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Yoshinaga-Itano C, Carr G, Davis A, Ching TYC, Chung K, Clark J, Harkus S, Kuan ML, Garg S, Adreoli Balen S, O'Leary S. Coalition for Global Hearing Health Hearing Care Pathways Working Group: Guidelines for Clinical Guidance for Readiness and Development of Evidence-Based Early Hearing Detection and Intervention Programs. Ear Hear 2024:00003446-990000000-00281. [PMID: 38783422 DOI: 10.1097/aud.0000000000001501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/25/2024]
Abstract
Editor's Note: The following article discusses the timely topic Clinical Guidance in the areas of Evidence-Based Early Hearing Detection and Intervention Programs. This article aims to discuss areas of services needed, guidance to countries/organizations attempting to initiate early hearing detection and intervention systems. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. In Ear and Hearing, our long-term goal for the Point of View article is to stimulate the field's interest in and to enhance the appreciation of the author's area of expertise. Hearing is an important sense for children to develop cognitive, speech, language, and psychosocial skills. The goal of universal newborn hearing screening is to enable the detection of hearing loss in infants so that timely health and educational/therapeutic intervention can be provided as early as possible to improve outcomes. While many countries have implemented universal newborn hearing screening programs, many others are yet to start. As hearing screening is only the first step to identify children with hearing loss, many follow-up services are needed to help them thrive. However, not all of these services are universally available, even in high-income countries. The purposes of this article are (1) to discuss the areas of services needed in an integrated care system to support children with hearing loss and their families; (2) to provide guidance to countries/organizations attempting to initiate early hearing detection and intervention systems with the goal of meeting measurable benchmarks to assure quality; and (3) to help established programs expand and improve their services to support children with hearing loss to develop their full potential. Multiple databases were interrogated including PubMed, Medline (OVIDSP), Cochrane library, Google Scholar, Web of Science and One Search, ERIC, PsychInfo. Expert consensus and systematic/scoping reviews were combined to produce recommendations for evidence-based clinical practice. Eight essential areas were identified to be central to the integrated care: (1) hearing screening, (2) audiologic diagnosis and management, (3) amplification, (4) medical evaluation and management, (5) early intervention services, (6) family-to-family support, (7) D/deaf/hard of hearing leadership, and (8) data management. Checklists are provided to support the assessment of a country/organization's readiness and development in each area as well as to suggest alternative strategies for situations with limited resources. A three-tiered system (i.e., Basic, Intermediate, and Advanced) is proposed to help countries/organizations at all resource levels assess their readiness to provide the needed services and to improve their integrated care system. Future directions and policy implications are also discussed.
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Affiliation(s)
- Christine Yoshinaga-Itano
- University of Colorado, Boulder, Colorado, USA
- University of Witwatersrand, Johannesburg, South Africa
| | - Gwen Carr
- UCL Ear Institute London, London, United Kingdom
| | - Adrian Davis
- UCL Ear Institute London, London, United Kingdom
- London School of Economics, London, United Kingdom
- Imperial College London, London, United Kingdom
- Anglia Ruskin University, Cambridge, United Kingdom
| | - Teresa Y C Ching
- Macquarie University, Sydney, New South Wales, Australia
- NextSense Institute, Sydney, New South Wales, Australia
- University of Queensland, Brisbane, Queensland, Australia
| | - King Chung
- MGH Institute of Health Professions, Department of Communication Sciences and Disorders, Charlestown, Massachusetts, United States
| | | | | | - Meei-Ling Kuan
- National Women's League Hearing Health Foundation, Taipei, Taiwan
| | | | - Sheila Adreoli Balen
- Speech, Language and Hearing Department, Federal University of Rio Grande do Norte, Natal, Rio Grande do Norte, Brazil
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Orb QT, Pesch M, Allen CM, Wilkes A, Ahmad I, Alfonso K, Antonio SM, Mithal LB, Brinkmeier JV, Carvalho D, Chan D, Cheng AG, Chi D, Cohen M, Discolo CM, Duran C, Germiller J, Gibson L, Grunstein E, Harrison G, Lee K, Hawley K, Kohlhoff S, Melvin A, MacArthur C, Nassar M, Neff L, Pecha P, Salvatore C, Schoem S, Virgin F, Saunders J, Schleiss M, Smith RJH, Sood S, Park AH. Congenital Cytomegalovirus Testing Outcomes From the ValEAR Trial. Otolaryngol Head Neck Surg 2024; 170:1430-1441. [PMID: 38415855 PMCID: PMC11060929 DOI: 10.1002/ohn.670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 11/13/2023] [Accepted: 12/02/2023] [Indexed: 02/29/2024]
Abstract
OBJECTIVE To determine the positivity rate of congenital cytomegalovirus (cCMV) testing among universal, hearing-targeted CMV testing (HT-cCMV) and delayed targeted dried blood spot (DBS) testing newborn screening programs, and to examine the characteristics of successful HT-cCMV testing programs. STUDY DESIGN Prospective survey of birth hospitals performing early CMV testing. SETTING Multiple institutions. METHODS Birth hospitals participating in the National Institutes of Health ValEAR clinical trial were surveyed to determine the rates of cCMV positivity associated with 3 different testing approaches: universal testing, HT-cCMV, and DBS testing. A mixed methods model was created to determine associations between successful HT-cCMV screening and specific screening protocols. RESULTS Eighty-two birth hospitals were surveyed from February 2019 to December 2021. Seven thousand six hundred seventy infants underwent universal screening, 9017 infants HT-cCMV and 535 infants delayed DBS testing. The rates of cCMV positivity were 0.5%, 1.5%, and 7.3%, respectively. The positivity rate for universal CMV screening was less during the COVID-19 pandemic than that reported prior to the pandemic. There were no statistically significant drops in positivity for any approach during the pandemic. For HT-cCMV testing, unique order sets and rigorous posttesting protocols were associated with successful screening programs. CONCLUSION Rates of cCMV positivity differed among the 3 approaches. The rates are comparable to cohort studies reported in the literature. Universal CMV prevalence decreased during the pandemic but not significantly. Institutions with specific order set for CMV testing where the primary care physician orders the test and the nurse facilitates the testing process exhibited higher rates of HT-cCMV testing.
