Virus cmv dan rubella

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Growth restriction may imply a pathological restriction of the genetic growth potential 1 and intrauterine growth restriction IUGR is a major cause of perinatal morbidity and mortality. Placental, maternal, environmental, and fetal factors contribute to IUGR and infection is one of the common etiologies. IgM level detection was one of the earlier methods for screening and remains a commonly used test.

With low incidence of TORCH in the general population, screening is likely to be of low utility and high expense. As de Jong et al. The study was conducted in the Department of Pediatrics, Bucheon St. Mary's Hospital in Bucheon, Korea. The present study protocol was reviewed and approved by the Institutional Review Board of Bucheon St. A retrospective review of medical charts was completed for all IUGR or SGA neonates born at the institution's neonatal unit, or transferred there within one month of birth, from January to December IUGR in this study refers to fetus with estimated weight less than 10 percentile.

SGA is defined as birth weight below the 10th percentile for gestational age. Clinical information collected included: gestational age, birth weight, delivery mode, 1- and 5-minute Apgar scores, and whether the infant was a singleton or twin. Maternal factors associated with IUGR considered in analyses included diseases such as preeclampsia, gestational diabetes mellitus, systemic lupus erythematosus, and renal disorder.

Fetal sonography was performed by an obstetrician to measure fetal heart rhythm, biparietal diameter, head circumference, abdominal circumference, and femur length. Fetal sonography was also used to screen for structural anomalies related to chromosomal disorders and clinical findings related to TORCH such as hepatosplenomegaly, cardiac lesions, hydrocephalus, microcephaly, and intracranial calcifications.

To determine long-term outcomes of SGA and IUGR, developmental followup data were reviewed for all patients who attended the pediatric or rehabilitation out-patient clinic. Developmental follow-up less than 1 year was categorized as follow-up loss.

Initial tests were performed within 1 week of admission and follow-up tests were done only when initial test results were positive. A total of 2, patients were treated at the neonatal intensive care and neonatal inpatient units at Bucheon Saint Mary's Hospital during the study period. Of the 95 IUGR neonates, 51 were symmetric and 44 were asymmetric. Neonatal characteristics are shown in Table 1. Average gestational age at birth was 37 weeks and 3 days with a greater portion of term compared to preterm neonates.

The earliest gestational age was 29 weeks and the latest was 41 weeks and 3 days. Birth weight average was 2, g with the smallest infant weighing g at birth. Average Apgar scores at 1 and 5 minutes were 7 and 8, respectively; seven neonates had a 5-minute Apgar score under 7. There were singleton neonates and 16 twins. Underlying maternal disorders are described in Table 2.

Due to our inclusion of 3 twin pairs, the number of mothers included in this study was No mother had a history of smoking, alcohol, or drug use during pregnancy. Seven mothers had multiple disorders. Repeated tests during pregnancy and over the next 3 years showed consistently positive IgM and IgG levels whereas repeated rubella reverse transcription PCR were all negative, suggesting false positive serological testing results or persistent IgM response.

The mother did not show any symptoms or signs of rubella infection and prior immunization history of MMR could not be checked due to insufficient data. Fetal sonography findings were used to determine status of IUGR and no other structural abnormalities were noted except for 1 patient with duodenal atresia. Placenta findings were recorded in 81 mothers, and 11 had abnormalities related to IUGR. Eight had extensive infarction, 3 had placenta abruption, and 1 had placenta previa 1 mother had both placenta abruption and placental previa.

Among the 36 neonates with abnormal findings, 24 showed clinical manifestations that could be related to TORCH infection. These are described in Table 3. Follow-up periods varied from 4 to 36 months. Patient 18 in Table 3 showed impaired hearing of the right ear on an automated brainstem response test done 3 weeks after birth.

Further follow-up of CMV was not done. One-month follow-up of the automated brainstem response test showed normal results for both ears.

At 24 months of age the patient showed delayed expressive speech and hearing was tested again with auditory brainstem response threshold test which showed normal results for both sides and otoacoustic emission test which showed right side impairment. At the most recent follow-up at 36 months, the patient showed normal development in all dimensions and had no hearing deficit.

Syphilis was tested in 19 patients with RPR titer test. Only one positive finding of toxoplasmosis IgM was found.

