary CMV infection occurs accompanied with severe complications. Emergency treatment with Ganciclovir should be considered as a first choice treatment in severe cases.

Keywords: cytomegalovirus, enterocolitis, newborn, infant

Neonatology: News, Opinions, Training. 2018; 6 (4): 70-85. doi: 10.24411/2308-2402-2018-14008

References

1. Colugnati F.A., et al. Incidence of cytomegalovirus infection among the general population and pregnant women in the United States. BMC Infect. Dis. 2007; 7: 71.

2. Staras S.A., et al. Seroprevalence of cytomegalovirus infection in the United States, 1988-1994. Clin Infect Dis. 2006; 43: 1143-51.

3. Remington J.S., Klein J.O. (eds). Infectious Diseases of the Fetus and Newborn Infant. Elsevier, 2011; Ch. 23. Cytomegalovirus (Britt W.): 708-75.

4. Marsico C., Kimberlin D.W. Congenital Cytomegalovirus infection: advances and challenges in diagnosis, prevention and treatment. Ital J Pediatr. 2017; 43 (1): 38. doi: 10.1186/s13052-017-0358-8.

5. Becroft D.M.O. Prenatal cytomegalovirus infection: epidemiology, pathology, pathogenesis. In: H.S. Rosenberg, J. Bernstein (eds). Perspective in Pediatric Pathology. New York: Masson, 1981: 203-41.

6. Rawlinson W.D., Boppana S.B., Fowler K.B., Kimberlin D.W., et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis. 2017; 17 (6): e177-88. doi: 10.1016/S1473-3099(17)30143-3.

7. Gonce A., Marcos M.A., Borrell A., Lopez M., et al. Maternal IgM antibody status in confirmed fetal cytomegalovirus infection detected by sonographic signs. Prenat Diagn. 2012; 32 (9): 817-21. doi: 10.1002/pd.3907.

8. Sue P.K., Salazar-Austin N.M., McDonald O.G., Rishi A., et al. Cytomegalovirus enterocolitis in immunocompetent young children: a report of two cases and review of the literature. Pediatr Infect Dis J. 2016; 35 (5): 573-6.

9. Abdulhannan P., Sugarman I.D., Wood P., Puntis J.W. Primary CMV Colitis in an immunocompetent infant, successfully treated by gancyclovir. J Pediatr Gastroenterol Nutr. 2008; 47 (2): 203-5.

10. Bonnard A., Le Huidoux P., Carricaburu E., et al. Cytomegalovirus infection as a possible underlying factor in neonatal surgical conditions. J Pediatr Surg. 2006; 41: 1826-9.

11. Irizarry K., Honigbaum S., Demmler-Harrison G., Rippel S., et al. Successful treatment with oral valganciclovir of primary CMV enterocolitis in a congenitally infected infant. Fetal Pediatr Pathol. 2011; 30: 437-41.

12. Bar-Meir M., Farrow K.N., Melin-Aldana H., Chadwick E.G. Cytomegalovirus enterocolitis mimicking necrotizing enterocolitis: case reports and review of the literature. J Pediatr Infect Dis Soc. 2013; 2 (1): 71-5.

13. Tran L., Ferris M., Norori J., Stark M., et al. Necrotizing enterocolitis and cytomegalovirus infection in a premature infant. Pediatrics. 2013; 131 (1): e318-22.

14. Lee S.L., Johnsen H., Applebaum H. Cytomegalovirus enterocolitis presenting as abdominal compartment syndrome in a premature neonate. World J Pediatr. 2012; 8 (1): 80-2.

15. Yeung F., Chung P.H.Y., Wong K.K.Y., Tam P.K.H. Cytomegalovirus-associated colitis mimicking necrotizing enterocolitis - a near miss diagnosis of neonatal colonic stricture. J Pediatr Surg Case Rep. 2014; 2 (10): 459-61.

16. Jonkhoff-Slok T.W., Veenhoven R.H., de Graeff-Meeder E.R., Buller H.A. An immunocompetent infant with cow's milk allergy and cytomegalovirus colitis. Eur J Pediatr. 1997; 156: 528-9.

17. Rongkavilit C., Bedard M.P., Ang J.Y., Asmar B.I., et al. Severe cytomegalovirus enterocolitis in an immunocompetent infant. Pediatr Infect Dis J. 2004; 23: 579-81.

18. Iwanaga M., et al. Protein-losing gastroenteropathy and retinitis associated with cytomegalovirus infection in an immunocompetent infant: a case report. Eur J Pediatr. 2004; 163 (2): 81-4.

19. Shetty A., Barnes R., Lazda E., Doherty C., et al. Cytomegalovirus: a cause of colonic stricture in a premature infant. J Infect. 2007; 54: e37-9.

