Cytomegalovirus (CMV) is a moderately common herpes group viral infection of the newborn. It is the most common congenital viral infection in the developed world. It is crucial to distinguish between congenital, perinatal, and postnatal transmission, as congenital transmission is associated with increased morbidity.

In the United States, congenital CMV is significantly more prominent in African American children compared to other racial and ethnic groups. Mothers who acquire CMV during pregnancy are at greatest risk for transferring the virus to the fetus. Seronegative women tend to acquire CMV through sexual activity or exposure while caring for infected children. Furthermore, seropositive mothers can undergo CMV reactivation during lactation, consequently shedding viral DNA into breast milk. Other forms of postnatal transmission include contamination with blood and bodily fluids during vaginal birth, as well as transmission during blood product administration.

Most babies born with congenital CMV appear healthy at birth, with some children developing hearing loss, vision loss, or developmental delays during the first few years of life. A minority of congenital infection cases will present with the classic presentation of an ill infant with purple skin nodules with a yellow base, caused by extramedullary hematopoiesis, often likened to the appearance of a blueberry muffin. Additionally, these infants are often delivered prematurely with low birth weight, microcephaly, jaundice, petechiae, pneumonia, hepatosplenomegaly, and/or retinitis. Periventricular calcifications may be seen on ultrasound or CT of the head. These infants may also develop seizures and sensorineural hearing loss, as well as motor and cognitive delays.

Postnatal infection in term infants is often asymptomatic and causes very few long-term sequelae; however, in very low birth weight preterm infants, CMV infection presents with sepsis-like symptoms and signs, encompassing apnea, bradycardia, hepatosplenomegaly, hepatitis, gray pallor, distended bowels, thrombocytopenia, neutropenia, atypical lymphocytosis, and elevated liver enzymes. These patients may also demonstrate a viral pneumonia / pneumonitis-like presentation.

CMV infection is often an asymptomatic infection in toddlers; other healthy individuals may have an infectious mononucleosis-like syndrome with a rubelliform eruption. Most other cutaneous eruptions of acquired CMV infection are seen in immunocompromised patients, usually adults. Lesions may have multiple morphologies including papules, vesicles, petechiae, erosions, and ulcers (frequently in the anogenital region).

Related topic: cytomegalovirus infection