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Infants born to mothers with severe viral (congenital rubella) human cytomegalovirus (HCMV) infection during the first trimester of pregnancy are at high risk of developing HCMV infection after birth. Antenatal screening and diagnosis of congenital HCMV infection are based on detection of viral DNA by PCR. Antiviral treatment of congenital HCMV infection is based on the use of ganciclovir or valganciclovir. HCMV screening is recommended in all pregnant women with risk factors for congenital HCMV infection (e.g., advanced maternal age, history of HCMV infection, pre-term labour, twin gestation, chorioamnionitis, maternal infections during first trimester, or pre-eclampsia). Vaccine studies in the literature are limited to one pre-clinical trial, and additional studies are needed to determine the efficacy of HCMV vaccine for preventing perinatal HCMV infection in at-risk infants and vaccine safety and long-term outcomes [206, 207].
In all patients with suspected erythema multiforme (EM), a complete history is taken, including duration of disease, prodrome, severity, and localization. Because the lesions of oralEM may be diffuse, an examination of the mucous membranes and oral cavity may be necessary. Laboratory studies may show a moderate leukocytosis with bandemia. An absolute transaminase measurement may be consistent with acute hepatitis (HIS) or acute hepatitis unrelated to viral or autoimmune hepatitis. In MS, the minimum set of investigations consists of a complete evaluation of the ongoing disease. In MS patients with viral illness, the duration of symptoms must be long enough for the possibility of an acute, replicating virus infection, even with mild viremia present, to be considered (e.g., herpes simplex virus—2). The study of a second infection with the same virus is of utmost importance, but real-world data in this regard are limited. One study at a single referral center of 161 patients with suspected MS and 74 patients with other neurologic disorders failed to show a link between the presence of an immune attack or immunologic factors mimicking an immune attack and the occurrence of viral infections (63% of patients with MS and 25% of the other neurologic disorders). a3f8a02ae1