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Leruez-Ville M, Chatzakis C, Lilleri D, Blazquez-Gamero D, Alarcon A, Bourgon N, Foulon I, Fourgeaud J, Gonce A, Jones CE, Klapper P, Krom A, Lazzarotto T, Lyall H, Paixao P, Papaevangelou V, Puchhammer E, Sourvinos G, Vallely P, Ville Y, Vossen A. Consensus recommendation for prenatal, neonatal and postnatal management of congenital cytomegalovirus infection from the European congenital infection initiative (ECCI). Lancet Reg Health Eur 2024; 40:100892. [PMID: 38590940 PMCID: PMC10999471 DOI: 10.1016/j.lanepe.2024.100892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 03/12/2024] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
Congenital cytomegalovirus (cCMV) infection carries a significant burden with a 0.64% global prevalence and a 17-20% chance of serious long-term effects in children. Since the last guidelines, our understanding, particularly regarding primary maternal infections, has improved. A cCMV guidelines group was convened under the patronage of the European Society of Clinical Virology in April 2023 to refine these insights. The quality and validity of selected studies were assessed for potential biases and the GRADE framework was employed to evaluate quality of evidence across key domains. The resulting recommendations address managing cCMV, spanning prevention to postnatal care. Emphasizing early and accurate maternal diagnosis through serological tests enhances risk management and prevention strategies, including using valaciclovir to prevent vertical transmission. The guidelines also strive to refine personalized postnatal care based on risk assessments, ensuring targeted interventions for affected families.
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Affiliation(s)
- Marianne Leruez-Ville
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Christos Chatzakis
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
- Second Department of Obstetrics and Gynecology of Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Daniele Lilleri
- Microbiology and Virology Unit, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Daniel Blazquez-Gamero
- Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Instituto de Investigación Hospital 12 de Octubre (imas12), Universidad Complutense, Madrid, Spain
| | - Ana Alarcon
- Department of Neonatology, Hospital Hospital Sant Joan de Déu, BCNatal (Barcelona Center for Maternal, Fetal and Neonatal Medicine), Institut de Recerca Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain
| | - Nicolas Bourgon
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Ina Foulon
- Department of Otorhinolaryngology and Head & Neck Surgery, Vrije Universiteit Brussels, University Hospital UZ Brussel, Brussels Health Campus. De Poolster, Rehabilitation Centre, Brussels, Belgium
| | - Jacques Fourgeaud
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Virology Laboratory, Reference Laboratory for Cytomegalovirus Infections, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Anna Gonce
- BCNatal: Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Universitat de Barcelona, Barcelona, Spain
| | - Christine E. Jones
- Faculty of Medicine and Institute for Life Sciences, University of Southampton and NIHR Southampton Clinical Research Facility and NIHR Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, United Kingdom
| | - Paul Klapper
- Microbiology and Virology Unit (EIGen), School of Biological Sciences, University of Manchester, Manchester, M139PT, UK
| | - André Krom
- Department of Medical Ethics and Health Law, Leiden University Medical Center, Leiden, the Netherlands
| | - Tiziana Lazzarotto
- Microbiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | | | - Paulo Paixao
- CHRC, NOVA Medical School/Faculdade de Ciências Médicas, Universidade NOVA de Lisboa, 1169-056, Lisbon, Portugal
| | - Vassiliki Papaevangelou
- Third Department of Pediatrics, School of Medicine, National and Kapodistrian University of Athens, Greece
| | | | - George Sourvinos
- Laboratory of Clinical Virology, Medical School, University of Crete, Heraklion, Crete, 71003, Greece
| | - Pamela Vallely
- Microbiology and Virology Unit (EIGen), School of Biological Sciences, University of Manchester, Manchester, M139PT, UK
| | - Yves Ville
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France
- Obstetrics, Fetal Medicine Surgery and Imaging Unit, Hôpital Necker Enfants Malades, GHU Paris Centre, AP-HP, Paris, France
| | - Ann Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, the Netherlands
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Corazzi V, Fordington S, Brown TH, Donnelly N, Bewick J, Ehsani D, Pelucchi S, Bianchini C, Ciorba A, Borsetto D. Late-onset, progressive sensorineural hearing loss in the paediatric population: a systematic review. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08527-x. [PMID: 38411671 DOI: 10.1007/s00405-024-08527-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 02/05/2024] [Indexed: 02/28/2024]
Abstract
PURPOSE To review possible risk factors for permanent delayed-onset, progressive sensorineural hearing loss (SNHL) in the paediatric population to recommend follow-up protocols for early detection. METHODS PRISMA-compliant systematic review was performed, including observational studies on the paediatric population up to 16 years old who have passed the newborn hearing screening programme (NHSP), investigating the development of late-onset, progressive SNHL. Electronic searches were performed through Medline, Embase, Cochrane, and Emcare. RESULTS 37 studies were included. 21 showed an association between late-onset SNHL and congenital cytomegalovirus (cCMV) infection (age at hearing loss diagnosis 0.75 to 204 months, mean 45.6 ± 43.9), while 16 between late-onset SNHL and other congenital or perinatal factors, namely Neonatal Intensive Care Unit (NICU) stay, prematurity, neonatal respiratory failure, mechanical ventilation, extracorporeal membrane oxygenation (ECMO) support, hypocapnia, hypoxia, alkalosis, seizure activity, congenital diaphragmatic hernia (CDH), inner ear malformation, and gene mutations (age at hearing loss diagnosis 2.5 to 156 months, mean 38.7 ± 40.7). CONCLUSIONS cCMV infection may cause late-onset SNHL, which can be missed on standard NHSP. There is, therefore, evidence to support universal screening programmes to enable detection in even asymptomatic neonates. Ongoing audiological follow-up for all children with cCMV is advisable, to enable timely treatment. In the paediatric population presenting conditions such as NICU stay > 5 days, prematurity ≤ 34 weeks gestation, severe neonatal respiratory failure, mechanical ventilation, ECMO support, and CDH surgery, an audiological follow-up from 3 months of age up to at least 3-4 years of age, and at least annually, should be recommended.
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Affiliation(s)
- Virginia Corazzi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Surina Fordington
- Department of Paediatrics, Cambridge University Hospitals, Hills Road, Cambridge, UK
| | | | - Neil Donnelly
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Jessica Bewick
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Diana Ehsani
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Stefano Pelucchi
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Chiara Bianchini
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy
| | - Andrea Ciorba
- ENT and Audiology Unit, Department of Neurosciences and Rehabilitation, University Hospital of Ferrara, Via Aldo Moro, 8, 44124, Ferrara, Cona, Italy.
| | - Daniele Borsetto
- Department of ENT, Addenbrookes Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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Fourgeaud J, Nguyen CÂ, Guilleminot T, Ville Y, Leruez-Ville M. Comparison of two serological screening strategies for cytomegalovirus primary infection in the first trimester of pregnancy. J Clin Virol 2023; 169:105614. [PMID: 37982548 DOI: 10.1016/j.jcv.2023.105614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Revised: 10/20/2023] [Accepted: 10/22/2023] [Indexed: 11/21/2023]
Abstract
INTRODUCTION CMV serology screening in the first trimester pregnancy is based on IgG and IgM testing followed by IgG avidity in cases with positive IgM. However, the sensitivity of this strategy to diagnose maternal primary infection has been questioned. The objective of the study was to compare this strategy 1 with a strategy 2 consisting of running avidity test on all samples with positive IgG (ignoring IgM results) using fully automated current generation CMV IgG, IgM and IgG avidity assays. POPULATION AND METHODS 1516 consecutive pregnant women between 12 and 14 weeks were screened in one maternity. Strategy 1 was done prospectively with LIAISON® CMV IgG II and LIAISON® CMV IgM II, followed by LIAISON® CMV IgG Avidity II and VIDAS® CMV IgG avidity II testing in cases with positive or equivocal IgM. Strategy 2 was done retrospectively on the same population and consisted of running avidity with the LIAISON® CMV IgG Avidity II in all samples with positive IgG. RESULTS The sensitivity to diagnose a confirmed or a possible maternal primary infection in the first trimester was 91.6 % and 83 % for strategy 1 and 2 respectively (p > 0.99). Strategy 1 missed one possible primary infection and strategy 2 missed 2 confirmed primary infection. Inconclusive results happened in 0 and 0.7 % of samples with strategy 1 and 2 respectively. CONCLUSION This study suggests that strategy 1 has better sensitivity and practicability than strategy 2. However, to achieve a good performance with strategy 1, using highly sensitive IgM assay is mandatory.