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Affiliation(s)
- Quinn T Orb
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Megan Pesch
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Chelsea M Allen
- Department of Population Health Sciences, Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Ashlea Wilkes
- Department of Population Health Sciences, Division of Biostatistics, University of Utah School of Medicine, Salt Lake City, Utah, USA
| | - Iram Ahmad
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | | | | | | | - Dylan Chan
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Alan G Cheng
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - David Chi
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | - Carlos Duran
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | - Laura Gibson
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | - Kenneth Lee
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Karen Hawley
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | - Ann Melvin
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | - Laura Neff
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | - Scott Schoem
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Frank Virgin
- ValEAR Study Group, Worcester, Massachusetts, USA
| | | | | | | | - Sunil Sood
- ValEAR Study Group, Worcester, Massachusetts, USA
| | - Albert H Park
- Division of Otolaryngology-Head and Neck Surgery, University of Utah School of Medicine, Salt Lake City, Utah, USA
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Rollman TB, Berkebile ZW, Okae H, Bardwell VJ, Gearhart MD, Bierle CJ. Human trophoblast stem cells restrict human cytomegalovirus replication. J Virol 2024; 98:e0193523. [PMID: 38451085 PMCID: PMC11019952 DOI: 10.1128/jvi.01935-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/18/2024] [Indexed: 03/08/2024] Open
Abstract
Placental infection plays a central role in the pathogenesis of congenital human cytomegalovirus (HCMV) infections and is a cause of fetal growth restriction and pregnancy loss. HCMV can replicate in some trophoblast cell types, but it remains unclear how the virus evades antiviral immunity in the placenta and how infection compromises placental development and function. Human trophoblast stem cells (TSCs) can be differentiated into extravillous trophoblasts (EVTs), syncytiotrophoblasts (STBs), and organoids, and this study assessed the utility of TSCs as a model of HCMV infection in the first-trimester placenta. HCMV was found to non-productively infect TSCs, EVTs, and STBs. Immunofluorescence assays and flow cytometry experiments further revealed that infected TSCs frequently only express immediate early viral gene products. Similarly, RNA sequencing found that viral gene expression in TSCs does not follow the kinetic patterns observed during lytic infection in fibroblasts. Canonical antiviral responses were largely not observed in HCMV-infected TSCs and TSC-derived trophoblasts. Rather, infection dysregulated factors involved in cell identity, differentiation, and Wingless/Integrated signaling. Thus, while HCMV does not replicate in TSCs, infection may perturb trophoblast differentiation in ways that could interfere with placental function. IMPORTANCE Placental infection plays a central role in human cytomegalovirus (HCMV) pathogenesis during pregnancy, but the species specificity of HCMV and the limited availability and lifespan of primary trophoblasts have been persistent barriers to understanding how infection impacts this vital organ. Human trophoblast stem cells (TSCs) represent a new approach to modeling viral infection early in placental development. This study reveals that TSCs, like other stem cell types, restrict HCMV replication. However, infection perturbs the expression of genes involved in differentiation and cell fate determination, pointing to a mechanism by which HCMV could cause placental injury.
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Affiliation(s)
- Tyler B. Rollman
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Zachary W. Berkebile
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Hiroaki Okae
- Department of Informative Genetics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Vivian J. Bardwell
- Developmental Biology Center, Department of Genetics, Cell Biology and Development and the Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Micah D. Gearhart
- Department of Obstetrics, Gynecology and Women’s Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Craig J. Bierle
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota, USA
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Leber AL. Maternal and congenital human cytomegalovirus infection: laboratory testing for detection and diagnosis. J Clin Microbiol 2024; 62:e0031323. [PMID: 38391188 PMCID: PMC11005381 DOI: 10.1128/jcm.00313-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Human cytomegalovirus (CMV) is the leading cause of congenital infection worldwide and the most common cause of non-genetic sensorineural hearing loss. As there is no vaccine or other specific intervention to prevent congenital CMV infection, there is a need to identify maternal and congenital infections with sensitive and specific testing as early as possible. There is no widely accepted practice for screening during pregnancy or in all newborns for identification of possible cases of congenital CMV. Currently, screening during pregnancy is limited to those identified as at risk followed by fetal and/or neonatal testing when congenital infection is suspected. This review focuses primarily on the current status of laboratory testing for diagnosis of maternal and congenital CMV infections. Primary maternal infection is best diagnosed using serologic testing, including CMV IgM, IgG, and avidity testing, while fetal infection should be assessed by nucleic acid amplification testing (NAAT) of amniotic fluid. Urine and saliva NAATs are the mainstay for diagnosis of congenital CMV in the first 3 weeks of life. Testing of dried blood spots can be useful for diagnosis of congenital CMV outside of the newborn period. The gaps in knowledge such as the prognostic value of viral loads in various sample types are addressed.
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Affiliation(s)
- Amy L. Leber
- Departments of Pathology and Laboratory Medicine and Pediatrics, Nationwide Children’s Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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Rypka KJ, Schleiss MR. Impact of Cytomegalovirus (CMV) on an Academic Pediatric Infectious Diseases Outpatient Clinic Referral Population, 2005-2020: Will the Advent of Universal Congenital CMV (cCMV) Screening Change Clinical Practice Referral Patterns? Int J Neonatal Screen 2024; 10:14. [PMID: 38390978 PMCID: PMC10885027 DOI: 10.3390/ijns10010014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 01/29/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
Cytomegalovirus (CMV) infections exert a substantial impact on the practice of pediatric infectious diseases. Although most infections in children are minimally symptomatic, several populations are at risk for CMV-associated disease, including immunosuppressed children, children with HIV infection, and, most significantly, children with congenital CMV (cCMV) infection. In spite of the ubiquitous nature of CMV infection, few studies have quantified the impact of CMV-associated care in a pediatric outpatient clinic setting. We evaluated the impact of CMV on clinical care in an outpatient clinic setting over a fifteen-year period at the University of Minnesota (UMN) Masonic Children's Hospital Pediatric Infectious Diseases (PID) Clinic. A retrospective review of clinic appointments identified 253 unique patients specifically evaluated over this time period for consideration of CMV infection. Of these, 242 were pediatric patients. The majority of the pediatric patients evaluated in the PID clinic were referred for either confirmed or suspected cCMV infection, including children referred for consideration of CMV as a potential reason for a failed newborn hearing screen (NHS) and/or for evaluation of CMV as a possible etiology for documented hearing loss. In total, 116 of the children evaluated during this time period (48%) were unequivocally confirmed as having cCMV infection, with an additional 37 (15%) presenting with presumed, probable, or possible cCMV infection. A total of 16 (7%) of the pediatric CMV cases were confirmed to be post-natally acquired infections. Of the 253 total patients, 11 (4%) of the referrals were for pregnant patients seeking advice about potential therapies in the setting of a known or suspected primary maternal infection during their pregnancies, with an attendant risk of fetal CMV infection. This overview of the demographics and referral patterns for patients evaluated for known or suspected CMV infections in a tertiary care center outpatient PID clinic will serve as a useful baseline assessment, even as future patterns of outpatient care are highly likely to evolve. We predict that PID clinic referrals for newborns identified by universal cCMV screening programs will result in a shift of the CMV outpatient population to healthier infants with clinically inapparent infections, and care will need to be taken by practitioners not to over-medicalize management for these asymptomatic newborns.
