Infekcja wirusem cytomegalii – Rokowania, prognozy i postęp choroby

Infekcja wirusem cytomegalii
Rokowania, prognozy i postęp choroby

Infekcja wirusem cytomegalii (CMV) wykazuje zróżnicowane rokowanie zależne od stanu immunologicznego pacjenta, czasu zakażenia oraz obecności objawów klinicznych. U noworodków z objawową wrodzoną infekcją CMV śmiertelność wynosi około 30%, a istotne wskaźniki prognostyczne obejmują zapalenie siatkówki i naczyniówki (10-15% przypadków, często związane z upośledzeniem umysłowym), małogłowie (około 50% noworodków), zwapnienia wewnątrzczaszkowe oraz podwyższone stężenie białka w płynie mózgowo-rdzeniowym. Dzieci z wrodzonym zakażeniem CMV wymagają stałej kontroli audiologicznej ze względu na ryzyko późnej, nieprzewidywalnej głuchoty. Czas trwania wydalania wirusa z moczem nie koreluje z późniejszymi zaburzeniami neurologicznymi, wzrokowymi czy audiologicznymi ocenianymi w wieku 6 lat.

Prognozy w infekcji wirusem cytomegalii

Rokowanie w wrodzonym zakażeniu CMV
Długoterminowe następstwa u dzieci z wrodzonym CMV
Rokowanie u pacjentów krytycznie chorych na oddziałach intensywnej terapii
Rokowanie u pacjentów z obniżonym systemem immunologicznym

Podsumowanie czynników prognostycznych

Kolejne rozdziały

Prognozy w infekcji wirusem cytomegalii

Infekcja wirusem cytomegalii (CMV) ma różnorodne prognozy zależnie od stanu immunologicznego pacjenta, czasu zakażenia oraz obecności objawów klinicznych. Wirus cytomegalii pozostaje w organizmie przez całe życie, a większość osób z prawidłową odpornością nie doświadcza żadnych problemów zdrowotnych związanych z zakażeniem.¹ Jednakże w określonych grupach pacjentów infekcja CMV może prowadzić do poważnych konsekwencji zdrowotnych wymagających szczególnej uwagi medycznej.

Rokowanie w wrodzonym zakażeniu CMV

Rokowanie u noworodków z objawową wrodzoną infekcją CMV jest znacząco gorsze niż u dzieci z bezobjawowym zakażeniem, choć trudne do precyzyjnej oceny ilościowej. Dzieci zakażone w wyniku pierwotnej infekcji matki są bardziej narażone na powikłania niż te, u których doszło do reaktywacji wirusa u matki.²

Istotne wskaźniki prognostyczne u noworodków z objawową infekcją CMV to:

Zapalenie siatkówki i naczyniówki – występuje u 10-15% objawowych noworodków i prawie zawsze wskazuje na znaczne upośledzenie umysłowe³
Małogłowie – występuje u około 50% noworodków podczas porodu, ale nie zawsze utrzymuje się i niekoniecznie oznacza późniejsze zaburzenia neurologiczne⁴
Zmiany radiologiczne – zwapnienia wewnątrzczaszkowe widoczne w badaniach radiograficznych lub tomografii komputerowej zwiększają prawdopodobieństwo niepełnosprawności⁵
Podwyższone stężenie białka w płynie mózgowo-rdzeniowym – wskazuje na gorsze rokowanie⁶

Śmiertelność w objawowym wrodzonym zakażeniu CMV wynosi około 30%.⁷ Wszystkie dzieci z wrodzonym zakażeniem CMV powinny być pod kontrolą audiologiczną ze względu na możliwość wystąpienia późnej głuchoty, która jest nieprzewidywalna.⁸

Długoterminowe następstwa u dzieci z wrodzonym CMV

Dzieci z wrodzonym zakażeniem CMV są przewlekle zakażone wirusem. Co istotne z punktu widzenia prognostycznego, czas trwania wydalania wirusa z moczem jest niezależny od objawowego lub bezobjawowego charakteru infekcji podczas porodu. Badania wykazały, że czas trwania wydalania CMV z moczem nie koreluje z zaburzeniami wzrostu ani z neurologicznymi, wzrokowymi czy audiologicznymi następstwami ocenianymi w wieku 6 lat.⁹

Powikłania u niemowląt, których matki po raz pierwszy zakaziły się CMV podczas ciąży, są bardziej prawdopodobne i mogą obejmować:¹⁰

Utratę słuchu
Niepełnosprawność intelektualną
Problemy ze wzrokiem
Napady padaczkowe
Brak koordynacji
Osłabienie lub problemy z używaniem mięśni

