DIAGNOSTICO RETROSPECTIVO DE LA INFECCION CONGENITA POR CITOMEGALOVIRUS





DIAGNOSTICO RETROSPECTIVO DE LA INFECCION CONGENITA POR CITOMEGALOVIRUS

(especial para SIIC © Derechos reservados)
El citomegalovirus congénito permanece infradiagnosticado en ausencia de clínica neonatal. Puede manifestarse con retraso de crecimiento intrauterino, microcefalia, hipoacusia neurosensorial, coriorretinitis, retardo mental y trastorno del espectro autista. El diagnóstico de certeza sólo se puede realizar pasadas las 3 primeras semanas mediante la detección de ADN de citomegalovirus a partir de sangre del papel de filtro del cribado neonatal.
Autor:
Raquel Pinillos Pisón
Columnista Experta de SIIC

Institución:
Hospital Miguel Servet Zaragoza España


Artículos publicados por Raquel Pinillos Pisón
Coautores
Javier Lopez-pison* Juan Pablo García Iñiguez** Victoria Caballero Perez*** Marta Callau*** Victor Rebage Moisés**** Segundo Rite Gracia* 
Hospital Miguel Servet Zaragoza España, Zaragoza, España*
Licenciado en Medicina y cirugía. Facultativo especialista en pediatría, Hospital Miguel Servet Zaragoza España, Zaragoza, España**
Licenciado en medicina y cirugía. Médico Interno Residente Pediatría, Hospital Miguel Servet Zaragoza España, Zaragoza, España***
Licenciado en medicina y cirugía. Facultativo Especialista en Pediatría. Neonatólogo, Hospital Miguel Servet Zaragoza España, Zaragoza, España****
Recepción del artículo
10 de Septiembre, 2012
Aprobación
14 de Diciembre, 2012
Primera edición
22 de Febrero, 2013
Segunda edición, ampliada y corregida
7 de Junio, 2021

Resumen
La infección por citomegalovirus (CMV) es la infección viral congénita más frecuente. Es causa de múltiples anomalías que involucran al sistema nervioso central. Debido a que es principalmente asintomática, dos tercios de las secuelas se producen en niños asintomáticos al nacimiento. Pasadas las primeras 2 a 3 semanas de vida, se ha propuesto como método ideal y único de certeza para el diagnóstico retrospectivo la detección del ADN viral en la muestra de sangre seca procedente de la pesquisa neonatal. La técnica se lleva a cabo mediante dilución, amplificación y extracción, con resultado en menos de 48 horas. Se han publicado en la bibliografía numerosos protocolos, que refieren variadas sensibilidades in Vitro que dependen fundamentalmente del método de extracción, desde la prueba del talón y de la amplificación, que son muy heterogéneas (entre 35% y 98%). La sensibilidad es mayor si es secundaria a primoinfección, en pacientes seleccionados, si se utiliza un buen método de extracción y amplificación, y una amplificación duplicada o, incluso, triplicada. La especificidad en todos ellos es concordante y alcanza casi el 100%. La carga viral de la prueba del talón está subestimada, pero altamente relacionada con la de sangre fresca y, aunque puede no haber viremia al nacimiento, los neonatos virémicos son los que tienen mayor riesgo de presentar secuelas neurosensoriales, por lo que los índices de detección clínica en pacientes seleccionados son altos. Se ha descrito la viabilidad de otras alternativas, como el cordón umbilical en Japón y, en los últimos años, el uso de orina seca en papel de filtro, y se comunicaron buenos resultados.

Palabras clave
infección congenita por citomegalovirus, diagnóstico retrospectivo


Artículo completo

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Abstract
Cytomegalovirus is the most common congenital viral infection. It´s cause of many abnormalities involving the central nervous system. Because of its mainly asymptomatic, two thirds of the sequelae occur in asymptomatic at birth child.

After the first 2-3 weeks of life, the viral DNA detection on dried blood sample from the neonatal screening has been proposed as an ideal and unique method of certainty for retrospective diagnosis.

The technique is carried out by dilution and extraction-amplification, resulting in less than 48 hours. It have been published a variable number of protocols in the literature that refer variables in vitro sensitivities depend mainly on the extraction method from the heel prick and amplification that are heterogeneous (between 35%-98%). The sensitivity is greater if it is secondary to primary infection, in selected patients, using a good method of extraction and amplification and amplification doubled or even tripled. The specificity is consistent in all of them reaching almost 100%. The viral load test of the voucher is underestimated but highly related to that of fresh blood and although it may not have viremia at birth, viraemic infants have higher risk of developing neurosensory sequelae, making clinical detection rates in patients selected are high.

Described the feasibility of alternatives such as the umbilical cord in Japan, and in recent years, the use of dried urine on filter paper, reported good results.

Key words
congenital citomegalovirus infection, retrospective diagnosis


Clasificación en siicsalud
Artículos originales > Expertos de Iberoamérica >
página   www.siicsalud.com/des/expertocompleto.php/

Especialidades
Principal: Diagnóstico por Laboratorio, Pediatría
Relacionadas: Bioquímica, Infectología, Neurología



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Raquel Pinillos Pisón, Hospital Universitario Miguel Servet de Zaragoza, 50009, C/ Rubén Darío nº8 bajo 2ª, Zaragoza, España
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