A newborn is infected in utero with an enveloped virus containing double-stranded DNA. The child develops petechiae, hepatosplenomegaly, and jaundice. Brain calcifications are detected on computed tomography (CT). With which of the following viruses is the newborn most likely infected?

Congenital cytomegalovirus infection results from transplacental acquisition of a primary or recurrent maternal infection. Most infections are asymptomatic, but about 5% will present with hepatosplenomegaly, periventricular brain calcification, petechial hemorrhages, and hydrops. Sensorineural deafness is a common manifestation in affected infants. Primary infection of the mother is strongly associated with more severe symptoms in affected infants. The moality rate is 30% and most of the survivors will have neurologic impairment. Also know: CMV infections in children and adults are often asymptomatic; however, the virus is responsible for 10% of infectious mononucleosis cases (characterized by an absence of sheep RBC agglutinins). CMV also causes serious disease in immunosuppressed patients, including bone marrow recipients and AIDS patients. Ganciclovir is the drug of choice, although foscarnet has also been used with some success. Infections with hepatitis viruses, if symptomatic, are characterized by jaundice, lethargy, failure to thrive, abdominal distention, clay- colored stools, and elevated transaminase levels. Hepatitis B is the only viral hepatitis agent that is recognized as an impoant cause of neonatal disease. The infection is usually acquired during the bih process; therapy includes hyperimmune human anti-hepatitis B serum followed a few weeks later with active immunization with HBsAg injections. Herpes simplex can also infect the neonate. The hallmark of infection is painful skin vesicles (present in 50% of affected infants); other manifestations include encephalitis, pneumonia, hepatitis, and disseminated intravascular coagulopathy. Massive hepatic and adrenal necrosis is common. Therapy is with acyclovir.