Rokowanie u pacjentów krytycznie chorych na oddziałach intensywnej terapii

Zakażenie cytomegalowirusem jest powszechne u immunokompetentnych pacjentów przebywających na oddziałach intensywnej terapii (OIT). Metaanalizy wykazały, że ogólny wskaźnik infekcji CMV wynosi 27% (95% CI 22-34%, I²=89%, n=2398), a reaktywacja CMV – 31% (95% CI 24-39%, I²=74%, n=666) w tej populacji pacjentów.¹¹

Iloraz szans (OR) dla śmiertelności z wszystkich przyczyn wśród pacjentów z infekcją CMV, w porównaniu z pacjentami bez infekcji, wynosi 2,16 (95% CI 1,70-2,74, I²=10%, n=2239). Infekcja CMV podczas naturalnego, niezmienionego przebiegu choroby lub reaktywacja u krytycznie chorych pacjentów wiąże się ze zwiększoną śmiertelnością.¹²

Co ciekawe, nie wykazano wpływu na śmiertelność, gdy CMV wykrywano we krwi. Badania sugerują, że istnieje wysoka częstość występowania seropozytywności CMV i infekcji CMV u krytycznie chorych pacjentów bez immunosupresji. Infekcja CMV bez leczenia przeciwwirusowego lub reaktywacja u krytycznie chorych pacjentów jest związana ze zwiększoną śmiertelnością.¹³

Rokowanie u pacjentów z obniżonym systemem immunologicznym

Dla osób z osłabionym układem odpornościowym, zwłaszcza po przeszczepie narządów, komórek macierzystych lub szpiku kostnego, infekcja CMV może być śmiertelna.¹⁴ W tej grupie pacjentów powikłania zakażenia CMV mogą obejmować:¹⁵

Utratę wzroku – spowodowaną zapaleniem światłoczułej warstwy oka (zapalenie siatkówki)
Problemy z układem pokarmowym – w tym zapalenie okrężnicy (colitis), przełyku (esophagitis) i wątroby (hepatitis)
Problemy z układem nerwowym – w tym zapalenie mózgu (encephalitis)
Zapalenie płuc

Podsumowanie czynników prognostycznych

Rokowanie w infekcji wirusem cytomegalii zależy od kilku kluczowych czynników:¹⁶¹⁷¹⁸

Stan immunologiczny pacjenta – osoby z obniżoną odpornością są najbardziej narażone na powikłania
Czas zakażenia – pierwotne zakażenie matki podczas ciąży wiąże się z gorszym rokowaniem dla płodu
Obecność objawów klinicznych – objawowe zakażenie wrodzone wiąże się z wyższą śmiertelnością
Obecność zmian narządowych – zwłaszcza zapalenie siatkówki i naczyniówki oraz zmiany w OUN
Stan krytyczny pacjenta – pacjenci na OIT z infekcją lub reaktywacją CMV mają zwiększone ryzyko zgonu

Długoterminowe monitorowanie, zwłaszcza audiologiczne, jest kluczowe dla wszystkich dzieci z wrodzonym zakażeniem CMV, niezależnie od początkowej obecności lub braku objawów.¹⁹²⁰

