Human cytomegalovirus (CMV), a member of the human herpesviruses, is a deoxyribonucleic acid virus that is ubiquitous in the world. After primary infection, CMV develops a latent state; however, when the defense of the immune system decreases in a host, it can reactivate. Human cytomegalovirus infections are acquired via several ways. CMV is spread through contact with infected bodily fluids in humans, whereas it occurs in pregnant women through close contact with young children or through sexual transmission. The clinical manifestations consist of non-specific symptoms or clinical findings. However, the patients with acute CMV infections are generally asymptomatic. Congenital CMV infection (present at birth) occurs via intrauterine transmission of the virus that is thought to be transferred to the developing fetus. The common clinical manifestations of congenital CMV infection are sensorineural hearing loss, petechiae, jaundice at birth, and hepatosplenomegaly. The vast majority of healthy children and adolescents infected with CMV infections are most often asymptomatic. Treatment is recommended to initiate to the infants who have a symptomatic infection or primary immunodeficiency or asymptomatic infection with an isolated hearing loss. The diagnosis of congenital CMV infections should be considered when it is detected in the newborns with signs and symptoms consistent with congenital CMV disease or with abnormal neuroimaging consistent with CMV or newborns who have documented sensorineural hearing loss.
Part of the book: Human Herpesvirus Infection
Acute bronchiolitis, which is the most common acute lower respiratory system disease, is resulting in significant morbidity and mortality in children less than 2 years. Respiratory syncytial virus (RSV) is the most common causative pathogen for over 30 million new acute lower respiratory infection episodes in children under 5 years of age. Rhinovirus, adenovirus, influenza virus, parainfluenza, and other respiratory viruses also cause acute bronchiolitis as the sole pathogen or as coinfection with or without RSV. Cardiovascular disease, chronic pulmonary disease, immunodeficiency, and premature birth are important risk factors for hospitalization and increase the risk of acute bronchiolitis-associated respiratory failure or even death. Bronchiolitis is a clinical diagnosis that varies from mild illness to severe respiratory failure. The severity of bronchiolitis is evaluated with several parameters including wheezing, retraction, respiratory rate, and general situation. However, the most important clinical finding is the presence or absence of hypoxemia and whether the patient can tolerate respiratory distress. Fluid support and oxygen supplementation by nasal cannula, face mask, or head box are critical for the treatment of bronchiolitis. Commonly used bronchodilators, corticosteroids, ribavirin, and antibiotics have not been shown to be effective in improving the clinical course of the bronchiolitis.
Part of the book: Update on Critical Issues on Infant and Neonatal Care