Giemsa stained smear of epithelial cells obtained from a newborn with hepatosplenomegaly is shown below. What is the most likely cause of this congenital infection?

Ans. a. CMV (Ref: Harrrison 19/e p1191, 18/e p1473; Nelson 19/e p247; Robbins 9/e p359-360)The figure given in the question shows intra-nuclear inclusions surrounded by a clear halo, suggesting CMV infection. Petechiae, hepalosplenomegaly, and jaundice are the most common presenting features (60-80% of cases) of congenital CMV infection.Congenital CMV InfectionFetal infections range from inapparent to severe and disseminated.Cytomegalic inclusion disease develops in 5% of infected fetusesSeen almost exclusively in infants born to mothers who develop primary infections during pregnancy.Petechiae, hepatosplenomegaly, and jaundiceQ are the most common presenting features (60-80% of cases).Microcephaly with or without cerebral calcifications, intrauterine growth retardation, and prematurity are reported in 30-50% of casesQ.Inguinal hernias and chorioretinitis are less common.Most congenital CMV infections are clinically inapparent at birthQ.Of asymptomatically infected infants. 5-25% develop significant psychomotor, hearing, ocular, or dental abnormalities over the next several years.Laboratory abnormalities:Laboratory abnormalities include elevated alanine aminotransferase levels in serum, thrombocytopenia, conjugated hyperbilirubinemia, hemolysis, and elevated protein levels in cerebrospinal fluidQ.Prognosis:The prognosis for severely infected infants is poor;The mortality rate is 20-30%, and few survivors escape intellectual or hearing difficulties later in childhood.