Repeated testing of toxoplasmosis IgM and IgG revealed negative findings. This patient had no clinical findings and follow-up until 4 years showed no comorbidities. The positive toxoplasmosis IgM finding was considered to be false positive based on negative result of repeated serologic IgM and lack of clinical symptoms. Direct detection of the parasite with highly specific PCR assay of placenta, blood, CSF, or urine would have been instrumental in clarifying the diagnosis.

An early study in by Matthews and O'Herlihy 5 in which the investigators measured cord IgM levels in SGA infants found 5 cases of proven intrauterine infection with rubella, syphilis, and toxoplasmosis all of which had elevated cord IgM levels.

However, these cases were related to premature rupture of membrane and chorioamnionitis and the authors suggest that elevated cord IgM levels may be related to such clinical findings rather than to intrauterine infections.

This study concluded that determination of cord IgM levels in SGA infants did not significantly help clinical management of these infants. One positive case of rubella HI showed no clinical signs of infection and was normal at follow-up, and the other 2 cases expired. The seroprevalence of toxoplasmosis has decreased in USA and similar trends have been observed in France and Sweden. In Korea, the toxoplasmosis seroprevalence rate was 0. The above review of prevalence of TORCH infection in Korea suggests that screening toward each disease entity should be individualized.

Low toxoplasmosis seroprevalance rate in pregnant women suggests lower risk of congenital infection, but higher seroprevalence in older aged Koreans shows that precaution should be taken to avoid consumption of food related to toxolasmosis infection during pregnancy. High seroprevalence of rubella IgG of childbearing age females demonstrates protection against congenital rubella infection and effort to keep immunization rates high should be maintained.

Significantly decreased prevalence of syphilis over 3 decades is evidence of lower risk of congenital syphilis infection, but sexual transmission risk needs to be educated. Comparative to the lowered risk of toxoplasmosis, rubella, and syphilis, neonatal screening for CMV should be focused on risks of congenital infection due to maternal reinfection and reactivation. However, high proportions of congenital infections show no clinical symptoms at birth which increases the risk of unforeseen congenital infections.

Terkadang bisa juga terjadi gangguan penglihatan. Pada penderita dengan sistem kekebalan tubuh yang lemah, infeksi CMV dapat memengaruhi hampir semua organ tubuh dan menyebabkan kondisi yang serius, seperti:. Umumnya gejala seperti flu yang disebabkan oleh cytomegalovirus akan hilang dengan sendirinya dalam waktu 3 minggu.

Namun, jika gejala tidak kunjung membaik, sebaiknya segera periksakan diri ke dokter, agar virus dapat terdeteksi dan ditangani sebelum menimbulkan komplikasi. Bila mengalami gejala-gejala di atas, Anda juga dianjurkan untuk segera memeriksakan diri ke dokter jika Anda sedang hamil, menjalani perawatan yang menekan sistem kekebalan tubuh, atau menderita penyakit yang membuat sistem kekebalan tubuh lemah.

Untuk mendiagnosis infeksi cytomegalovirus, awalnya dokter akan menanyakan gejala, kondisi dan riwayat kesehatan, serta obat-obatan atau suplemen yang sedang dikonsumsi pasien. Selanjutnya, dokter akan melakukan fisik. Pemeriksaan penunjang akan dilakukan jika dokter mencurigai adanya infeksi CMV. Pemeriksaan penunjang yang bisa dilakukan antara lain:. Khusus bagi ibu hamil yang diduga terinfeksi CMV, dokter akan melakukan pemeriksaan tambahan berupa:.

Pada janin yang diduga terinfeksi CMV, dokter akan melakukan pemeriksaan 3 minggu setelah persalinan. CMV pada bayi baru lahir dapat didiagnosis dengan pemeriksaan urine.

Perlu diketahui, pemeriksaan untuk memastikan diagnosis infeksi cytomegalovirus sering kali tidak dilakukan, terutama pada orang dewasa dan anak-anak dengan sistem kekebalan tubuh yang baik. Hal ini karena infeksi CMV pada orang dengan imunitas yang kuat dapat sembuh dengan sendirinya tanpa pengobatan. Seperti yang sudah dijelaskan sebelumnya, penderita infeksi cytomegalovirus dengan sistem kekebalan tubuh yang sehat dan hanya mengalami gejala ringan tidak membutuhkan pengobatan.