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Affiliation(s)
- Jacques Fourgeaud
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France; Virology Laboratory, Reference Laboratory for cytomegalovirus infections, AP-HP, Hôpital Necker Enfants Malades, F-75015, Paris, France.
| | - Chiêu-Ân Nguyen
- Virology Laboratory, Reference Laboratory for cytomegalovirus infections, AP-HP, Hôpital Necker Enfants Malades, F-75015, Paris, France
| | - Tiffany Guilleminot
- Virology Laboratory, Reference Laboratory for cytomegalovirus infections, AP-HP, Hôpital Necker Enfants Malades, F-75015, Paris, France
| | - Yves Ville
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France; AP-HP, Hôpital Necker Enfants Malades, Maternity, Paris, 75015, France
| | - Marianne Leruez-Ville
- Université Paris Cité, URP 7328 FETUS, F-75015, Paris, France; Virology Laboratory, Reference Laboratory for cytomegalovirus infections, AP-HP, Hôpital Necker Enfants Malades, F-75015, Paris, France.
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Park H, Kim DR, Shin A, Jeong E, Son S, Ahn JH, Ahn SY, Choi SJ, Oh SY, Chang YS, Kim YJ, Kang M. Loop-mediated isothermal amplification assay for screening congenital cytomegalovirus infection in newborns. Appl Microbiol Biotechnol 2023; 107:6789-6798. [PMID: 37725139 PMCID: PMC10589182 DOI: 10.1007/s00253-023-12771-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 08/17/2023] [Accepted: 09/02/2023] [Indexed: 09/21/2023]
Abstract
Congenital cytomegalovirus (CMV) infection is a common cause of sensorineural hearing loss and neurodevelopmental impairment in newborns. However, congenital CMV infection cannot be diagnosed using samples collected more than 3 weeks after birth because testing after this time cannot distinguish between congenital infection and postnatal infection. Herein, we developed a robust loop-mediated isothermal amplification (LAMP) assay for the large-scale screening of newborns for congenital CMV infection. In contrast to conventional quantitative polymerase chain reaction (qPCR), which detects CMV within a dynamic range of 1.0 × 106 to 1.0 × 102 copies/μL, our quantitative LAMP assay (qLAMP) detects CMV within a dynamic range of 1.1 × 108 to 1.1 × 103 copies/μL. Moreover, the turnaround time for obtaining results following DNA extraction is 90 min in qPCR but only 15 min in qLamp. The colorimetric LAMP assay can also detect CMV down to 1.1 × 103 copies/μL within 30 min, irrespective of the type of heat source. Our LAMP assay can be utilized in central laboratories as an alternative to conventional qPCR for quantitative CMV detection, or for point-of-care testing in low-resource environments, such as developing countries, via colorimetric naked-eye detection. KEY POINTS: • LAMP assay enables large-scale screening of newborns for congenital CMV infection. • LAMP allows colorimetric or quantitative detection of congenital CMV infection. • LAMP assay can be used as a point-of-care testing tool in low-resource environments.
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Affiliation(s)
- Hyeonseek Park
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Doo Ri Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Areum Shin
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Eunjung Jeong
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Seoul, Republic of Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Sohee Son
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Jin-Hyun Ahn
- Department of Microbiology, Sungkyunkwan University School of Medicine, Suwon, Republic of Korea
| | - So Yoon Ahn
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Suk-Joo Choi
- Department of Gynecology and Obstetrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Soo-Young Oh
- Department of Gynecology and Obstetrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yun Sil Chang
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Yae-Jean Kim
- Department of Pediatrics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
- Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
| | - Minhee Kang
- Biomedical Engineering Research Center, Smart Healthcare Research Institute, Samsung Medical Center, Seoul, Republic of Korea.
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Science & Technology, Sungkyunkwan University, Seoul, Republic of Korea.
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Keymeulen A, De Leenheer E, Casaer A, Cossey V, Laroche S, Mahieu L, Oostra A, Van Mol C, Dhooge I, Smets K. Neurodevelopmental outcome in children with congenital cytomegalovirus infection: A prospective multicenter cohort study. Early Hum Dev 2023; 182:105777. [PMID: 37187139 DOI: 10.1016/j.earlhumdev.2023.105777] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 03/13/2023] [Accepted: 04/18/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Congenital cytomegalovirus infection (cCMV) is the most common congenital infection worldwide and is a major cause of neurodevelopmental impairment in children. At this point there are insufficient data on neurodevelopmental outcome of children with cCMV, both symptomatic and asymptomatic. AIM This study aimed to describe the neurodevelopmental outcome in a large prospective cohort of children with cCMV. METHODS All children with cCMV, included in the Flemish cCMV register, were eligible for this study. Data on neurodevelopmental outcome was available in 753 children. Data on neuromotor, cognitive, behavioral, audiological and ophthalmological outcome were analyzed. RESULTS Neurodevelopmental outcome was normal in 530/753 (70,4 %) at any age of last follow-up. Mild, moderate and severe neurodevelopmental impairment was found in 128/753 (16,9 %), 56/753 (7,4 %) and 39/753 (5,2 %), respectively. Adverse outcome is found both in the symptomatic and asymptomatic children (53,5 % versus 17,8 %). Autism spectrum disorder (ASD) was diagnosed more often than in the general population in Flanders (2,5 % versus 0,7 %). Speech and language impairment was found in 2 %, even in absence of hearing loss. CONCLUSION Both symptomatic and asymptomatic cCMV children are at risk of sequelae, with higher risk in case of first trimester infection. During follow-up of this population, special attention should be given to the audiological follow-up, the presence of hypotonia at young age, the possible higher risk of ASD and the risk of speech and language impairment even in absence of hearing loss. Our results emphasize the need for multidisciplinary neurodevelopmental follow-up of all cCMV infected children.
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Affiliation(s)
- A Keymeulen
- Department of neonatology, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - E De Leenheer
- Department of ear-nose-throat, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - A Casaer
- COS Ghent, Department of neonatology, AZ Sint Jan Bruges, Ruddershove 10, 8000 Bruges, Belgium.
| | - V Cossey
- Department of neonatology, University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - S Laroche
- Department of neonatology, Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - L Mahieu
- Department of neonatology, Antwerp University Hospital, Antwerp University, Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - A Oostra
- COS Ghent, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - C Van Mol
- Department of neonatology, GZA Antwerp, Oosterveldlaan 24, 2610 Wilrijk, Belgium.