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Affiliation(s)
- Katelyn J. Rypka
- University of Minnesota Medical School, 420 Delaware Street SE, Minneapolis, MN 55455, USA;
| | - Mark R. Schleiss
- Division of Infectious Diseases, Department of Pediatrics, University of Minnesota Medical School, 2001 6th Street SE, Minneapolis, MN 55455, USA
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Hernandez-Alvarado N, Bierle CJ, Schleiss MR. Droplet Digital PCR (ddPCR) Does Not Enhance the Sensitivity of Detection of Cytomegalovirus (CMV) DNA in Newborn Dried Blood Spots Evaluated in the Context of Newborn Congenital CMV (cCMV) Screening. Int J Neonatal Screen 2023; 10:1. [PMID: 38501568 PMCID: PMC10954086 DOI: 10.3390/ijns10010001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 12/14/2023] [Accepted: 12/18/2023] [Indexed: 03/20/2024] Open
Abstract
Congenital cytomegalovirus (cCMV) infection is a leading cause of sensorineural hearing loss (SNHL) and neurodevelopmental disabilities in children worldwide. Some regions in the United States and Canada have implemented universal newborn screening for cCMV, which requires molecular diagnostic technologies for identifying cCMV, such as PCR testing of newborn dried blood spots (DBS). This study aimed to evaluate the sensitivity of droplet digital PCR (ddPCR) compared to quantitative real-time PCR to detect CMV DNA in newborn DBS. The limit of detection of various ddPCR primer/probe combinations (singleplex UL55-HEX, singleplex UL83-FAM, and multiplex UL55-HEX/UL83-FAM) was evaluated using the National Institute of Standards and Technology's (NIST) CMV quantitative standard. Singleplex UL55-HEX ddPCR exhibited the lowest limit of detection among the primer/probe combinations tested for ddPCR. UL55 ddPCR was then compared to real-time PCR in 49 infants with confirmed cCMV identified through newborn screening for CMV in saliva swabs and confirmed by a urine test. The results showed that ddPCR was only positive for 59% (29 out of 49) of the cCMV infants, while real-time PCR was positive for 80% (39 out of 49). Due to its lower sensitivity and throughput, ddPCR may not be suitable for cCMV newborn screening.
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Affiliation(s)
| | | | - Mark R. Schleiss
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Minnesota Medical School, Minneapolis, MN 55455, USA; (N.H.-A.); (C.J.B.)
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Rollman TB, Berkebile ZW, Okae H, Bardwell VJ, Gearhart MD, Bierle CJ. Human Trophoblast Stem Cells Restrict Human Cytomegalovirus Replication. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.12.13.571456. [PMID: 38168202 PMCID: PMC10760179 DOI: 10.1101/2023.12.13.571456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
Placental infection plays a central role in the pathogenesis of congenital human cytomegalovirus (HCMV) infections and is a cause of fetal growth restriction and pregnancy loss. HCMV can replicate in some trophoblast cell types, but it remains unclear how the virus evades antiviral immunity in the placenta and how infection compromises placental development and function. Human trophoblast stem cells (TSCs) can be differentiated into extravillous trophoblasts (EVTs), syncytiotrophoblasts (STBs), and organoids, and this study assessed the utility of TSCs as a model of HCMV infection in the first trimester placenta. HCMV was found to non-productively infect TSCs, EVTs, and STBs. Immunofluorescence assays and flow cytometry experiments further revealed that infected TSCs frequently only express immediate early viral gene products. Similarly, RNA-sequencing found that viral gene expression in TSCs does not follow the kinetic patterns observed during lytic infection in fibroblasts. Canonical antiviral responses were largely not observed in HCMV-infected TSCs and TSC-derived trophoblasts. Rather, infection dysregulated factors involved in cell identity, differentiation, and WNT signaling. Thus, while HCMV does not replicate in TSCs, infection may perturb trophoblast differentiation in ways that could interfere with placental function. Importance Placental infection plays a central role in HCMV pathogenesis during pregnancy, but the species-specificity of HCMV and the limited availability and lifespan of primary trophoblasts have been persistent barriers to understanding how infection impacts this vital organ. Human TSCs represent a new approach to modeling viral infection early in placental development. This study reveals that TSCs, like other stem cell types, restrict HCMV replication. However, infection perturbs the expression of genes involved in differentiation and cell fate determination, pointing to a mechanism by which HCMV could cause placental injury.
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Wunderlich W, Sidebottom AC, Schulte AK, Taghon J, Dollard S, Hernandez-Alvarado N. The Use of Saliva Samples to Test for Congenital Cytomegalovirus Infection in Newborns: Examination of False-Positive Samples Associated with Donor Milk Use. Int J Neonatal Screen 2023; 9:46. [PMID: 37606483 PMCID: PMC10443263 DOI: 10.3390/ijns9030046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 07/20/2023] [Accepted: 08/09/2023] [Indexed: 08/23/2023] Open
Abstract
A universal screening research study was conducted in six hospitals to identify the clinical sensitivity of polymerase chain reaction (PCR) testing on newborn dried blood spots (DBSs) versus saliva specimens for the diagnosis of congenital cytomegalovirus (cCMV). CMV DNA positive results from DBSs or saliva were confirmed with urine testing. Findings of several false-positive (FP) saliva PCR results prompted an examination of a possible association with donor milk. Documentation of the frequency of positive saliva results, including both true-positive (TP) and FP status from clinical confirmation, occurred. The frequency of donor milk use was compared for TP and FP cases. Of 22,079 participants tested between 2016 and 2022, 96 had positive saliva results, 15 were determined to be FP, 79 TP, and 2 were excluded for incomplete clinical evaluation. Newborn donor milk use was identified for 18 (19.14%) of all the positive saliva screens. Among the 15 FPs, 11 (73.33%) consumed donor milk compared to 7 of the 79 TPs (8.8%) (OR 28.29, 95% CI 7.10-112.73, p < 0.001). While milk bank Holder pasteurization inactivates CMV infectivity, CMV DNA may still be detectable. Due to this possible association, screening programs that undertake testing saliva for CMV DNA may benefit from documenting donor milk use as a potential increased risk for FP results.
