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Chapter 12: Intrauterine Infections Affecting the Brain

Gustavo Malinger; Andrés Malinger; Igal Wolman; Karina Krajden-Haratz

KEY POINTS

KEY POINTS

  • Depending on geographic factors, cytomegalovirus (CMV) and toxoplasmosis are the more frequent intrauterine infections.

  • 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, hemorrhages).

  • Regardless the etiology, the prognosis is usually poor in the presence of intracranial findings.

  • CMV infected fetuses without brain findings are generally asymptomatic at birth but may develop sensorineural deafness.

  • In patients at risk, search systematically for signs of infection. Check the placenta, liver, intestines, and brain (ventriculomegaly, abnormal periventricular white matter, cysts, etc).

  • In low-risk patients, these signs may be the only clue for prenatal diagnosis.

DIAGNOSTIC APPROACH

The fetus may become infected with a variety of microrganisms through transplacental passage or as a result of ascending infection. In some patients, the infection may involve the central nervous system (CNS), causing lesions in different areas and of different grades of severity (Table 12–1).

Table 12–1.US CNS FINDINGS FOLLOWING INTRAUTERINE INFECTIONS
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Table 12–1. US CNS 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
Zika virus Common Fetus, Infant Common Common Common Common CC, cerebellum
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

CC, corpus callosum; MCD, malformations of cortical development; PVWM, periventricular white matter, including cysts.

Cytomegalovirus (CMV) and Toxoplasma gondii are the most common pathogens affecting the brain. Other less common pathogens include, rubella virus,1 varicella-zoster virus,2 herpes simplex virus,3,4 parvovirus B19,5,6 Zika virus,7–9 Treponema pallidum,10 lymphocytic choriomeningitis virus,11 West Nile virus (WNV),12 Trypanosoma cruzi,13 and the nematode filaria.14

CYTOMEGALOVIRUS

Definition

CMV is a large DNA virus with a wide infectious clinical spectrum ranging from subclinical to severe multisystem involvement; it is transmitted by direct contact with body fluids (saliva, tears, urine, blood, semen, and breast milk). Following maternal infection, CMV may cross the placenta and affect the fetus.

Synonyms

Herpesvirus 5, cytomegalic inclusion disease

Incidence/Prevalence

Following the almost complete ...

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