| | - I Dhooge
- Department of ear-nose-throat, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - K Smets
- Department of neonatology, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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Ben Shoham A, Schlesinger Y, Miskin I, Kalderon Z, Michelson-Cohen R, Wiener-Well Y. Cytomegalovirus (CMV) seroprevalence among women at childbearing age, maternal and congenital CMV infection: policy implications of a descriptive, retrospective, community-based study. Isr J Health Policy Res 2023; 12:16. [PMID: 37098565 PMCID: PMC10131385 DOI: 10.1186/s13584-023-00566-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 04/20/2023] [Indexed: 04/27/2023] Open
Abstract
BACKGROUND Maternal CMV infection during pregnancy, either primary or non-primary, may be associated with fetal infection and long-term sequelae. While guidelines recommend against it, screening for CMV in pregnant women is a prevalent clinical practice in Israel. Our aim is to provide updated, local, clinically relevant, epidemiological information about CMV seroprevalence among women at childbearing age, the incidence of maternal CMV infection during pregnancy and the prevalence of congenital CMV (cCMV), as well as to provide information about the yield of CMV serology testing. METHODS We performed a descriptive, retrospective study of women at childbearing age who were members of Clalit Health Services in the district of Jerusalem and had at least one gestation during the study period (2013-2019). We utilized serial serology tests to determine CMV serostatus at baseline and at pre/periconception and identified temporal changes in CMV serostatus. We then conducted a sub-sample analysis integrating inpatient data on newborns of women who gave birth in a single large medical center. cCMV was defined as either positive urine CMV-PCR test in a sample collected during the first 3 weeks of life, neonatal diagnosis of cCMV in the medical records, or prescription of valganciclovir during the neonatal period. RESULTS The study population Included 45,634 women with 84,110 associated gestational events. Initial CMV serostatus was positive in 89% women, with variation across different ethno-socioeconomic subgroups. Based on consecutive serology tests, the detected incidence rate of CMV infection was 2/1000 women follow-up years, among initially seropositive women, and 80/1000 women follow-up years, among initially seronegative women. CMV infection in pregnancy was identified among 0.2% of women who were seropositive at pre/periconception and among 10% of women who were seronegative. In a subsample, which included 31,191 associated gestational events, we identified 54 newborns with cCMV (1.9/1000 live births). The prevalence of cCMV among newborns of women who were seropositive at pre/periconception was lower than among newborns of women who were seronegative (2.1 vs. 7.1/1000). Frequent serology tests among women who were seronegative at pre/periconception detected most primary CMV infections in pregnancy that resulted in cCMV (21/24). However, among women who were seropositive, serology tests prior to birth detected none of the non-primary infections that resulted in cCMV (0/30). CONCLUSIONS In this retrospective community-based study among women of childbearing age characterized by multiparity and high seroprevalence of CMV, we find that consecutive CMV serology testing enabled to detect most primary CMV infections in pregnancy that led to cCMV in newborns but failed to detect non-primary CMV infections in pregnancy. Conducting CMV serology tests among seropositive women, despite guidelines' recommendations, has no clinical value, while it is costly and introduces further uncertainties and distress. We thus recommend against routine CMV serology testing among women who were seropositive in a prior serology test. We recommend CMV serology testing prior to pregnancy only among women known to be seronegative or women whose serology status is unknown.
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Affiliation(s)
- Assaf Ben Shoham
- Clalit Health Services, Yehuda Burla 26/28, 9371426, Jerusalem, Israel.
| | - Yechiel Schlesinger
- Wilf Children's Hospital, Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ian Miskin
- Clalit Health Services, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Ziva Kalderon
- Clalit Health Services, Yehuda Burla 26/28, 9371426, Jerusalem, Israel
| | - Rachel Michelson-Cohen
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonit Wiener-Well
- Shaare Zedek Medical Center, Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
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Kokkola E, Niemensivu R, Lappalainen M, Palomäki M, Nieminen T, Boppana S, Saxèn H, Puhakka L. Long-term outcome of vestibular function and hearing in children with congenital cytomegalovirus infection: a prospective cohort study. Eur Arch Otorhinolaryngol 2023; 280:3141-3147. [PMID: 36645498 DOI: 10.1007/s00405-022-07816-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 12/23/2022] [Indexed: 01/17/2023]
Abstract
PURPOSE Congenital cytomegalovirus infection (cCMV) is the most frequent nonhereditary cause for sensorineural hearing loss (SNHL) in children. Data on vestibular function in children with cCMV are, however, scarce, although some evidence for cCMV-associated vestibular dysfunction exists. In this prospective cohort study, we evaluated long-term vestibular function and hearing outcomes in a cohort of children with cCMV. METHODS Participants were 6-7-year-old children with cCMV from a large population-based screening study. Controls were age and gender matched healthy children, who were CMV-negative at birth. Hearing was examined with pure tone audiometry. Definition of hearing loss was pure-tone average > 20 dB. Vestibular function was assessed using the video head impulse test that provides a measure of semicircular canal function. Definition of vestibular dysfunction was lateral semicircular canal gain < 0.75. RESULTS Vestibular dysfunction occurred in 7/36 (19.4%) of children with cCMV and in 1/31 (3.2%) of controls (p = 0.060). SNHL was recorded in 4/38 (10.5%) of children with cCMV and in 0/33 of controls (p = 0.118). Hearing loss was unilateral in all cases. In cCMV group, the two children with bilateral vestibular dysfunction also had SNHL, whereas those with unilateral vestibular dysfunction (n = 5) had normal hearing. CONCLUSIONS In this cohort of children with cCMV identified using newborn screening, vestibular dysfunction was more common than SNHL at 6 years of age. Vestibular dysfunction occurred both in children with and without SNHL. Based on these data, inclusion of vestibular tests in follow-up protocol of cCMV should be considered.
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Affiliation(s)
- Eeva Kokkola
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Riina Niemensivu
- Department of Otorhinolaryngology-Head and Neck Surgery, Hearing Clinic, Helsinki University Hospital, Helsinki, Finland
| | - Maija Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Maarit Palomäki
- Department of Neuroradiology, HUS Medical Imaging Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suresh Boppana
- Department of Pediatrics, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA.,Department of Microbiology, Heersink School of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harri Saxèn
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Laura Puhakka
- New Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Pande S, Gandhewar M, Gaikwad P, Shende P, Munne K, Bhor VM, Das D, Bashani D, Bhase M, Rathore A, Shah K, Gawde H, Padwal V, Bhagat S, Menon S, Palav H, Sachdeva G, Patel V. Cytomegalovirus reactivation in a SARS-CoV-2 infected woman experiencing fetal demise in the first trimester with fetal trisomy 21: A case report. Indian J Med Microbiol 2023; 41:1-4. [PMID: 36870740 DOI: 10.1016/j.ijmmb.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/28/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022]
Abstract
Cytomegalovirus (CMV) is the most common cause of congenital viral infections. Women seropositive for CMV prior to pregnancy can develop a non-primary CMV infection. Here, we present a case of first trimester pregnancy loss during active SARS-CoV-2 infection. There was no evidence of SARS-CoV-2 RNA in placenta and fetal tissue, but there was presence of congenital cytomegalovirus infection by nested PCR. To the best of our knowledge, this is the first report demonstrating association of early congenital CMV infection due to reactivation and fetal demise in a SARS-CoV-2 positive woman with fetal trisomy 21.
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Aldè M, Caputo E, Di Berardino F, Ambrosetti U, Barozzi S, Piatti G, Zanetti D, Pignataro L, Cantarella G. Hearing outcomes in children with congenital cytomegalovirus infection: From management controversies to lack of parents' knowledge. Int J Pediatr Otorhinolaryngol 2023; 164:111420. [PMID: 36563581 DOI: 10.1016/j.ijporl.2022.111420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/27/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVES Congenital cytomegalovirus (cCMV) is the leading nongenetic cause of sensorineural hearing loss (HL). However, there are no universally accepted approaches to diagnosis, follow-up and treatment. The aim of this study was to evaluate the main characteristics of cCMV-infected children, focusing on their management and long-term hearing outcomes. METHODS This retrospective study included all children with cCMV infection who were referred to a third-level referral audiologic center for a 6-year hearing follow-up. The main information collected from the medical records included gestational age, birth weight, trimester of maternal seroconversion, hearing status at birth and after 6 years, hearing fluctuations, treatment with oral valganciclovir (within the first month of life and for 6 months), use of hearing devices, presence of speech-language delay, motor delay, cognitive delay and balance disorders, awareness of cCMV among parents, and parents' engagement in behaviors that could increase the risk of CMV infection during pregnancy. RESULTS A total of 141 children with cCMV infection (72 males and 69 females; mean gestational age: 37+3 weeks; mean birth weight: 2893 g) were assessed. Overall, 48 children (34.0%) had a diagnosis of speech-language delay, 32 (22.7%) of sensorineural HL (59.4% bilaterally; 50% of profound degree), 18 (12.8%) of motor delay, 16 (11.3%) of balance disorders, and 6 (4.3%) of cognitive delay. Among children with HL, 8 (25.0%) were fitted with hearing aids (5 unilaterally and 3 bilaterally), and 5 (15.6%) had undergone cochlear implantation (1 unilaterally and 4 bilaterally), while a bimodal hearing solution was adopted for 2 (6.3%) patients. Compared to children with asymptomatic cCMV infection, symptomatic children had a higher prevalence of neurological and auditory sequelae (P < 0.01) and bilateral (P = 0.003) and severe-to-profound HL (P = 0.004). Overall, 23 children (16.3%) received oral valganciclovir, and only one of them experienced hearing deterioration. Only 14.9% of mothers and 5% of fathers were aware that cCMV could cause progressive or late-onset HL, and 87.9% of parents (248/282) had engaged in behaviors that increased the risk of CMV infection during pregnancy. CONCLUSION This study confirmed the importance of performing a long audiological follow-up in children diagnosed with cCMV infection due to the possible late-onset, progressive and fluctuating nature of HL. Moreover, the study highlighted many current controversies in preventive (poor prenatal education), diagnostic (routine maternal serological screening) and therapeutic (valganciclovir administered to asymptomatic children) approaches to cCMV infection. More efforts should be made to improve prevention strategies and raise awareness of cCMV infection risks among the population.