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Materiały źródłowe

#1 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358
Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don’t know they have cytomegalovirus (CMV) because it rarely causes problems in healthy people. […] If you’re pregnant or if your immune system is weakened, CMV is cause for concern. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal. […] Complications of CMV infection can include: Vision loss, due to inflammation of the light-sensing layer of the eye (retinitis), Digestive system problems, including inflammation of the colon (colitis), esophagus (esophagitis) and liver (hepatitis), Nervous system problems, including brain inflammation (encephalitis), Pneumonia. […] An infant whose mother first became infected with CMV during pregnancy is more likely to experience complications. Complications for the baby can include: Hearing loss, Intellectual disability, Vision problems, Seizures, Lack of coordination, Weakness or problems using muscles.
#2 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#3 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#4 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#5 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#6 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#7 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#8 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#9 Cytomegalovirus (CMV) Urinary Excretion and Long-Term Outcome in Children with Congenital CMV Infection | Pediatric Research
https://www.nature.com/articles/pr19991122
Children with congenital CMV infection are chronically infected with CMV. […] The duration of viral excretion is independent of the symptomatic or asymptomatic nature of the infection at birth. Furthermore, the duration of CMV urinary excretion does not correlate with abnormalities of growth, or with neuro-developmental, visual or audiologic sequelae at 6 years of age.
#10 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358
Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don’t know they have cytomegalovirus (CMV) because it rarely causes problems in healthy people. […] If you’re pregnant or if your immune system is weakened, CMV is cause for concern. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal. […] Complications of CMV infection can include: Vision loss, due to inflammation of the light-sensing layer of the eye (retinitis), Digestive system problems, including inflammation of the colon (colitis), esophagus (esophagitis) and liver (hepatitis), Nervous system problems, including brain inflammation (encephalitis), Pneumonia. […] An infant whose mother first became infected with CMV during pregnancy is more likely to experience complications. Complications for the baby can include: Hearing loss, Intellectual disability, Vision problems, Seizures, Lack of coordination, Weakness or problems using muscles.
#11 Cytomegalovirus infection and outcome in immunocompetent patients in the intensive care unit: a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6027797/
Cytomegalovirus (CMV) infection is common in immunocompetent patients in intensive care units (ICUs). However, whether CMV infection or CMV reactivation contributes to mortality of immunocompetent patients remains unclear. […] The overall rate of CMV infection was 27% (95%CI 2234%, I2=89%, n=2398) and the CMV reactivation was 31% (95%CI 2439%, I2=74%, n=666). The odds ratio (OR) for all-cause mortality among patients with CMV infection, compared with those without infection, was 2.16 (95%CI 1.702.74, I2=10%, n=2239). […] CMV infection during the natural unaltered course or reactivation in critically ill patients is associated with increased mortality, but have no effect on mortality when CMV in blood. […] Our findings suggest that there is a high incidence of CMV seropositivity and CMV infection in critically ill patients without immunosuppression. This study suggests that CMV infection without antiviral drug treatment or reactivation in critically ill patients is associated with increased mortality, and is not associated with mortality when CMV infection is detected in blood.
#12 Cytomegalovirus infection and outcome in immunocompetent patients in the intensive care unit: a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6027797/
Cytomegalovirus (CMV) infection is common in immunocompetent patients in intensive care units (ICUs). However, whether CMV infection or CMV reactivation contributes to mortality of immunocompetent patients remains unclear. […] The overall rate of CMV infection was 27% (95%CI 2234%, I2=89%, n=2398) and the CMV reactivation was 31% (95%CI 2439%, I2=74%, n=666). The odds ratio (OR) for all-cause mortality among patients with CMV infection, compared with those without infection, was 2.16 (95%CI 1.702.74, I2=10%, n=2239). […] CMV infection during the natural unaltered course or reactivation in critically ill patients is associated with increased mortality, but have no effect on mortality when CMV in blood. […] Our findings suggest that there is a high incidence of CMV seropositivity and CMV infection in critically ill patients without immunosuppression. This study suggests that CMV infection without antiviral drug treatment or reactivation in critically ill patients is associated with increased mortality, and is not associated with mortality when CMV infection is detected in blood.
#13 Cytomegalovirus infection and outcome in immunocompetent patients in the intensive care unit: a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6027797/
Cytomegalovirus (CMV) infection is common in immunocompetent patients in intensive care units (ICUs). However, whether CMV infection or CMV reactivation contributes to mortality of immunocompetent patients remains unclear. […] The overall rate of CMV infection was 27% (95%CI 2234%, I2=89%, n=2398) and the CMV reactivation was 31% (95%CI 2439%, I2=74%, n=666). The odds ratio (OR) for all-cause mortality among patients with CMV infection, compared with those without infection, was 2.16 (95%CI 1.702.74, I2=10%, n=2239). […] CMV infection during the natural unaltered course or reactivation in critically ill patients is associated with increased mortality, but have no effect on mortality when CMV in blood. […] Our findings suggest that there is a high incidence of CMV seropositivity and CMV infection in critically ill patients without immunosuppression. This study suggests that CMV infection without antiviral drug treatment or reactivation in critically ill patients is associated with increased mortality, and is not associated with mortality when CMV infection is detected in blood.
