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Question |
If an infant presents to us at age of 5 months with confirmed CMV infection should we still treat him/her with ganciclovir? Which test should we order in such a pt. CMV IgM or IgG? What if IgM comes out negative at 5 months of age.. can we still take it as positive on basis of a +VE IgG?? QUESTION 2.. Please send me more info on RESOMAL solutions?
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Answer |
One must first determine what is the presentation of CMV in this child. If the child is asymptomatic and only has a positive CMV test, then one should not treat the child as one would never be sure that this is congenital or acquired.
Acquired CMV can be got as early as 2 weeks after life.
For diagnosis of CMV, only IgM is not enough as it is not very specific test. One must confirm the same by either a rising titre of CMV IgG (four fold rise) or a positive CMV PCR (in urine or blood) or by tissue diagnosis (presence of inclusion bodies).
If the child is symptomatic and CMV is confirmed, then one may consider Ganciclovir. There is no consensus on the use of ganciclovir except in patients with CMV pneumonia and CMV retinitis. However a study from US has depicted decreased in incidence of deafness in babies with vertically transmitted CMV when treated with ganciclovir.
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