NEJM:先天性巨细胞病毒感染-病例报道

2018-09-27 xing.T MedSci原创

先天性CMV感染可以是无症状的,或者症状可以包括生长受限、血液疾病和感觉神经发育障碍,其严重程度从轻微到严重。

患者为一名35岁的女性,在妊娠24周时被送到产科诊所进行常规胎儿超声检查。该患者受孕后不久发生发热性疾病。超声图像显示胎儿脑室扩张,T2加权磁共振成像显示脑室扩大(如图A所示)和小脑发育不全。母体血清免疫测定巨细胞病毒(CMV)IgG和IgM抗体呈阳性。



在妊娠38周时,该妇女阴道分娩正常,婴儿体重2556g(第8百分位),头围30.5cm(第1百分位数)。在新生儿的脸部和躯干上可观察到瘀点。实验室检查显示血小板计数为136000mm3(参考范围为150000-450000),血细胞比容和氨基转移酶水平正常。新生儿大脑的计算机断层扫描显示脑室扩张,实质发育不全伴多发性纤维化和脑室周围钙化(如图B箭头所示)。胎盘的免疫组织化学检查CMV呈阳性,新生儿尿液聚合酶链反应检查发现CMV DNA,证实为先天性CMV感染

先天性CMV感染可以是无症状的,或者症状可以包括生长受限、血液疾病和感觉神经发育障碍,其严重程度从轻微到严重。

该新生儿采用更昔洛韦治疗,在11个月大时进行随访,孩子出现右耳感觉神经性聋、癫痫、痉挛性四肢瘫痪和发育迟缓;治疗包括抗癫痫药物和发育服务。

原始出处:

Kenta Kawai, et al.Congenital Cytomegalovirus Infection.N Engl J Med 2018; https://www.nejm.org/doi/full/10.1056/NEJMicm1800262

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    2018-09-28 wwzzly
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createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:48 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346903, encodeId=934634690337, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:45 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346902, encodeId=39b334690264, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:42 CST 2018, time=2018-09-27, status=1, ipAttribution=)]
    2018-09-28 1e178ab4m51(暂无匿称)

    这么严重的问题,在国内肯定已经终止妊娠了

    0

  5. 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createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:48 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346903, encodeId=934634690337, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:45 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346902, encodeId=39b334690264, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:42 CST 2018, time=2018-09-27, status=1, ipAttribution=)]
    2018-09-28 123d664am65暂无昵称

    可怕

    0

  6. 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createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:48 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346903, encodeId=934634690337, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:45 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346902, encodeId=39b334690264, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:42 CST 2018, time=2018-09-27, status=1, ipAttribution=)]
    2018-09-27 xiaotao112411

    学习学习学习

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1928338, encodeId=767e19283381f, content=<a href='/topic/show?id=00e9286129d' target=_blank style='color:#2F92EE;'>#先天性巨细胞病毒感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28612, encryptionId=00e9286129d, topicName=先天性巨细胞病毒感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Sun Oct 21 06:55:00 CST 2018, time=2018-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1369396, encodeId=4cc713693967a, content=<a href='/topic/show?id=bc9f28589d0' target=_blank style='color:#2F92EE;'>#先天性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28589, encryptionId=bc9f28589d0, topicName=先天性)], attachment=null, authenticateStatus=null, createdAvatar=, 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createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:48 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346903, encodeId=934634690337, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:45 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346902, encodeId=39b334690264, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:42 CST 2018, time=2018-09-27, status=1, ipAttribution=)]
    2018-09-27 xiaotao112411

    学习学习学习

    0

  8. 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createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:48 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346903, encodeId=934634690337, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:45 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346902, encodeId=39b334690264, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:42 CST 2018, time=2018-09-27, status=1, ipAttribution=)]
    2018-09-27 xiaotao112411

    学习学习学习

    0

  9. [GetPortalCommentsPageByObjectIdResponse(id=1928338, encodeId=767e19283381f, content=<a href='/topic/show?id=00e9286129d' target=_blank style='color:#2F92EE;'>#先天性巨细胞病毒感染#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28612, encryptionId=00e9286129d, topicName=先天性巨细胞病毒感染)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=fd34186, createdName=wshxjq, createdTime=Sun Oct 21 06:55:00 CST 2018, time=2018-10-21, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1369396, encodeId=4cc713693967a, content=<a href='/topic/show?id=bc9f28589d0' target=_blank style='color:#2F92EE;'>#先天性#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=28589, encryptionId=bc9f28589d0, topicName=先天性)], attachment=null, authenticateStatus=null, createdAvatar=, 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createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:48 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346903, encodeId=934634690337, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=0, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:45 CST 2018, time=2018-09-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=346902, encodeId=39b334690264, content=学习学习学习, beContent=null, objectType=article, channel=null, level=null, likeNumber=15, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/11/05/dc628308c49d4aa82335673176ebb6d3.jpg, createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:42 CST 2018, time=2018-09-27, status=1, ipAttribution=)]
    2018-09-27 xiaotao112411

    学习学习学习

    0

  10. 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createdBy=153c1955083, createdName=xiaotao112411, createdTime=Thu Sep 27 11:00:42 CST 2018, time=2018-09-27, status=1, ipAttribution=)]
    2018-09-27 xiaotao112411

    学习学习学习

    0