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Affiliation(s)
- Whitney Wunderlich
- Care Delivery Research, Allina Health, Minneapolis, MN 55410, USA; (A.C.S.); (A.K.S.); (J.T.)
| | - Abbey C. Sidebottom
- Care Delivery Research, Allina Health, Minneapolis, MN 55410, USA; (A.C.S.); (A.K.S.); (J.T.)
| | - Anna K. Schulte
- Care Delivery Research, Allina Health, Minneapolis, MN 55410, USA; (A.C.S.); (A.K.S.); (J.T.)
| | - Jessica Taghon
- Care Delivery Research, Allina Health, Minneapolis, MN 55410, USA; (A.C.S.); (A.K.S.); (J.T.)
| | - Sheila Dollard
- Division of Viral Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA;
| | - Nelmary Hernandez-Alvarado
- Division of Pediatric Infectious Diseases, Department of Pediatrics, University of Minnesota, Minneapolis, MN 55455, USA;
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Aldè M, Binda S, Primache V, Pellegrinelli L, Pariani E, Pregliasco F, Di Berardino F, Cantarella G, Ambrosetti U. Congenital Cytomegalovirus and Hearing Loss: The State of the Art. J Clin Med 2023; 12:4465. [PMID: 37445500 DOI: 10.3390/jcm12134465] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 06/29/2023] [Accepted: 07/02/2023] [Indexed: 07/15/2023] Open
Abstract
In developed countries, congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection, representing the leading non-genetic cause of sensorineural hearing loss (HL). Diagnosis of cCMV infection can be performed by detection of CMV DNA in urine or saliva within 2-3 weeks after birth, or later in dried blood samples on the Guthrie card. Currently, there are many controversies regarding the preventive, diagnostic, and therapeutic approaches to cCMV infection. HL secondary to cCMV is highly variable in onset, side, degree, audiometric configuration, and threshold changes over time. Therefore, it is of paramount importance to perform a long and thorough audiological follow-up in children with cCMV infection to ensure early identification and prompt treatment of progressive and/or late-onset HL. Early cochlear implantation appears to be a valid solution not only for children with bilateral profound HL, but also for those with single-sided deafness, improving localization ability and understanding speech in noisy environments. Moreover, the decision to apply a unilateral cochlear implant in children with cCMV is strengthened by the non-negligible possibility of hearing deterioration of the contralateral ear over time.
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Affiliation(s)
- Mirko Aldè
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Valeria Primache
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Fabrizio Pregliasco
- Department of Biomedical Sciences for Health, University of Milan, 20133 Milan, Italy
| | - Federica Di Berardino
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Giovanna Cantarella
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
- Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Umberto Ambrosetti
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy
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Almeida S, Gouveia P, Jorge A, Fortuna A, Binda S, Barbi M, Nascimento MSJ, Paixão P. Diagnosing congenital cytomegalovirus infections using archived dried blood spots: A 15-year observational study, Portugal. J Clin Virol 2023; 165:105516. [PMID: 37302249 DOI: 10.1016/j.jcv.2023.105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) is a leading cause of congenital infections. Dried blood spots (DBS) collected in the first week of life (Guthrie cards) have been used in the diagnosis of CMV infection outside the three-week window period following birth. The present work summarizes the results of a 15-year observational study in which DBS from 1388 children were used for a late diagnosis of congenital CMV infection. METHODS Three groups of children were studied: (i) symptomatic (with symptoms at birth or late sequelae) (N = 779); (ii) born to mothers with serological profile of primary CMV infection (N = 75); (iii) without any information (N = 534). A highly sensitive method of DNA extraction (heat-induced) from the DBS was used. CMV DNA was detected by a nested PCR. RESULTS In total CMV DNA was detected in 7.5% (104/1388) of children. Symptomatic children showed a low rate of CMV DNA detection (6.7%) than children born to mothers with serological profile of primary CMV infection (13.3%) (p = 0.034). Sensorial hearing loss and encephalopathy were the two clinical manifestations with the highest CMV detection rate (18.3% and 11.1%, respectively). Children whose mothers had a confirmed primary infection showed a higher rate of CMV detection (35.3%) when compared with children whose mothers had a not confirmed primary infection (6.9%) (p = 0.007). CONCLUSION The present work emphasises the importance of testing DBS in symptomatic children even a long time after symptoms onset and in children born to mothers with serologic diagnosis of maternal primary CMV infection when they miss the diagnosis during the three-week window following birth.
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Affiliation(s)
- Sofia Almeida
- CHUCB: Centro Hospitalar Cova da Beira, Covilhã, Portugal; CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | - Paula Gouveia
- CHUCB: Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | - Arminda Jorge
- CHUCB: Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | - Ana Fortuna
- Centro de Genética Médica Doutor Jacinto Magalhães, Centro Hospitalar Universitário de Santo António - Unit for Multidisciplinary Research in Biomedicine and Laboratory for Integrative and Translational Research in Population Health, Institute of Biomedical Sciences Abel Salazar, Portugal
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Barbi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Paulo Paixão
- Centro de Estudos de Doenças Crónicas, Faculdade de Ciências Médicas, NOVA Medical School, CEDOC, Campo Mártires da Pátria, 130, Lisboa 1169-056, Portugal.
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Clinical, Virologic and Immunologic Correlates of Breast Milk Acquired Cytomegalovirus (CMV) Infections in Very Low Birth Weight (VLBW) Infants in a Newborn Intensive Care Unit (NICU) Setting. Viruses 2021; 13:v13101897. [PMID: 34696327 PMCID: PMC8539954 DOI: 10.3390/v13101897] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Revised: 09/03/2021] [Accepted: 09/09/2021] [Indexed: 01/01/2023] Open
Abstract
Cytomegalovirus (CMV) infections acquired by very-low-birthweight (VLBW) infants are incompletely characterized. To examine CMV transmission in VLBW infants, we evaluated maternal DNAlactia, infant DNAemia, and presence of clinical disease in a blinded study in VLBW infants in our newborn intensive care unit (NICU). To examine these issues, 200 VLBW infants were enrolled in a surveillance study, with weekly breast milk and infant whole blood samples collected, as available. Virologic (breast milk and infant whole blood real time PCR) and immunologic (IgG, IgM, and IgG avidity) correlates were evaluated. A chart review examined whether infants had symptoms compatible with CMV disease. DNAlactia was identified in 65/150 (43%) of lactating mothers. Nine CMV infections were identified in 9/75 CMV-exposed infants (12% of exposed infants). A higher median breast milk viral load (DNAlactia) correlated with an increased likelihood of DNAemia (p = 0.05). Despite potential symptoms compatible with CMV infection, clinicians had not considered the diagnosis of CMV in 6/9 cases (66%). All of these infants had chronic lung disease at discharge. There was no correlation between IgG antibody titer or IgG avidity index and the likelihood of transmission or CMV disease. In conclusion, in VLBW infants receiving milk from seropositive mothers, CMV infections are commonly acquired, and are frequently unrecognized. Future studies are needed to determine whether routine surveillance for CMV of either breast milk or infant plasma is beneficial in preventing or recognizing infection.
