Depending on geographic factors, cytomegalovirus (CMV) and toxoplasmosis are the more frequent intrauterine infections (IUIs).
The pattern of brain involvement in CMV-IUI may range from minimal (small periventricular cysts, intrathalamic vasculopathy) to severe damage (brain atrophy, malformations of cortical development, and hemorrhages).
The prognosis is usually poor in the presence of intracranial findings.
Infected fetuses without brain findings are generally asymptomatic at birth but may develop sensorineural deafness.
The fetus may become infected with a variety of organisms through transplacental passage or as a result of an ascending infection. In some patients, the infection may involve the central nervous system (CNS), causing lesions in different areas and grades of severity (Table 9–1).
TABLE 9–1.ULTRASOUND CENTRAL NERVOUS SYSTEM FINDINGS FOLLOWING INTRAUTERINE INFECTIONS |Favorite Table|Download (.pdf) TABLE 9–1. ULTRASOUND CENTRAL NERVOUS SYSTEM FINDINGS FOLLOWING INTRAUTERINE INFECTIONS
|Pathogen ||CNS involvement ||Reported in ||Ventriculomegaly ||Abnormal PVWM ||Calcifications ||Microcephaly ||Others |
|CMV ||Common ||Fetus, infant ||Common ||Common ||Frequent ||Frequent ||MCD, CC, cerebellum, hemorrhage |
|Toxoplasma ||Common ||Fetus, infant ||Common ||Rare ||Common ||Rare ||Hydranencephaly |
|Rubella ||Common ||Infant ||Rare ||Common ||Common ||Common ||– |
|Varicella zoster ||Extremely rare ||Fetus, infant ||Rare ||– ||Rare ||Rare ||Encephalitis, cerebellum, MCD |
|Herpes simplex ||Extremely rare ||Fetus, infant ||Common ||Common ||Rare ||Rare ||Encephalitis |
|Parvovirus B19 ||Extremely rare ||Fetus, infant ||Rare ||– ||– ||– ||Hemorrhage, stroke, MCD |
|LCMV ||Common ||Fetus, infant ||Common ||Rare ||Common ||– ||– |
|West Nile virus ||Extremely rare ||Fetus, infant ||– ||Rare ||– ||– ||Meningitis, encephalitis |
|Syphilis ||Extremely rare ||Fetus, infant ||Rare ||Rare ||– ||Rare ||MCD |
|Trypanosoma ||Extremely rare ||Fetus, infant ||– ||– ||– ||– ||Meningoencephalitis |
Cytomegalovirus (CMV) and Toxoplasma gondii are the most common pathogens affecting the brain. Other organisms that may infect the developing fetal brain are rubella virus,1 varicella zoster virus,2 herpes simplex virus,3,4 parvovirus B19,5,6 lymphocytic choriomeningitis virus,7 West Nile virus,8 Treponema pallidum,9 Trypanosoma cruzi,10 and the nematode filarial.11 This chapter reviews each of these sources of infection.
Cytomegalovirus (CMV) is a large DNA virus with a wide infectious clinical spectrum ranging from subclinical to severe multisystem involvement. CMV is transmitted by person-to-person contact. Following maternal infection, it may be transmitted through the placenta to the fetus.
Herpesvirus 5, cytomegalic inclusion disease
Following the almost complete disappearance of congenital rubella after the introduction of widespread immunization programs, CMV infection has become the most common infection affecting the developing fetus.
The prevalence of CMV-seropositive pregnant women or at reproductive age ranges from > 99% in Turkey12 to between 43.6% and 57.2% in France13...