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Affiliation(s)
- Mirko Aldè
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Eliana Caputo
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Federica Di Berardino
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Umberto Ambrosetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Stefania Barozzi
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.
| | - Gioia Piatti
- Department of Pathophysiology and Transplantation, University of Milan and Unit of Bronchopneumology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Diego Zanetti
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Audiology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Lorenzo Pignataro
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Giovanna Cantarella
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; Otolaryngology Unit, Department of Specialist Surgical Sciences, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
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Chien HW, Lee CY, Huang JY, Chen HC, Wang K, Yang SF. The association between late-onset keratitis in congenital cytomegalovirus infection: A nationwide population-based cohort study. Eur J Ophthalmol 2022; 33:11206721221136320. [PMID: 36343960 DOI: 10.1177/11206721221136320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
AIM To estimate the relationship between congenital cytomegalovirus (CMV) infection and late-onset keratitis via use of the National Health Insurance Research Database (NHIRD) of Taiwan. METHODS We yielded this retrospective cohort study and subjects with congenital CMV infection, which according to the diagnostic codes and laboratory exam, were selected as our study group that diagnosed with congenital CMV infection. Each participant in the study group was matched to four individuals without the non-congenital CMV infection by propensity-score matching (PSM) process and the latter served as the control group. The main outcome is the late-onset keratitis that occurs one year after the congenital CMV infection diagnosis. We applied Cox proportional hazard regression to produce the adjusted hazard ratio (HR) and corresponding 95% confidence interval (CI) of late-onset keratitis between two groups. RESULTS There were 426 (7.4%) and 1,516 (6.5%) events of keratitis in the study and control groups. The study group revealed significantly higher ratio of late-onset keratitis than control group after adjusting many confounders (adjusted HR: 1.14, 95% CI: 1.02-1.27), and the cumulative probability of keratitis in the study group was also higher than control group. For the subgroup analysis, the existence of severe congenital CMV infection was significantly correlated to the late-onset keratitis in individuals with congenital CMV infection (adjusted HR: 1.48, 95% CI: 1.01-2.70; P < 0.05). CONCLUSION The congenital CMV infection is related to higher rate of late-onset keratitis, especially for those with severe form.
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Affiliation(s)
- Hsiang-Wen Chien
- Department of Ophthalmology, 60616Cathay General Hospital, Taipei, Taiwan
- Departments of Ophthalmology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
- School of Medicine, National Tsing Hua University, Hsinchu, Taiwan
| | - Chia-Yi Lee
- Institute of Medicine, 34899Chung Shan Medical University, Taichung, Taiwan
- Nobel Eye Institute, Taipei, Taiwan
- Department of Ophthalmology, Jen-Ai Hospital Dali Branch, Taichung, Taiwan
| | - Jing-Yang Huang
- Department of Medical Research, 34899Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Hung-Chi Chen
- Department of Ophthalmology, Chang Gung Memorial Hospital, Linkou, Taiwan
- Department of Medicine, Chang Gung University College of Medicine, Taoyuan, Taiwan
- Center for Tissue Engineering, Chang Gung Memorial Hospital, Linkou, Taiwan
| | - Kai Wang
- Department of Ophthalmology, 60616Cathay General Hospital, Taipei, Taiwan
- Departments of Ophthalmology, Sijhih Cathay General Hospital, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Shun-Fa Yang
- Institute of Medicine, 34899Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, 34899Chung Shan Medical University Hospital, Taichung, Taiwan
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11
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Torii Y, Horiba K, Kawada JI, Haruta K, Yamaguchi M, Suzuki T, Uryu H, Kashiwa N, Goishi K, Ogi T, Ito Y. Detection of antiviral drug resistance in patients with congenital cytomegalovirus infection using long-read sequencing: a retrospective observational study. BMC Infect Dis 2022; 22:568. [PMID: 35733089 PMCID: PMC9219161 DOI: 10.1186/s12879-022-07537-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 06/08/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Congenital human cytomegalovirus (cCMV) infection can cause sensorineural hearing loss and neurodevelopmental disabilities in children. Ganciclovir and valganciclovir (GCV/VGCV) improve long-term audiologic and neurodevelopmental outcomes for patients with cCMV infection; however, antiviral drug resistance has been documented in some cases. Long-read sequencing can be used for the detection of drug resistance mutations. The objective of this study was to develop full-length analysis of UL97 and UL54, target genes with mutations that confer GCV/VGCV resistance using long-read sequencing, and investigate drug resistance mutation in patients with cCMV infection. METHODS Drug resistance mutation analysis was retrospectively performed in 11 patients with cCMV infection treated with GCV/VGCV. UL97 and UL54 genes were amplified using blood DNA. The amplicons were sequenced using a long-read sequencer and aligned with the reference gene. Single nucleotide variants were detected and replaced with the reference sequence. The replaced sequence was submitted to a mutation resistance analyzer, which is an open platform for drug resistance mutations. RESULTS Two drug resistance mutations (UL54 V823A and UL97 A594V) were found in one patient. Both mutations emerged after 6 months of therapy, where viral load increased. Mutation rates subsided after cessation of GCV/VGCV treatment. CONCLUSIONS Antiviral drug resistance can emerge in patients with cCMV receiving long-term therapy. Full-length analysis of UL97 and UL54 via long-read sequencing enabled the rapid and comprehensive detection of drug resistance mutations.
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Affiliation(s)
- Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Kazuhiro Horiba
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan.,Department of Genetics, Research Institute of Environmental Medicine Nagoya University, Furo-cho, Chikusa-ku, 464-8601, Nagoya, Japan.,Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Kazunori Haruta
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Makoto Yamaguchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Hideko Uryu
- Department of Pediatrics, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, Japan
| | - Naoyuki Kashiwa
- Department of Pediatrics, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, Japan
| | - Keiji Goishi
- Department of Pediatrics, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, Japan
| | - Tomoo Ogi
- Department of Genetics, Research Institute of Environmental Medicine Nagoya University, Furo-cho, Chikusa-ku, 464-8601, Nagoya, Japan.,Department of Human Genetics and Molecular Biology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, 466-8550, Nagoya, Japan. .,Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchi, Kami-cho, Itabashi-ku, 173-8610, Tokyo, Japan.