20. Gaytant M.A., Rours G.I., Steegers E.A., Galama J.M., et al. Congenital cytomegalovirus infection after recurrent infection: case reports and review of the literature. Eur J Pediatr. 2003; 162 (4): 248-53.

21. Gessler P., Bischoff G.A., Wiegand D., Essers B., et al. Cytomegalovirus-associated necrotizing enterocolitis in a preterm twin after breastfeeding. J Perinatol. 2004; 24: 124-6.

22. Stiskal J., Jacquette M., Kaplan G., Ritterman R., et al. Congenital cytomegalovirus infection with gastrointestinal involvement. J Pediatr. 1997; 131 (1): 168.

23. Srinivasjois R.M., Kava M.P., Thomas A., Rao S.C. Cytomegalovirus-associated ileal stricture in a preterm neonate. J Paediatr Child Health. 2008; 44 (1-2): 80-2.

24. Tengsupakul S., Birge N.D., Bendel C.M., et al. Asymptomatic DNAemia heralds CMV-associated NEC: case report, review, and rationale for preemption. Pediatrics. 2013; 132 (5): e1428-34.

25. Tzialla C., Decembrino L., Di Comite A., Bollani L., et al. Colonic stricture and retinitis due to cytomegalovirus infection in an immunocompetent infant. Pediatr Int. 2010; 52 (4): 659-60.

26. Cheong J.L.Y., Cowan F.M., Modi N. Gastrointestinal manifestations of postnatal cytomegalovirus infection in infants admitted to a neonatal intensive care unit over a five year period. Arch Dis Child Fetal Neonatal Ed. 2004; 89: F367-9.

27. Berardi A., Spaggiari E., Cattelani C., Roversi M.F., et al. Persistent intestinal bleeding due to severe CMV-related thrombocytopenia in a preterm newborn. J Matern Fetal Neonatal Med. 2018; 31 (9): 1246-9. doi: 10.1080/14767058.2017.1312331.

28. Aksu A.U., Sari S., Karabulut R., Ekinci O., et al. Jejunal stricture in a premature infant: is cytomegalovirus the causative pathogen or a superinfection? Turk J Gastroenterol. 2013; 24 (3): 273-6.

29. Terry N.E., Fowler C.L. Cytomegalovirus enterocolitis complicated by perforated appendicitis in a premature infant. J Pediatr Surg. 2006; 41 (8): 1476-8.

30. Reyes C., Pereira S., Warden M.J., Sills J. Cytomegalovirus enteritis in a premature infant. J Pediatr Surg. 1997; 32 (11): 1545-7.

31. Goelz R., Hamprecht K., Klingel K., Poets C.F. Intestinal manifestations of postnatal and congenital cytomegalovirus infection in term and preterm infants. J Clin Virol. 2016; 83: 29-36. doi: 10.1016/j.jcv.2016.08.289.

32. 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 (1): 27-32.

33. Fischer C., Meylan P., Bickle Graz M., et al. Severe postnatally acquired cytomegalovirus infection presenting with colitis, pneumonitis and sepsis-like syndrome in an extremely low birth weight infant. Neonatology. 2010; 97 (4): 339-45.

34. Huang Y.C., Lin T.Y., Huang C.S., Hseun C. Ileal perforation caused by congenital or perinatal cytomegalovirus infection. J Pediatr. 1996; 129 (6): 931-4.

35. Novakova V., Hamprecht K., Muller A.M., Arellano-Galindo J., et al. Severe postnatal CMV colitis with an extensive colonic stenosis in a 2-month-old male immunocompetent term infant infected via breast milk. J Clin Virol. 2014; 59 (4): 259-63.

36. Ekema G., Pedersini P., Milianti S., Ubertazzi M., et al Colonic stricture mimicking Hirschsprung's disease: a localized cytomegalovirus infection. J Pediatr Surg. 2006; 41 (4): 850-2.

37. Gupta A.K., Maria A., Goyal D., Verma A. Intractable diarrhoea caused by cytomegalovirus enterocolitis in an immunocompetent term neonate. J Trop Pediatr. 2013; 59 (6): 509-1.

38. Fox L.M., Gerber M.A., Penix L., Ricci A. Jr, et al. Intractable diarrhea from cytomegalovirus enterocolitis in an immunocompetent infant. Pediatrics. 1999; 103 (1): E10.

39. Hinds R., Brueton M.J., Francis N., Fell J.M. Another cause of bloody diarrhoea in infancy: cytomegalovirus colitis in an immunocompetent child. J Paediatr Child Health. 2004; 40 (9-10): 581-2.

40. Quiros-Tejeira R.E., Ament M.E., Rivera-Penera T., Cortina G., et al Cytomegalovirus enterocolitis in an immunocompetent infant host: another cause of treatable intractable diarrhea in infancy. J Pediatr Gastroenterol Nutr. 1999; 29 (1): 86-90.