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Núñez-Batalla F, Jáudenes-Casaubón C, Sequí-Canet JM, Vivanco-Allende A, Zubicaray-Ugarteche J, Olleta Lascarro I. New-born Hearing Screening Programmes in 2020: CODEPEH Recommendations. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021; 72:312-323. [PMID: 34535222 DOI: 10.1016/j.otoeng.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/18/2020] [Indexed: 10/20/2022]
Abstract
Programmes for early detection of congenital hearing loss have been successfully implemented mainly in developed countries, after overcoming some conceptual errors argued against their implementation and some criticism of their efficacy. However, some difficulties and weaknesses are still identified in these programmes: the detection of late-onset hearing loss and the percentage of children who did not pass the screening and did not complete the process of diagnosis and treatment, these being cases that are lost in the process. The purpose of this Document is to analyse these problems to determine areas for improvement and to emphasize one of the basic principles for the success of the programmes: continuous training for the interdisciplinary team. The result of the review process carried out by CODEPEH has been drafted as Recommendations for updating the Programmes with the evidence of the last decade, including advances in screening technology, the impact of the present knowledge on congenital infection by cytomegalovirus, genetic hearing loss research and control systems of lost to follow-up cases, treatment and follow up.
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Núñez-Batalla F, Jáudenes-Casaubón C, Sequí-Canet JM, Vivanco-Allende A, Zubicaray-Ugarteche J, Olleta Lascarro I. Programas de cribado de la hipoacusia congénita en 2020: recomendaciones CODEPEH. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2021. [DOI: 10.1016/j.otorri.2020.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Garbaruk ES, Fedorova LA, Savenko IV, Vikhnina SM, Boboshko MY. [Childhood hearing screening: achievements, difficulties, and possible ways to improve]. Vestn Otorinolaringol 2021; 86:82-89. [PMID: 33720658 DOI: 10.17116/otorino20218601182] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Hearing impairment is the most common sensory impairment that is seen among adults and children. The frequency of congenital hearing loss is well-known due to implementation of newborn hearing screening. Hearing may change throughout a lifetime due to different factors and, therefore, the number of hearing impaired children increases with age. Introduction of universal newborn hearing screening has enabled earlier detection of hearing loss including unilateral and minimal disorders. Nevertheless, despite significant progress made in this field, there is still a group of hearing impairments that stay undiagnosed timely. Auditory neuropathy spectrum disorders, late-onset hearing loss, low-frequency and minimal hearing impairment are sometimes missed in newborn hearing screening or they manifest later. These types of hearing disorders are covered in detail in this review as well as possible ways of increasing the effectiveness of early diagnosis.
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Affiliation(s)
- E S Garbaruk
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia.,Pavlov State Medical University, St. Petersburg, Russia
| | - L A Fedorova
- St. Petersburg State Pediatric Medical University, St. Petersburg, Russia
| | - I V Savenko
- Pavlov State Medical University, St. Petersburg, Russia
| | - S M Vikhnina
- Pavlov State Medical University, St. Petersburg, Russia
| | - M Yu Boboshko
- Pavlov State Medical University, St. Petersburg, Russia.,North-Western State Medical University named after I.I. Mechnikov, St. Petersburg, Russia
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Dollard SC, Dreon M, Hernandez-Alvarado N, Amin MM, Wong P, Lanzieri TM, Osterholm EA, Sidebottom A, Rosendahl S, McCann MT, Schleiss MR. Sensitivity of Dried Blood Spot Testing for Detection of Congenital Cytomegalovirus Infection. JAMA Pediatr 2021; 175:e205441. [PMID: 33523119 PMCID: PMC7851756 DOI: 10.1001/jamapediatrics.2020.5441] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE The sensitivity of dried blood spots (DBS) to identify newborns with congenital cytomegalovirus (cCMV) infection has not been evaluated in screening studies using the current, higher-sensitivity methods for DBS processing. OBJECTIVE To assess the sensitivity of DBS polymerase chain reaction (PCR) for newborn screening for cCMV infection using saliva as the reference standard for screening, followed by collection of a urine sample for confirmation of congenital infection. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study took place at 5 newborn nurseries and 3 neonatal intensive care units in the Minneapolis/Saint Paul area in Minnesota from April 2016 to June 2019. Newborns enrolled with parental consent were screened for cCMV using DBS obtained for routine newborn screening and saliva collected 1 to 2 days after birth. Dried blood spots were tested for CMV DNA by PCR at both the University of Minnesota (UMN) and the US Centers for Disease Control and Prevention (CDC). Saliva swabs were tested by CMV DNA PCR at the UMN laboratory only. Newborns who screened positive by saliva or DBS had a diagnostic urine sample obtained by primary care professionals, tested by PCR within 3 weeks of birth. Analysis began July 2019. EXPOSURES Detection of CMV from a saliva swab using a PCR assay. MAIN OUTCOMES AND MEASURES Number of children with urine-confirmed cCMV and the proportion of them who were CMV positive through DBS screening. RESULTS Of 12 554 individuals enrolled through June 2019 (of 25 000 projected enrollment), 56 newborns were confirmed to have cCMV (4.5 per 1000 [95% CI, 3.3-5.7]). Combined DBS results from either UMN or CDC had a sensitivity of 85.7% (48 of 56; 95% CI, 74.3%-92.6%), specificity of 100.0% (95% CI, 100.0%-100.0%), positive predictive value (PPV) of 98.0% (95% CI, 89.3%-99.6%), and negative predictive value (NPV) of 99.9% (95% CI, 99.9%-100.0%). Dried blood spot results from UMN had a sensitivity of 73.2% (95% CI, 60.4%-83.0%), specificity of 100.0% (100.0%-100.0%), PPV of 100.0% (95% CI, 91.4%-100.0%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Dried blood spot results from CDC had a sensitivity of 76.8% (95% CI, 64.2%-85.9%), specificity of 100.0% (95% CI, 100.0%-100.0%), PPV of 97.7% (95% CI, 88.2%-99.6%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Saliva swab results had a sensitivity of 92.9% (52 of 56; 95% CI, 83.0%-97.2%), specificity of 99.9% (95% CI, 99.9%-100.0%), PPV of 86.7% (95% CI, 75.8%-93.1%), and NPV of 100.0% (95% CI, 99.9%-100.0%). CONCLUSIONS AND RELEVANCE This study demonstrates relatively high analytical sensitivity for DBS compared with previous studies that performed population-based screening. As more sensitive DNA extraction and PCR methods continue to emerge, DBS-based testing should remain under investigation as a potential low-cost, high-throughput option for cCMV screening.