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12
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Vanbuggenhout L, Aertsen M, De Catte L, Naulaers G. Pre- and postnatal brain magnetic resonance imaging in congenital cytomegalovirus infection: a case report and a review of the literature. BMC Pediatr 2022; 22:293. [PMID: 35585581 PMCID: PMC9118604 DOI: 10.1186/s12887-022-03334-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/04/2022] [Indexed: 11/10/2022] Open
Abstract
Background Congenital cytomegalovirus infection (cCMV) is the most common known viral cause of neurodevelopmental delay in children. The risk of severe cerebral abnormalities and neurological sequelae is greatest when the infection occurs during the first trimester of pregnancy. Pre- and postnatal imaging can provide additional information and may help in the prediction of early neurological outcome. Case presentation This report presents the case of a newborn with cCMV infection with diffuse parenchymal calcifications, white matter (WM) abnormalities and cerebellar hypoplasia on postnatal brain imaging after magnetic resonance imaging (MRI) and neurosonogram (NSG) at 30 weeks showing lenticulostriate vasculopathy, bilateral temporal cysts and normal gyration pattern according to the gestational age (GA). No calcifications were seen on prenatal imaging. Conclusion cCMV infection can still evolve into severe brain damage after 30 weeks of GA. For this reason, a two-weekly follow-up by fetal NSG with a repeat in utero MRI (iuMRI) in the late third trimester is recommended in cases with signs of active infection.
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Affiliation(s)
- Laurien Vanbuggenhout
- Department of Pediatrics, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.
| | - Michael Aertsen
- Department of Radiology, University Hospitals Leuven, Leuven, Belgium
| | - Luc De Catte
- Department of Feto-Maternal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Gunnar Naulaers
- Neonatal Intensive Care Unit, University Hospitals Leuven, Leuven, Belgium
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13
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Puhakka L, Lappalainen M, Lönnqvist T, Nieminen T, Boppana S, Saxen H, Niemensivu R. Hearing outcome in congenitally CMV infected children in Finland - Results from follow-up after three years age. Int J Pediatr Otorhinolaryngol 2022; 156:111099. [PMID: 35276528 DOI: 10.1016/j.ijporl.2022.111099] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 11/12/2021] [Accepted: 03/01/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES Cytomegalovirus (CMV) is the most common congenital infection affecting about 0.6% of all newborns in developed countries. Vertical transmission to fetus can take place either after maternal primary or non-primary CMV infection during pregnancy. It is the most common infectious agent for sensorineural hearing loss (SNHL) in young children. The hearing loss after congenital CMV (cCMV) may be present at birth, or may develop after months or even years. In this study, we evaluated hearing outcome at 3-4 years of age in children (n 32) with cCMV identified in universal saliva CMV-PCR-based screening. METHODS Study population consisted of mainly asymptomatic children (median age 3.1 years) with cCMV identified in newborn CMV screening. The type of maternal CMV infection (primary or non-primary) was determined by analyzing CMV antibodies (IgM, IgG and IgG avidity) from preserved maternal serum samples drawn in the end of first trimester of pregnancy. Hearing was evaluated with pure tone audiometry (PTA), or transient-evoked otoacoustic emission (TEOAE) and sound field audiometry (SF). RESULTS Unilateral hearing loss occurred in 5/32 (16%) of the children with cCMV. None of the subjects in our cohort had bilateral hearing loss. Hearing loss occurred in 3/15 (20%) of children who were born to mothers with non-primary CMV infection during pregnancy, and in 2/10 (20%) of children whose mother had had a primary CMV infection during the 2-3 trimester. None of the additional 6 children, whose mother had primary infection in the first trimester, had hearing loss by age of 3-4 years. Two children with normal hearing at 1 years age had developed unilateral hearing loss by the age of three. CONCLUSIONS Unilateral hearing loss was relatively common among the mainly asymptomatic children with cCMV identified in screening. Long-term follow up of children with cCMV is essential to identify the children with late-onset hearing loss.
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Affiliation(s)
- Laura Puhakka
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland.
| | - Maija Lappalainen
- HUS Diagnostic Center, HUSLAB, Clinical Microbiology, University of Helsinki and Helsinki University Hospital, Finland
| | - Tuula Lönnqvist
- Department of Child Neurology, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Tea Nieminen
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Suresh Boppana
- Pediatrics and Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Harri Saxen
- Department of Pediatric Infectious Diseases, New Children's Hospital, Pediatric Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Riina Niemensivu
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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14
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Keymeulen A, De Leenheer E, Casaer A, Cossey V, Herregods N, Laroche S, Mahieu L, Van Mol C, Vanhaesebrouck S, Walle CV, Smets K. Cranial ultrasound and MRI: complementary or not in the diagnostic assessment of children with congenital CMV infection? Eur J Pediatr 2022; 181:911-920. [PMID: 34636957 DOI: 10.1007/s00431-021-04273-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 08/27/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
Whether or not cranial ultrasound (crUS) and cerebral magnetic resonance imaging (MRI) have both a place in the assessment of children with congenital cytomegalovirus infection (cCMV) remains a topic of discussion between research groups. Literature suggests that MRI is indicated only in children with abnormal crUS.In Flanders, Belgium, combined crUS and MRI was performed on 639 children with cCMV, referred for diagnostic assessment. Cranial US was classified as abnormal in the presence of striatal vasculopathy, calcifications, cysts, cystic germinolysis, and/or ventriculomegaly. MRI findings were classified as abnormal in the presence of gyration disorders, cerebellar abnormalities, ventriculomegaly, cysts, or pathologic white matter lesions.One in five children (93/480) with normal crUS showed abnormal findings on MRI. Of them, 85 (91.4%) were classified as symptomatic. In 37 of those 93 children (39.8%), classification as severely symptomatic was made based on MRI lesions alone. MRI and crUS proved to be complementary in the assessment of CNS involvement in children with cCMV. Long-term studies are needed to evaluate the importance of this finding with respect to outcome and benefit of therapy in this particular subgroup of patients with cCMV infection.Conclusion: Our findings support an enhanced role of MRI in the diagnosis of CNS involvement in children with cCMV infection. The ideal assessment should include both imaging techniques, as the strengths of each test compensate for the other's weaknesses. What is Known: • Congenital CMV infection involves the central nervous system with direct injury to and possible disruption of brain development. • Experts suggest that MRI is indicated only in children with abnormal crUS. What is New: • In almost 20% of our children with a normal cranial ultrasound, abnormalities were detected on MRI. • Our results suggest that performing both MRI and cranial US is important to obtain a complete assessment of central nervous system involvement in children with cCMV.
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Affiliation(s)
- Annelies Keymeulen
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Els De Leenheer
- Ear-Nose-Throat Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Alexandra Casaer
- Neonatology Department, AZ Sint Jan Bruges, Rudderhove 10, 8000, Bruges, Belgium
| | - Veerle Cossey
- Neonatology Department, University Hospital Leuven, Herestraat 49, 3000, Leuven, Belgium
| | - Nele Herregods
- Radiology Department, Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Sabine Laroche
- Neonatology Department, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Ludo Mahieu
- Neonatology Department, Antwerp University, Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
| | - Christine Van Mol
- Neonatology Department, GZA Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium
| | - Sophie Vanhaesebrouck
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Caroline Vande Walle
- Radiology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Koenraad Smets
- Neonatology Department, Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Ríos-Barnés M, Fontalvo MA, Liñán N, Plana M, Moreno M, Esteva C, Muñoz-Almagro C, Noguera-Julian A, Alarcón A. Letter to the Editor on the original article: Lower prevalence of congenital cytomegalovirus infection in Portugal: possible impact of COVID-19 lockdown? Eur J Pediatr 2022; 181:1293-1294. [PMID: 35091799 PMCID: PMC8799405 DOI: 10.1007/s00431-021-04354-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Revised: 12/11/2021] [Accepted: 12/16/2021] [Indexed: 11/03/2022]
Affiliation(s)
- María Ríos-Barnés
- grid.411160.30000 0001 0663 8628Infectious Diseases Unit, Department of Pediatrics, Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Melissa Andrea Fontalvo
- grid.411160.30000 0001 0663 8628Department of Neonatology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Nerea Liñán
- grid.411160.30000 0001 0663 8628Department of Molecular Microbiology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Montserrat Plana
- grid.411160.30000 0001 0663 8628Department of Neonatology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - María Moreno
- grid.411160.30000 0001 0663 8628Department of Neonatology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain
| | - Cristina Esteva
- grid.411160.30000 0001 0663 8628Department of Molecular Microbiology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246Center for Biomedical Network Research On Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Carmen Muñoz-Almagro
- grid.411160.30000 0001 0663 8628Department of Molecular Microbiology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain ,grid.466571.70000 0004 1756 6246Center for Biomedical Network Research On Epidemiology and Public Health (CIBERESP), Madrid, Spain ,grid.410675.10000 0001 2325 3084Department of Medicine, Universitat Internacional de Catalunya, Barcelona, Spain
| | - Antoni Noguera-Julian
- Infectious Diseases Unit, Department of Pediatrics, Infectious Diseases and Systemic Inflammatory Response in Pediatrics, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain. .,Center for Biomedical Network Research On Epidemiology and Public Health (CIBERESP), Madrid, Spain. .,Translational Research Network in Pediatric Infectious Diseases (RITIP), Madrid, Spain. .,Department of Pediatrics, University of Barcelona, Barcelona, Spain.
