Congenital Cytomegalovirus Infection

CV ao. Univ. Prof. Prim. Dr. med. Gabriele Halwachs-Baumann, MSc, MBABorn: 21. 02. 1962, Gmunden, AustriaAcademic studies:1981 – 1990 Medical study at the Karl-Franzens-University in Graz, Austria19. 12. 1990 Medical degreePostgraduate studies:2005 – 2006 University Course Health Services Management (Master of Science, MSc) at the Donau University Krems, Austria2006 – 2007 University Study Health Care Management (Master of Business Administration, MBA), at the University of Economics and Business, Vienna, AustriaAcademic career:1991 – 1996 Assistant at the Department of Internal Medicine, Division for Laboratory Medicine, University Hospital Graz1996 – 1997 Research period at the University of Tübingen, Germany, Department of Virology15.02.1998 Specialist for Laboratory Medicine27.05.1998 University lecturer for Laboratory Medicine01.10.1998 ao. University Professor for Laboratory Medicine2001 – 2006 Head of the Division for Laboratory Medicine at the University Clinics for Surgery, University Hospital Graz2006 – pres. Head of the Department (Primaria) for Laboratory Medicine at the Hospital Steyr

1 Long known, long ignored - a brief history of cytomegalovirus research1.1 Beginnings: 1881-19141.2 Between the wars: 1914-19301.3 From 1930 to 19601.4 From 1960 to the presentReferences2 Virus-host interaction for defence and transmission2.1 The virus2.2 The host2.2.1 Cell types involved in replication and distribution2.2.2 The immune system - strengths and weakness2.2.3 The placenta - a barrier?2.2.4 Cytomegalovirus - placenta - fetus: a slippery slope between defence and transmissionReferences3 Epidemiology - the influence of socioeconomic differences3.1 Infant mortality as a social mirror3.2 One effect - many causes3.2.1 Maternal aetiology3.2.2 Foetal aetiology3.2.3 Placental aetiology3.3 Epidemiology of congenital CMV infection3.3.1 Congenital CMV and virus strainsReferences4 Prospects and obstacles of diagnosis4.1 Screening for congenital CMV infection4.1.1 Screening of the mother4.1.2 Screening of the newborn4.2 Diagnosis of congenital CMV infection4.2.1 Prenatal diagnosis4.2.2 Neonatal diagnosisReferences5 Clinical outcome: acute symptoms and sleeping hazards Thorsten W. Orlikowsky5.1 Relevance of connatal CMV infection for the paediatrician and neonatologist5.2 The tip of the iceberg5.3 Lucky chance by neonatal immune response5.4 Features of symptomatic CMV infection5.5 Timing of infection5.6 Symptoms of the central nervous system in detail5.6.1 Microcephaly5.6.2 Ocular defects5.6.3 Hearing loss5.6.4 Mental and psychomotor retardation5.6.5 Seizures5.7 Unspecific symptoms in detail5.7.1 Temperature instability5.7.2 Perfusion and rash5.7.3 Lung5.7.4 Liver5.7.5 Jaundice5.7.6 Spleen5.7.7 Platelet system5.7.8 Anaemia5.7.9 Gastrointestinal tract5.8 Asymptomatic infection5.9 Differential diagnosisReferences6 Prevention and therapy - more than trial and error6.1 Antivirals6.1.1 Treatment of pregnant women6.1.2 Treatment of neonates6.2 Passive immunisation6.3 Active immunisation (vaccination)References7 How to save money: congenital CMV infection and the economy Evelyn Walter, Christine Brennig, Vera Schollbauer7.1 Introduction7.2 Methodology7.2.1 Incidence-based approach7.2.2 Cost calculation7.2.3 Cost of sequelae7.3 Cost of illness in Germany7.3.1 Total societal costs7.3.2 Sensitivity analysis7.3.3 Impact through prevention7.4 DiscussionReferencesIndexList of contributors