#14 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358
Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don’t know they have cytomegalovirus (CMV) because it rarely causes problems in healthy people. […] If you’re pregnant or if your immune system is weakened, CMV is cause for concern. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal. […] Complications of CMV infection can include: Vision loss, due to inflammation of the light-sensing layer of the eye (retinitis), Digestive system problems, including inflammation of the colon (colitis), esophagus (esophagitis) and liver (hepatitis), Nervous system problems, including brain inflammation (encephalitis), Pneumonia. […] An infant whose mother first became infected with CMV during pregnancy is more likely to experience complications. Complications for the baby can include: Hearing loss, Intellectual disability, Vision problems, Seizures, Lack of coordination, Weakness or problems using muscles.
#15 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358
Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don’t know they have cytomegalovirus (CMV) because it rarely causes problems in healthy people. […] If you’re pregnant or if your immune system is weakened, CMV is cause for concern. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal. […] Complications of CMV infection can include: Vision loss, due to inflammation of the light-sensing layer of the eye (retinitis), Digestive system problems, including inflammation of the colon (colitis), esophagus (esophagitis) and liver (hepatitis), Nervous system problems, including brain inflammation (encephalitis), Pneumonia. […] An infant whose mother first became infected with CMV during pregnancy is more likely to experience complications. Complications for the baby can include: Hearing loss, Intellectual disability, Vision problems, Seizures, Lack of coordination, Weakness or problems using muscles.
#16 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#17 Cytomegalovirus (CMV) infection – Symptoms & causes – Mayo Clinic
https://www.mayoclinic.org/diseases-conditions/cmv/symptoms-causes/syc-20355358
Cytomegalovirus (CMV) is a common virus. Once infected, your body retains the virus for life. Most people don’t know they have cytomegalovirus (CMV) because it rarely causes problems in healthy people. […] If you’re pregnant or if your immune system is weakened, CMV is cause for concern. Women who develop an active CMV infection during pregnancy can pass the virus to their babies, who might then experience symptoms. For people who have weakened immune systems, especially people who have had an organ, stem cell or bone marrow transplant, CMV infection can be fatal. […] Complications of CMV infection can include: Vision loss, due to inflammation of the light-sensing layer of the eye (retinitis), Digestive system problems, including inflammation of the colon (colitis), esophagus (esophagitis) and liver (hepatitis), Nervous system problems, including brain inflammation (encephalitis), Pneumonia. […] An infant whose mother first became infected with CMV during pregnancy is more likely to experience complications. Complications for the baby can include: Hearing loss, Intellectual disability, Vision problems, Seizures, Lack of coordination, Weakness or problems using muscles.
#18 Cytomegalovirus infection and outcome in immunocompetent patients in the intensive care unit: a systematic review and meta-analysis
https://pmc.ncbi.nlm.nih.gov/articles/PMC6027797/
Cytomegalovirus (CMV) infection is common in immunocompetent patients in intensive care units (ICUs). However, whether CMV infection or CMV reactivation contributes to mortality of immunocompetent patients remains unclear. […] The overall rate of CMV infection was 27% (95%CI 2234%, I2=89%, n=2398) and the CMV reactivation was 31% (95%CI 2439%, I2=74%, n=666). The odds ratio (OR) for all-cause mortality among patients with CMV infection, compared with those without infection, was 2.16 (95%CI 1.702.74, I2=10%, n=2239). […] CMV infection during the natural unaltered course or reactivation in critically ill patients is associated with increased mortality, but have no effect on mortality when CMV in blood. […] Our findings suggest that there is a high incidence of CMV seropositivity and CMV infection in critically ill patients without immunosuppression. This study suggests that CMV infection without antiviral drug treatment or reactivation in critically ill patients is associated with increased mortality, and is not associated with mortality when CMV infection is detected in blood.
#19 Predicting the outcome of symptomatic congenital cytomegalovirus infection – PubMed
https://pubmed.ncbi.nlm.nih.gov/7794627/
The prognosis of babies with symptomatic congenital cytomegalovirus (CMV) infection is worse than for those with asymptomatic CMV, but is difficult to quantify. […] Babies affected as a result of primary maternal CMV are at greater risk than after reactivation CMV. […] Chorioretinitis occurs in 10-15% of symptomatic babies and almost always indicates significant mental impairment. […] Microcephaly occurs in around 50% at birth, but does not always persist, and does not necessarily imply later neurological handicap. […] Investigative findings that increase the likelihood of handicap include radiographic or computerized tomography scan finding of intracranial calcification and raised cerebrospinal fluid protein. […] Late deafness is always unpredictable and all babies with congenital CMV infection should have an audiological follow up. […] The mortality of symptomatic congenital CMV infection is about 30%.
#20 Cytomegalovirus (CMV) Urinary Excretion and Long-Term Outcome in Children with Congenital CMV Infection | Pediatric Research
https://www.nature.com/articles/pr19991122
Children with congenital CMV infection are chronically infected with CMV. […] The duration of viral excretion is independent of the symptomatic or asymptomatic nature of the infection at birth. Furthermore, the duration of CMV urinary excretion does not correlate with abnormalities of growth, or with neuro-developmental, visual or audiologic sequelae at 6 years of age.