| | - Ana Alarcón
- grid.411160.30000 0001 0663 8628Department of Neonatology, Institut de Recerca Sant Joan de Déu, Hospital Sant Joan de Déu, Barcelona, Spain ,grid.5841.80000 0004 1937 0247Department of Pediatrics, University of Barcelona, Barcelona, Spain
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Corazzi V, Hatzopoulos S, Bianchini C, Skarżyńska MB, Pelucchi S, Skarżyński PH, Ciorba A. Vestibular and postural impairment in congenital Cytomegalovirus infection. Int J Pediatr Otorhinolaryngol 2022; 152:111005. [PMID: 34894538 DOI: 10.1016/j.ijporl.2021.111005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 11/16/2021] [Accepted: 12/05/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES To describe the vestibular and postural impairment related to the congenital Cytomegalovirus infection (cCMV), including the inner ear damages CMV-induced. METHODS A PRISMA systematic review was performed, with the PubMed, Embase, and Cinahl databases searched from inception through to March 2021; after the application of inclusion and exclusion criteria a total of 12 papers were included in this review. RESULTS Vestibular and postural disorders have been reported in cCMV children, with a high variability of clinical manifestation. Presently, the available reported data on vestibular and postural impairment in cCMV children differ in terms of the sample size and the features of the studied populations. CONCLUSION At present, the vestibular and postural impairment in cCMV cases is underestimated; a complete vestibular assessment, a follow-up and management of all children affected by cCMV or, at least, of all cCMV patients showing sensorineural hearing loss, is recommended.
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Affiliation(s)
- Virginia Corazzi
- ENT and Audiology Department, University Hospital of Ferrara, A. Moro 8, loc Cona, Ferrara, 44124, Italy
| | - Stavros Hatzopoulos
- ENT and Audiology Department, University Hospital of Ferrara, A. Moro 8, loc Cona, Ferrara, 44124, Italy
| | - Chiara Bianchini
- ENT and Audiology Department, University Hospital of Ferrara, A. Moro 8, loc Cona, Ferrara, 44124, Italy
| | - Magdalena B Skarżyńska
- Institute of Sensory Organs, 1 Mokra Street, 05-830, Nadarzyn/Kajetany, Poland; Institute of Physiology and Pathology of Hearing, 10 Mochnackiego Street, 02-042, Warsaw, Poland
| | - Stefano Pelucchi
- ENT and Audiology Department, University Hospital of Ferrara, A. Moro 8, loc Cona, Ferrara, 44124, Italy
| | - Piotr Henryk Skarżyński
- Institute of Sensory Organs, 1 Mokra Street, 05-830, Nadarzyn/Kajetany, Poland; Institute of Physiology and Pathology of Hearing, 10 Mochnackiego Street, 02-042, Warsaw, Poland; Department of Heart Failure and Cardiac Rehabilitation, Medical University of Warsaw, 8 Kondratowicza Street, 03-242, Warsaw, Poland
| | - Andrea Ciorba
- ENT and Audiology Department, University Hospital of Ferrara, A. Moro 8, loc Cona, Ferrara, 44124, Italy.
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Kobayashi M, Okahashi A, Okuyama K, Hiraishi N, Morioka I. Awareness and knowledge of congenital cytomegalovirus infection among pregnant women and the general public: a web-based survey in Japan. Environ Health Prev Med 2021; 26:117. [PMID: 34933677 PMCID: PMC8903704 DOI: 10.1186/s12199-021-01029-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 10/23/2021] [Indexed: 11/15/2022] Open
Abstract
Background The best approach to reduce congenital cytomegalovirus infection (cCMVi) is to practice behaviors that reduce cytomegalovirus (CMV) transmission during pregnancy. Expanding awareness and knowledge of CMV is expected to result in increased practice of preventative behaviors. To this end, it is necessary to understand current awareness and knowledge of CMV. Methods This web-based cross-sectional survey assessed the awareness and knowledge of cCMVi among pregnant women and the general public in Japan. Participants aged 20–45 years (pregnant and non-pregnant women, and men) were identified from a consumer panel. Study outcomes (all participants) included awareness of cCMVi and other congenital conditions. Among those aware of cCMVi, outcomes included knowledge of CMV transmission routes, long-term outcomes of cCMVi, and behaviors to prevent CMV transmission during pregnancy. Outcomes limited to pregnant women included the practice of preventative behaviors and opinion on how easy it is to implement these behaviors. The data of the pregnant group (pregnant at the time of the survey) were compared with those of the general group (non-pregnant women and men). Results There were 535 participants in the pregnant group and 571 in the general group. Awareness of cCMVi was generally low (pregnant, 16.1%; general, 10.2%). Pregnant participants were significantly more aware of most congenital conditions than those in the general group, including cCMVi (P = 0.004). Knowledge about CMV/cCMVi was limited; there were no significant differences between the two groups for 24 of the 26 knowledge questions. A small proportion (one third or less) of pregnant women practiced behaviors to prevent the transmission of CMV, though most (73.3–95.3%) pregnant women who were aware of cCMVi considered such behaviors easy to implement. Conclusions Awareness and knowledge of CMV/cCMVi is low among pregnant women in Japan; the level of knowledge is similar to that among the general public. This needs to be improved. Most pregnant women considered behaviors to prevent CMV transmission easy to perform, which indicates that effectively educating pregnant women regarding the long-term outcomes of cCMVi, CMV transmission routes, and preventative behaviors will contribute to a reduced incidence of cCMVi. Trial registration UMIN Clinical Trials Registry, UMIN000041260.
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Affiliation(s)
- Masayuki Kobayashi
- Medical Affairs, MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667, Japan
| | - Aya Okahashi
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan
| | - Kotoba Okuyama
- Medical Affairs, MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667, Japan
| | - Naomi Hiraishi
- Medical Affairs, MSD K.K., Kitanomaru Square, 1-13-12 Kudan-kita, Chiyoda-ku, Tokyo, 102-8667, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, 30-1 Oyaguchikamicho, Itabashi-ku, Tokyo, 173-8610, Japan.
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Kasuga M, Yoshimura H, Shinagawa J, Nishio SY, Takumi Y, Usami SI. Frequency and natural course of congenital cytomegalovirus-associated hearing loss in children. Acta Otolaryngol 2021; 141:1038-1043. [PMID: 34825622 DOI: 10.1080/00016489.2021.2000638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Congenital cytomegalovirus-associated hearing loss (cCMV-associated HL) is a common cause of congenital or early-onset deafness. Although cCMV infection has been reported to lead to various types of HL, the natural course of cCMV-associated HL over a long period is not yet known. OBJECTIVES To investigate the clinical phenotype of cCMV-associated HL in the largest study to date. METHODS Thirty-one CMV-positive children, diagnosed by examining CMV DNA extracted from their dried umbilical cords retrospectively, were divided into unilateral and bilateral HL groups, and their hearing ability was evaluated using pure-tone audiometry and auditory steady-state response over time. RESULTS Thirteen patients (41.9%) had unilateral HL and 18 (58.1%) had bilateral HL. In most cases of unilateral cCMV-associated HL, the ear with better hearing maintained a normal hearing threshold. Notably, in most cases of both unilateral and bilateral HL, the ear with worse hearing ultimately showed severe to profound HL. CONCLUSION Our findings revealed that the natural course of cCMV-associated HL was different between the cases of unilateral and bilateral HL, as well as between the ears with better or worse hearing in all cases. These findings indicate that accurate diagnosis could enable proper follow-up and management of cCMV-associated HL in children.