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Affiliation(s)
| | - Maggie Dreon
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Nelmary Hernandez-Alvarado
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis
| | - Minal M. Amin
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Phili Wong
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Erin A. Osterholm
- Division of Neonatology, University of Minnesota Medical School, Minneapolis
| | | | - Sondra Rosendahl
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Mark T. McCann
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Mark R. Schleiss
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis
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Prospective multicenter comparison of urine culture with PCR on dried blood spots using 2 different extraction and PCR methods in neonates suspected for congenital cytomegalovirus infection. Diagn Microbiol Infect Dis 2020; 97:115051. [DOI: 10.1016/j.diagmicrobio.2020.115051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/21/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022]
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18
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Yamamoto AY, Anastasio ART, Massuda ET, Isaac ML, Manfredi AKS, Cavalcante JMS, Carnevale-Silva A, Fowler KB, Boppana SB, Britt WJ, Mussi-Pinhata MM. Contribution of Congenital Cytomegalovirus Infection to Permanent Hearing Loss in a Highly Seropositive Population: The Brazilian Cytomegalovirus Hearing and Maternal Secondary Infection Study. Clin Infect Dis 2020; 70:1379-1384. [PMID: 31102409 PMCID: PMC7931844 DOI: 10.1093/cid/ciz413] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 05/16/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The exact contribution of congenital cytomegalovirus infection (cCMVI) to permanent hearing loss (HL) in highly seropositive populations is unknown. We determined the contribution of cCMVI to HL and estimated the effectiveness of newborn hearing screening (HS) in identifying neonates with CMV-related HL. METHODS A total of 11 900 neonates born from a population with ≥97% maternal seroprevalence were screened for cCMVI and HL. cCMVI was confirmed by detection of CMV-DNA in saliva and urine at age <3 weeks. RESULTS Overall, 68 (0.6%; 95% confidence interval [CI], 0.4-0.7) neonates were identified with cCMVI. Of the 91 (0.8%) newborns who failed the HS, 24 (26.4%) were confirmed with HL, including 7 (29.2%; 95% CI, 17.2-59.3) with cCMVI. Another newborn with cCMVI passed the HS but was confirmed with HL at age 21 days. Of the 62 neonates with cCMVI who underwent a complete hearing evaluation, 8 (12.9%; 95% CI, 6.7-23.4) had HL and most (7/8; 87.5%; 95% CI, 46.6-99.7) were identified by HS. The rate of CMV-related HL was 8 per 11 887 neonates (0.7 per 1000 live births). The prevalence ratio of HL among neonates with cCMVI compared to CMV-uninfected neonates was 89.5 (95% CI, 39.7-202.0). No late-onset cCMVI-related HL was detected during a median follow-up of 36 months. CONCLUSIONS cCMVI is an important cause of HL in childhood in all settings. Integrating targeted cCMVI screening among neonates who fail a HS could be a reasonable, cost-effective strategy to identify newborns with early-onset cCMVI-related HL.
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Affiliation(s)
- Aparecida Y Yamamoto
- Department of Pediatrics, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Adriana R T Anastasio
- Department of Health Sciences, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Eduardo T Massuda
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Myriam L Isaac
- Department of Ophthalmology, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Alessandra K S Manfredi
- Department of Health Sciences, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Juliana M S Cavalcante
- Department of Health Sciences, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Adriana Carnevale-Silva
- Department of Pediatrics, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
| | - Karen B Fowler
- Department of Pediatrics, University of Alabama School of Medicine, Birmingham
| | - Suresh B Boppana
- Department of Pediatrics, University of Alabama School of Medicine, Birmingham
| | - William J Britt
- Department of Pediatrics, University of Alabama School of Medicine, Birmingham
| | - Marisa M Mussi-Pinhata
- Department of Pediatrics, Otorhinolaryngology, and Head and Neck Surgery, Ribeirão Preto Medical School, University of São Paulo, Brazil
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Pellegrinelli L, Alberti L, Pariani E, Barbi M, Binda S. Diagnosing congenital Cytomegalovirus infection: don't get rid of dried blood spots. BMC Infect Dis 2020; 20:217. [PMID: 32164599 PMCID: PMC7069171 DOI: 10.1186/s12879-020-4941-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background Congenital Cytomegalovirus (cCMV) is a serious global public health issue that can cause irreversible fetal and neonatal congenital defects in symptomatic or asymptomatic newborns at birth. In absence of universal cCMV screening, the retrospective diagnosis of cCMV infection in children is only possible by examining Dried Blood Spot (DBS) samples routinely collected at birth and stored for different time spans depending on the newborn screening regulations in force in different countries. In this article, we summarize the arguments in favor of long-term DBS sample storage for detecting cCMV infection. Main text CMV infection is the most common cause of congenital infection resulting in severe defects and anomalies that can be apparent at birth or develop in early childhood. Sensorineural hearing loss is the most frequent consequence of cCMV infection and may have a late onset and progress in the first years of life. The virological diagnosis of cCMV is essential for clinical research and public health practices. In fact, in order to assess the natural history of CMV infection and distinguish between congenital or acquired infection, children should be diagnosed early by analyzing biological samples collected in the first weeks of life (3 weeks by using viral culture and 2 weeks by molecular assays), which, unfortunately, are not always available for asymptomatic or mildly symptomatic children. It now seems possible to overcome this problem since the CMV-DNA present in the blood of congenitally infected newborns can be easily retrieved from the DBS samples on the Guthrie cards routinely collected and stored within 3 days from birth in the neonatal screening program for genetic and congenital diseases. Early collection and long-term storage are inexpensive methods for long-term bio-banking and are the key points of DBS testing for the detection of cCMV. Conclusion DBS sampling is a reliable and inexpensive method for long-term bio-banking, which enables to diagnose known infectious diseases - including cCMV - as well as diseases not jet recognized, therefore their storage sites and long-term storage conditions and durations should be the subject of political decision-making.