41. Nigro G., Pietrobattista A., Divito S., Gambarara M. Oral ganciclovir therapy for immunocompetent infants with cytomegalovirus-associated hemorrhagic or intractable enterocolitis. J Pediatr Gastroenterol Nutr. 2010; 50: 111-3.

42. Ramos Boluda E., Molina Arias M., Sarria Osses J., Larrauri Martinez J., et al. Cytomegalovirus infection causing protracted diarrhea in an immunocompetent child. An Pediatr (Barc). 2009; 70 (6): 582-5. doi: 10.1016/j.anpedi.2009.01.013.

43. Rogalidou M., Roma E., Kouroumalis E., Michailidou E., et al. Allergic colitis in an infant with perinatal cytomegalovirus infection. Ann Gastroenterol. 2010; 23 (2): 139-41.

44. Louazon T., Collardeau S., Lachaux A. Cytomegalovirus colitis in an immunocompetent child. Arch. Pediatr. 2014; 21 (9): 1016-9. doi: 10.1016/j.arcped.2014.05.018.

45. Refai Z., Nicholls S., Garg A. Infant death due to CMV enterocolitis. BMJ Case Rep. 2012. doi: 10.1136/bcr.11.2011.5080.

46. Hakim A., Mimouni F., Payandeh F., Morawski J. Immunochemical staining in congenital cytomegalovirus-induced ileal ulceration. J Pediatr. 1997; 131 (1): 168-70.

47. Torregrossa A., Reinberg O., Alamo L., Sarro R., et al. Surgical complications due to postnatal cytomegalovirus infection in a preterm infant with malrotation. Pediatr Int. 2015; 57 (5): 993-5. doi: 10.1111/ped.12675.

48. Colomba C., Giuffre M., La Placa S., Cascio A., et al. Congenital cytomegalovirus related intestinal malrotation: a case report. Ital J Pediatr. 2016; 42: 105. doi: 10.1186/s13052-016-0318-8.

49. Dimmick J.E., Bove K.E. Cytomegalovirus infection of the bowel in infancy: pathogenetic and diagnostic significance. Pediatr Pathol. 1984; 2: 95-102.

50. Kosloske J.M., Jewell P.F., Florman A.L., et al. Acute abdominal emergencies associated with cytomegalovirus infection in the young infant. Pediatr Surg Int. 1988; 3: 43-6.

51. Lopes A., Belhabri S., Karaoui L. Clinical findings and autopsy of a preterm infant with breast milk-acquired cytomegalovirus infection. AJP Rep. 2016; 6 (2): e198-202. doi: 10.1055/s-0035-1566249.

52. Dworsky M., Stagno S., Pass R.F., Cassady G., et al. Persistence of cytomegalovirus in human milk after storage. J Pediatr. 1982; 101: 440-3.

53. Hamprecht K., Maschmann J., Muller D., et al. Cytomegalovirus (CMV) inactivation in breast milk: Reassessment of pasteurization and freeze-thawing. Pediatr Res. 2004; 56: 529-35.

54. Bapistella S., Hamprecht K., Thomas W., Speer C., et al. Efficacy and feasibility of CMV short time inactivation of breast milk in neonatal intensive care units. Monatsschr Kinderheilkd. 2015; 163 (1): 16.

55. 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 (1): 27-32.

56. Lopes A.A., Champion V., Mitanchez D. Nutrition of preterm infants and raw breast milk-acquired cytomegalovirus infection: French National Audit of Clinical Practices and Diagnostic Approach. Nutrients. 2018; 10 (8). pii: E1119. doi: 10.3390/nu10081119.

57. Eidelman A.I., Schanler R.J., Johnston M., Landers S., et al.; American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics. 2012; 129: e827-41.

58. Clinical recommendations (project) on the diagnosis, treatment and prevention of congenital cytomegalovirus infection. RASPM, 2016. (in Russian)

59. Clinical recommendations (treatment protocol) for the provision of medical care to children with cytomegalovirus infection. FGBU NIIDI FMBA of Russia, Public organization "Euro-Asian Society for Infectious Diseases", Public Association "Association of Physicians of Infectious Persons of St. Petersburg and leningrad Region", 2015. (in Russian)

All articles in our journal are distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0 license)

CHIEF EDITOR
CHIEF EDITOR
Degtyarev Dmitriy Nikolaevich
Doctor of Medical Sciences, Professor, Deputy Director for Scientific Research of the V.I. Kulakov Obstetrics, Gynecology and Perinatology National Medical Research Center of Ministry of Healthсаre of the Russian Federation, Head of the Chair of Neonatology at the Clinical Institute of Children's Health named after N.F. Filatov, I.M. Sechenov First Moscow State Medical University, Chairman of the Ethics Committee of the Russian Society of Neonatologists, Moscow, Russian Federation

ORCID iD 0000-0001-8975-2425

Journals of «GEOTAR-Media»