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Affiliation(s)
- Mariko Kasuga
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Hidekane Yoshimura
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Jun Shinagawa
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-ya Nishio
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yutaka Takumi
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-ichi Usami
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
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Annelies K, Leenheer D, Alexandra C, Veerle C, Sabine L, Ludo M, Christine VM, Ingeborg D, Koenraad S. Results of a multicenter registry for congenital cytomegalovirus infection in Flanders, Belgium: From prenatal diagnosis over neonatal management to therapy. Early Hum Dev 2021; 163:105499. [PMID: 34743933 DOI: 10.1016/j.earlhumdev.2021.105499] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 08/27/2021] [Accepted: 10/20/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In 2006, a consensus was made on management and follow up of children with congenital cytomegalovirus infection (cCMV) in Flanders, Belgium. Since 2007 systematic registration of those children was initiated. In this report, focus is on the perinatal data of our population. STUDY DESIGN Children with confirmed diagnosis of cCMV were eligible for registration. Information on prenatal/neonatal investigations, management and therapy in those children was obtained. RESULTS Over 14 years, 1059 children were included. Symptomatic disease was diagnosed in 319/1059 (30,5%) children. Of those 13,5% were classified as mild, 16% as moderate and 70,5% as severe infections. Clinical signs at birth were present in 9,1%, central nervous system involvement in 31,2% and hearing loss in 15,5%. Antiviral therapy was given in 63,9% of patients eligible for therapy. Some of our data seem to confirm some hypotheses regarding cCMV or support the current recommendations for counselling and management. However, some data, although sometimes acquired in small groups, add to the discussion on some topics. Neonatal/prenatal screening or not, correlation between viral load and neonatal outcome or the use of both MRI and US in every child are some of those topics. CONCLUSIONS This is the first report on perinatal characteristics of children with cCMV in Flanders, Belgium during a 14-year period, based on a large multicenter CMV dataset. Worldwide, the systematic registration and follow-up of children with cCMV infection will become increasingly important to document the impact of forthcoming preventive and therapeutic measures.
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Affiliation(s)
- Keymeulen Annelies
- Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - De Leenheer
- Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | | | - Cossey Veerle
- University Hospital Leuven, Herestraat 49, 3000 Leuven, Belgium.
| | - Laroche Sabine
- Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium.
| | - Mahieu Ludo
- Antwerp University Hospital, Drie Eikenstraat 655, 2650 Edegem, Belgium; Antwerp University, Antwerp, Belgium.
| | | | - Dhooghe Ingeborg
- Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
| | - Smets Koenraad
- Ghent University Hospital Ghent, Corneel Heymanslaan 10, 9000 Ghent, Belgium.
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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 Otorrinolaringol Esp (Engl Ed) 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] [What about the content of this article? (0)] [Affiliation(s)] [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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Acke FRE, De Vriese C, Van Hoecke H, De Leenheer EMR. Twelve years of neonatal hearing screening: audiological and etiological results. Eur Arch Otorhinolaryngol 2021; 279:3371-3378. [PMID: 34463816 DOI: 10.1007/s00405-021-07060-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/24/2021] [Indexed: 11/28/2022]
Abstract
PURPOSE Most developed countries have implemented some form of universal newborn hearing screening program. Early identification and rehabilitation of congenital hearing loss is important in functional outcome, and the need to identify the cause of hearing impairment has become clear. We aimed to evaluate audiological and etiological outcomes in a large group of patients with failed neonatal hearing screening. METHODS We performed a retrospective chart analysis of patients who were referred to our tertiary referral center after failing neonatal hearing screening during a 12-year period (2007-2019). Screening was based on automated auditory brainstem response (AABR) or a combined approach of AABR and auditory steady-state response (ASSR) with chirp stimulus. Extensive audiometric testing was performed to confirm and determine the type and degree of hearing loss. In case of permanent hearing loss, a standardized etiological protocol was followed to determine the cause. RESULTS Of the 802 referred newborns, hearing loss was confirmed by diagnostic ABR in 78%. Main causes of hearing loss included otitis media with effusion (56%, higher in patients screened by AABR/ASSR compared to AABR), a genetic disorder (12%), congenital cytomegalovirus infection (cCMV, 5%) and atresia/stenosis of the external ear canal (5%). Of the patients with permanent hearing loss, 15% showed changes in hearing loss severity over time. CONCLUSION In the majority of newborns referred after failing universal neonatal hearing screening, hearing loss could be confirmed. The leading cause was reversible hearing loss due to otitis media with effusion, but hearing loss proved permanent in about 35% of referred newborns, with genetics as predominant cause. Follow-up of congenital hearing loss patients is important as deterioration as well as improvement was observed over time.
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Affiliation(s)
- Frederic R E Acke
- Department of Otorhinolaryngology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium.
| | - Casper De Vriese
- Department of Otorhinolaryngology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Helen Van Hoecke
- Department of Otorhinolaryngology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
| | - Els M R De Leenheer
- Department of Otorhinolaryngology, Ghent University Hospital, Corneel Heymanslaan 10, 9000, Ghent, Belgium
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Shimada K, Toriyabe K, Kitamura A, Morikawa F, Ikejiri M, Minematsu T, Nakamura H, Suga S, Ikeda T. Characteristics and serology of pregnant women with cytomegalovirus immunoglobulin G seroconversion during pregnancy in Japan. Taiwan J Obstet Gynecol 2021; 60:621-627. [PMID: 34247798 DOI: 10.1016/j.tjog.2021.05.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/26/2021] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE Investigate the characteristics and serology of pregnant women with cytomegalovirus (CMV) immunoglobulin (Ig)G seroconversion during pregnancy to understand the risk factors associated with primary CMV infection and the occurrence of fetal congenital CMV infection. MATERIALS AND METHODS We retrospectively studied 3202 pregnant women who were CMV IgG-negative in early pregnancy and were retested for IgG in late pregnancy. Characteristics were compared between participants with and without IgG seroconversion, and serological parameters were compared between participants with and without fetal congenital CMV infection. RESULTS Twenty-six participants showed CMV IgG seroconversion and fifteen showed fetal congenital CMV infection. Seroconversion rates were significantly higher in teens (5.0%) than in older women (20s: 0.8%; 30s and over: 0.6%) (p < 0.001). Titers of CMV IgM at IgG seroconversion were higher in women without (median 8.66) than with (median 6.54) congenital infection (p = 0.045). The congenital infection rate was high when IgM titers at IgG seroconversion were low (47.1% with 4.00-12.00 titers and 100% with 1.21-3.99 IgM titers) (p = 0.048). CONCLUSIONS Nulliparous pregnant teenagers have a high risk of CMV IgG seroconversion and the CMV IgM titer at IgG seroconversion may help predict the occurrence of fetal congenital CMV infection.