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Affiliation(s)
- Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Luisella Alberti
- Newborn Screening Laboratory, ASST Fatebenefratelli Sacco-PO Ospedale dei Bambini "V. Buzzi", Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Barbi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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20
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Zhang XY, Fang F. Congenital human cytomegalovirus infection and neurologic diseases in newborns. Chin Med J (Engl) 2020; 132:2109-2118. [PMID: 31433331 PMCID: PMC6793797 DOI: 10.1097/cm9.0000000000000404] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
Objective: This review aimed to summarize research progress regarding congenital cytomegalovirus (cCMV) infection-related nervous system diseases and their mechanisms. Data sources: All literature quoted in this review was retrieved from PubMed and Web of Science using the keywords “Cytomegalovirus” and “Neurologic disease” in English. To identify more important information, we did not set time limits. Study selection: Relevant articles were selected by carefully reading the titles and abstracts. Then, different diagnosis and clinical treatment methods for human CMV infection-related neurologic diseases were compared, and the main mechanism and pathogenesis of neurologic damage caused by CMV were summarized from the selected published articles. Results: cCMV infection is a major cause of neonatal malformation. cCMV can infect the fetal encephalon during early gestation and compromise neurodevelopment, resulting in varying degrees of neurologic damage, mainly including hearing impairment, central nervous system (CNS) infection, neurodevelopmental disorders, ophthalmic complications, cerebral neoplasms, infantile autism, epilepsy, and other neurologic abnormalities. Conclusions: cCMV infection-induced neurodevelopmental abnormalities, which were directly caused by fetal encephalon infection, thus inducing neuroimmune responses to damage nerve cells. Such abnormalities were also caused by suppression of the proliferation and differentiation of neural progenitor cells by CMV's gene products. cCMV infection in the fetal encephalon can also inhibit neuronal migration and synapse formation and indirectly trigger placental inflammation and thus disrupt the oxygen supply to the fetus.
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Affiliation(s)
- Xin-Yan Zhang
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, China
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21
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Peterson J, Nishimura C, Smith RJH. Genetic Testing for Congenital Bilateral Hearing Loss in the Context of Targeted Cytomegalovirus Screening. Laryngoscope 2020; 130:2714-2718. [PMID: 31985074 DOI: 10.1002/lary.28536] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2019] [Revised: 12/19/2019] [Accepted: 12/24/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS To determine the prevalence of children with genetic hearing loss who are cytomegalovirus (CMV) positive at birth and the relative proportion of genetic and CMV etiology among children with congenital bilateral hearing loss. STUDY DESIGN Database review. METHODS We performed a review of clinical test results for patients undergoing comprehensive genetic testing for all known hearing loss-associated genes from January 2012 to January 2019. This population was reviewed for reported CMV status and genetic causes of congenital bilateral hearing loss. RESULTS In the OtoSCOPE database, 61/4,282 patients were found to have a documented CMV status, and 661/4282 had documented bilateral congenital hearing loss. Two patients were identified who had both a positive CMV result and a genetic cause for their hearing loss. Forty-eight percent of patients with bilateral congenital hearing loss (320/661) were found to have a genetic etiology. In 62% (198/320), the hearing loss was associated with pathogenic variants in GJB2, STRC, SLC26A4 or an Usher syndrome-associated gene. CONCLUSIONS We estimate that ~2% of CMV-positive newborns with hearing loss have a known genetic variant as a cause. The subcohort of CMV-positive newborns with symmetric mild-to-moderate bilateral hearing loss will have at least a 7% chance of having pathogenic gene variants associated with hearing loss. In a CMV-positive neonate who failed their newborn hearing screen bilaterally, genetic screening needs to be considered for accurate diagnosis and possible deferment of antiviral treatment. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2714-2718, 2020.
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Affiliation(s)
- Joseph Peterson
- Department of Otolaryngology-Head and Neck Surgery, Molecular Otolaryngology and Renal Research Labs, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Carla Nishimura
- Department of Otolaryngology-Head and Neck Surgery, Molecular Otolaryngology and Renal Research Labs, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
| | - Richard J H Smith
- Department of Otolaryngology-Head and Neck Surgery, Molecular Otolaryngology and Renal Research Labs, University of Iowa Hospitals and Clinics, Iowa City, Iowa, U.S.A
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Pellegrinelli L, Galli C, Primache V, Alde' M, Fagnani E, Di Berardino F, Zanetti D, Pariani E, Ambrosetti U, Binda S. Diagnosis of congenital CMV infection via DBS samples testing and neonatal hearing screening: an observational study in Italy. BMC Infect Dis 2019; 19:652. [PMID: 31331274 PMCID: PMC6647195 DOI: 10.1186/s12879-019-4296-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 07/17/2019] [Indexed: 11/25/2022] Open
Abstract
Background Congenital Cytomegalovirus (cCMV) is the most common cause of non-genetic hearing loss in childhood. A newborn hearing screening program (NHSP) is currently running in Italy, but no universal cCMV nor statewide hearing-targeted CMV screening programs have been implemented yet. This observational monocentric study was aimed at estimating the rate of cCMV infections identified by CMV-DNA analysis on Dried Blood Spots (DBS) samples in deaf children identified via NHSP in Northern Italy in the period spanning from 2014 to 2018. Methods Children with a confirmed diagnosis of deafness and investigated for CMV-DNA by nucleic acid extraction and in-house polymerase-chain reaction (PCR) on stored newborns screening cards (DBS-test) were included in this study. Deafness was defined by a hearing threshold ≥20 decibel (dB HL) by Auditory Brainstem Responses (ABR); all investigated DBS samples were collected within 3 days of life. Results Overall, 82 children were included (median age: 3.4 months; lower-upper quartiles: 2–5.3 months; males: 60.9%). Most of them (70.7%) presented bilateral hearing loss with a symmetrical pattern in 79.3% of the cases. ABR thresholds were ≥ 70 dB HL (severe/profound deafness) in 46.5% of children. Among all tested children, 6.1% resulted positive for cCMV. The rate of severe/profound deafness was statistically higher in children with cCMV infection. Conclusions The addition of DBS-test to the NHSP allowed the identification, in their first months of life, of a cCMV infection in 6.1% of children who had failed NHS. The introduction of a targeted CMV screening strategy could help clinicians in the differential diagnosis and in the babies’ management. DBS samples can be considered a “universal newborns biobank”: their storage site and duration should be the subject of political decision-making.
