Prematürelerde Postnatal Sitomegalovirüs Enfeksiyonu

Yıl 2018, Cilt: 16 Sayı: 1, 105 - 114, 01.04.2018

Elif Özalkaya , Özlem Öz Arzu Akdağ Sevilay Topçuoğlu Deniz Çakır

Öz

GİRİŞ: Prematürelerde postnatal CMV (sitomegalovirüs) enfeksiyonu en sık enfekte anne sütü alımı ile
kazanılmaktadır. Diğer bulaş yolları perinatal dönemde genital sekresyonlar ve kan transfüzyonudur.
Tanı postnatal 3. haftadan sonra idrar, kan ve sekresyonlarda PCR ya da kültür ile virüsün izole
edilmesine dayanmaktadır. Term olgularda enfeksiyon çoğunlukla asemptomatiktir. Prematürelerde
CMV ilişkili klinik bulgu ve sepsise neden olabilir. Prematüre olgularda CMV ilişkili sepsis az sayıda
bildirilmiştir.

OLGU SUNUMU: Olgularımızın her ikisi de 1000 gr altında prematüre idi. C/S ile doğmuşlardı.
Premature formulası ile beslenmişler, lökosit filtresi kullanılarak çoklu eritrosit süspansiyonu
transfüzyonu almışlardı. İzlemlerinin 2. ayında birinci olguda beslenme intoleransı ve splenomegali,
ikinci olguda oksijen ihtiyacında artma ve invaziv ventilasyon ihtiyacı gelişti. Laboratuvar bulgularında
her iki olguda karaciğer fonksiyon testlerinde yükselme, kolestaz, trombositopeni ve akut faz yüksekliği
saptandı. Kan CMV IgM ve CMV DNA PCR pozitif bulundu. Gansiklovir başlandı. Birinci olgunun 2,
ikinci olgunun altı hafta sonunda klinik ve laboratuvar bulguları düzeldi. İzlemlerinde nörolojik sekel
ya da işitme kaybı gelişmedi.

TARTIŞMA: Prematürelerde, 3. haftadan sonra gelişen sepsis nedeni olarak postnatal CMV
enfeksiyonu akılda tutulmalıdır. 

ABSTRACT

INTRODUCTION: Postnatal CMV (cytomegalovirus) infection in the premature infants is most often
transmitted with infected breast milk. The other routes of transmission are blood transfusion and genital
secretions. Diagnosis is made by PCR or viral culture of urine, blood, or other body secretions after the
first 3 weeks of life. It is mostly asymptomatic in term infants. CMV infection may cause sepsis and
many clinical signs in premature infants. There are a few reports of premature infants with CMV sepsis
in the literature.

CASE REPORTS: Both of our cases were premature infants weighing less than 1000 g and born with
ceaserean section. Since both of the mothers did not have breast milk, infants were fed with premature
formula. They were transfused with erythrocyte suspension more than once. The first case has developed
feeding intolerance and splenomegaly, the second case had increased oxygen demand and invasive
mechanical ventilation support at the end of the second month of life. Laboratory findings showed
cholestasis, thrombocytopenia, elevated transaminases and acute phase reactants. Blood CMV IgM and
CMV DNA PCR were positive in both cases. Ganciclovir treatment was started. The first case had
improvement in clinical and laboratory findings in 2 weeks, the second case had improvement in 6th
week of the treatment. None of the patiens developed neurological sequelae or hearing loss.

CONCLUSİON: We aimed to remind that postnatal CMV infection should be suspected in preterm
infants who developed sepsis later than fist 3 weeks of life.

Anahtar Kelimeler

postnatal CMV enfeksiyonu, CMV ilişkili sepsis

Kaynakça

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