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Affiliation(s)
- Laura Pellegrinelli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal, 36, 20133, Milan, Italy.
| | - Cristina Galli
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal, 36, 20133, Milan, Italy
| | - Valeria Primache
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal, 36, 20133, Milan, Italy
| | - Mirko Alde'
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.,U.O.S.D di Audiologia, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Enrico Fagnani
- U.O.S.D di Audiologia, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Federica Di Berardino
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.,U.O.S.D di Audiologia, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Diego Zanetti
- U.O.S.D di Audiologia, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Elena Pariani
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal, 36, 20133, Milan, Italy
| | - Umberto Ambrosetti
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, Milan, Italy.,U.O.S.D di Audiologia, Fondazione I.R.C.C.S. Ca' Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
| | - Sandro Binda
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Via Carlo Pascal, 36, 20133, Milan, Italy
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23
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Lee ER, Chan DK. Implications of dried blood spot testing for congenital CMV on management of children with hearing loss: A preliminary report. Int J Pediatr Otorhinolaryngol 2019; 119:10-14. [PMID: 30660013 DOI: 10.1016/j.ijporl.2018.12.029] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Revised: 12/17/2018] [Accepted: 12/19/2018] [Indexed: 11/25/2022]
Abstract
INTRODUCTION Non-genetic, congenital sensorineural hearing loss (cSNHL) is commonly caused by congenital CMV infection (cCMV). Hearing loss related to cCMV is variable in degree, often progressive, and can affect one or both ears. OBJECTIVES We sought to examine the outcomes of DBS testing in California, and the hearing outcomes of cCMV-positive children. METHODS This is a retrospective study of patients with SNHL of unknown etiology aged 6 months to 17 years old presenting to a tertiary care pediatric center and evaluated for cCMV by DBS testing. RESULTS 114 children (228 ears) with SNHL of unknown origin were included. 6/114 (5.3%) tested positive for cCMV versus 108/114 (94.7%), who tested negative. None of the cCMV-positive children had symmetric bilateral hearing loss, compared with 56.5% (61/108) of cCMV-negative children (p < 0.05). cCMV-positive children were more likely to have profound SNHL in the worse-hearing ear (5/6 (83%) vs 16/108 (14.9%) of cCMV-negative children, p < 0.001). 86% (5/6) exhibited progressive hearing loss, including progression or new-onset hearing loss in the previously better hearing ear. 3 of the 6 children with cCMV underwent CI. CONCLUSION A small proportion of patients presenting with SNHL tested positive on DBS. Of cCMV-positive children, most presented with profound hearing loss in the worse-hearing ear, and 50% of cCMV-positive children developed progressive hearing loss in the initially better-hearing ear. Prognostic information afforded by etiologic confirmation of cCMV infection informed decision-making concerning cochlear implantation in these cases.
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Affiliation(s)
- Edward R Lee
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA
| | - Dylan K Chan
- Division of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, USA.
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Wroblewska-Seniuk K, Dabrowski P, Greczka G, Szabatowska K, Glowacka A, Szyfter W, Mazela J. Sensorineural and conductive hearing loss in infants diagnosed in the program of universal newborn hearing screening. Int J Pediatr Otorhinolaryngol 2018; 105:181-186. [PMID: 29447811 DOI: 10.1016/j.ijporl.2017.12.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The aim of this study was to analyze infants diagnosed with sensorineural or conductive hearing deficit and to identify risk factors associated with these defects. MATERIAL AND METHODS A retrospective analysis of infants diagnosed with hearing deficit based on the database of the universal newborn hearing screening program and medical records of the patients. RESULTS 27 935 infants were covered by the universal neonatal hearing screening program. 109 (0.39%) were diagnosed with hearing deficit and referred for treatment and rehabilitation. 56 (51.4%) children were diagnosed with conductive, 38 (34.9%) with sensorineural and 15 (13.8%) with mixed type of hearing deficit. Children with sensorineural hearing deficit more frequently suffered from hyperbilirubinemia (p < 0.05), while infants with conductive hearing loss were more frequently diagnosed with isolated craniofacial anomalies (p < 0.05). The prevalence of other risk factors did not differ between the groups. Sensorineural hearing deficit occurred almost 3 times more often bilaterally than unilaterally (p < 0.05). In other types of hearing deficit, the difference was not significant. In children with conductive and mixed type of hearing loss the impairment was mainly mild while among those with sensorineural hearing deficit in almost 45% it was severe and profound (p < 0.05). When analyzing the consistency between hearing screening test by means of otoacoustic emissions and the final diagnosis of hearing deficit we found that the highest agreement rate was observed in children with sensorineural hearing loss (p < 0.01). CONCLUSIONS The prevalence of most risk factors of hearing deficit was similar in children with sensorineural, conductive and mixed type of hearing loss, only hyperbilirubinemia seemed to predispose to sensorineural hearing deficit and isolated craniofacial malformations seemed to be associated with conductive hearing loss. Sensorineural hearing deficit usually occurred bilaterally and was severe or profound, while conductive and mixed type of hearing deficit were most often of mild degree. Most children with the final diagnosis of sensorineural hearing deficit had positive result of hearing screening by means of otoacoustic emissions.
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Affiliation(s)
- Katarzyna Wroblewska-Seniuk
- Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, ul. Polna 33, 60-535 Poznan, Poland.
| | - Piotr Dabrowski
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, ul. Przybyszewskiego 39, 60-101 Poznan, Poland
| | - Grazyna Greczka
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, ul. Przybyszewskiego 39, 60-101 Poznan, Poland
| | - Katarzyna Szabatowska
- Students' Research Circle at the Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland, ul. Polna 33, 60-535 Poznan, Poland
| | - Agata Glowacka
- Students' Research Circle at the Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland, ul. Polna 33, 60-535 Poznan, Poland
| | - Witold Szyfter
- Department of Otolaryngology and Oncological Laryngology, Poznan University of Medical Sciences, ul. Przybyszewskiego 39, 60-101 Poznan, Poland
| | - Jan Mazela
- Department of Newborns' Infectious Diseases, Poznan University of Medical Sciences, ul. Polna 33, 60-535 Poznan, Poland
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