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Affiliation(s)
- Kyoko Shimada
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan; Mie Association of Obstetricians and Gynecologists, Tsu, Japan
| | - Kuniaki Toriyabe
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan; Mie Association of Obstetricians and Gynecologists, Tsu, Japan.
| | - Asa Kitamura
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan; Mie Association of Obstetricians and Gynecologists, Tsu, Japan
| | | | | | - Toshio Minematsu
- Center for Disease Control, Aisenkai Nichinan Hospital, Nichinan, Japan
| | - Haruna Nakamura
- Institute for Clinical Research, National Mie Hospital, Tsu, Japan
| | - Shigeru Suga
- Institute for Clinical Research, National Mie Hospital, Tsu, Japan
| | - Tomoaki Ikeda
- Department of Obstetrics and Gynecology, Mie University Graduate School of Medicine, Tsu, Japan; Mie Association of Obstetricians and Gynecologists, Tsu, Japan
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Tanimura K, Shi Y, Uchida A, Uenaka M, Imafuku H, Ikuta T, Fujioka K, Morioka I, Deguchi M, Minematsu T, Yamada H. Immunoglobulin fetal therapy and neonatal therapy with antiviral drugs improve neurological outcome of infants with symptomatic congenital cytomegalovirus infection. J Reprod Immunol 2021; 143:103263. [PMID: 33422744 DOI: 10.1016/j.jri.2020.103263] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/09/2020] [Accepted: 11/25/2020] [Indexed: 11/20/2022]
Abstract
Infants with symptomatic congenital cytomegalovirus infection (cCMV) suffer from long-term sequelae. This study aimed at evaluating the efficacy of combining immunoglobulin (Ig) fetal therapy (FT) and neonatal therapy (NT) with antiviral drugs to improve neurological outcomes of affected infants. Women whose fetuses had symptomatic cCMV received Ig injection into the fetal peritoneal cavity and/or maternal blood as FT, while affected newborns received oral valganciclovir or intravenous ganciclovir as NT. We compared the neurological outcomes at ≥18 months old between infants receiving FT with or without NT (FT group) and those receiving NT only (NT group). From 2009-2019, 15 women whose fetuses had symptomatic cCMV received FT, while 19 newborns received NT only. In FT group, two newborns died, and two were <18 months old. Neurological outcomes of the remaining 11 infants in FT group were as follows: normal 45.5 %, mild impairments 36.4 %, and severe impairments 18.2 %. In NT group, one newborn died, one's parents refused the follow-up, one was <18 months old, and two had only chorioretinitis as symptoms. Neurological outcomes of the remaining 14 infants in NT group were as follows: normal 21.4 %, mild impairments 14.3 %, and severe impairments 64.3 %. The proportion of infants with severe impairments in FT group was significantly lower than that in NT group (18.2 % vs 64.3 %, p < 0.05). This is the first trial demonstrating that the combination of Ig FT and NT with antiviral drugs may be more effective in improving neurological outcomes of newborns with symptomatic cCMV as compared to NT only.
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Rauch AK, Arndt S, Aschendorff A, Beck R, Speck I, Ketterer MC, Jakob TF, Hassepass F. Long-term results of cochlear implantation in children with congenital single-sided deafness. Eur Arch Otorhinolaryngol 2020; 278:3245-3255. [PMID: 33079248 PMCID: PMC8328851 DOI: 10.1007/s00405-020-06409-6] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 09/28/2020] [Indexed: 11/30/2022]
Abstract
Purpose The purpose of this retrospective study was to investigate the outcome and critical age of cochlear implantation in congenital single-sided deafness (SSD). Methods 11 children with congenital SSD were implanted with a cochlear implant (CI). Auditory performance was measured through the results of speech discrimination, subjective assessment by the Categories of auditory performance (CAP) score, the Speech, Spatial and Qualities scale questionnaire (SSQ) and the German version of the IOI-HA [Internationales Inventar zur Evaluation von Hörgeräten (IIEH, version for CI)]. Results Long-term follow-up [median: 3 years and 5 months (3;5 years)] revealed that nine children use their CI (> 8 h/day) and two became nonusers. In children aged below 3;2 years at surgery, there was a substantial long-term increase in speech discrimination and subjective benefit. Children over 4;4 years of age at CI surgery improved partially in audiological/subjective measurements. Among children above 5 years, the SSQ score did not improve despite further slight improvement in speech discrimination long-term. Conclusion Our data suggest a critical age for CI surgery below 3 years in children with congenital SSD for successful hearing rehabilitation. It is mandatory to identify children with SSD as early as bilaterally deaf children.
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Affiliation(s)
- Ann-Kathrin Rauch
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany.
| | - Susan Arndt
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Antje Aschendorff
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Rainer Beck
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Iva Speck
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Manuel Christoph Ketterer
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Till Fabian Jakob
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
| | - Frederike Hassepass
- Department of Otorhinolaryngology, ENT Clinic, Medical Centre, University of Freiburg, Freiburg, Germany
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De la Calle M, Baquero-Artigao F, Rodríguez-Molino P, Cabanes M, Cabrera M, Antolin E, Mellado MJ, Bartha JL. Combined treatment with immunoglobulin and valaciclovir in pregnant women with cytomegalovirus infection and high risk of symptomatic fetal disease. J Matern Fetal Neonatal Med 2020; 35:3196-3200. [PMID: 32933353 DOI: 10.1080/14767058.2020.1815188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Congenital cytomegalovirus (CMV) infection is one of the most common during pregnancy. The infection, particularly in the first trimester, is associated with important sequelae in up to half of the children. Valaciclovir and immunoglobulin have been tested separately for the treatment of fetal CMV infection with relative success. Nevertheless, there is no experience with the simultaneous use of both therapies. METHODS combination therapy (oral valaciclovir 2 g/6h until the end of pregnancy and intravenous hyperimmune gamma globulin 200 UI/kg) was offered to pregnant women with CMV infection acquired during pregnancy and viral load (VL) in amniotic fluid above 105 copies/ml and/or brain injuries in the ultrasonography. Additional immunoglobulin monthly doses were used in case of ultrasonography or MRI evidence of persistent fetal involvement. Neurological and hearing evaluations of infants were performed at birth and every 3 months during follow-up. RESULTS 15 pregnant women were enrolled: primary infection, 14, non-primary infection, 1; first trimester, 11, second trimester, 4. Mean gestational age at the start of combination treatment were 23.2 weeks and 29.3 weeks, depending on the infection being diagnosed in the first or the second trimester, respectively. Median VL of CMV-DNA in amniotic fluid was 62.5 × 105 copies/ml. Intrauterine progression of fetal brain lesions was only observed in two cases in which the dose of CMV-HIG was repeated, slowing their progression. Although the treatment has failed to reverse ultrasound fetal lesions, only 3 children were born with hearing impairment and their psychomotor development was consistent with chronological age in all patients but one. Combination therapy was not associated with adverse effects in either the mothers or the fetuses. CONCLUSION Combination therapy with immunoglobulin and valaciclovir may be a useful alternative in CMV fetal infection, particularly if changes in cerebral echography or high VL in the amniotic fluid are present.
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Affiliation(s)
- Maria De la Calle
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | | | | | - Maria Cabanes
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | - Marta Cabrera
- Department of Neonatology, La Paz University Hospital, Madrid, Spain
| | - Eugenia Antolin
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
| | - Maria José Mellado
- Department of Pediatric Infectology, La Paz University Hospital, Madrid, Spain
| | - José Luis Bartha
- Department of Obstetrics and Gynaecology, Maternal-Fetal Medicine Unit, La Paz University Hospital, Madrid, Spain
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Hranilovich JA, Park AH, Knackstedt ED, Ostrander BE, Hedlund GL, Shi K, Bale JF Jr. Brain Magnetic Resonance Imaging in Congenital Cytomegalovirus With Failed Newborn Hearing Screen. Pediatr Neurol 2020; 110:55-8. [PMID: 32713673 DOI: 10.1016/j.pediatrneurol.2020.05.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/30/2020] [Accepted: 05/13/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND In 2013, Utah enacted legislation requiring that infants failing newborn hearing screening be tested for cytomegalovirus infection. As a result, cytomegalovirus-infected infants are being identified because of hearing deficits. The neuroimaging findings in this population have not been characterized. METHODS Retrospective medical record review was used to identify patients seen at the University of Utah and Primary Children's Hospitals in Salt Lake City, Utah, who failed newborn hearing screening. A cohort of patients with congenital cytomegalovirus infection, brain magnetic resonance imaging (MRI), and sedated auditory brainstem response testing was studied. RESULTS Seventeen patients were identified; 11 (65%) were female. Confirmatory auditory brainstem response testing, performed at a median age 29 days, showed profound hearing loss in 8 (47%) subjects, severe loss in two (12%), moderate loss in two (12%), and mild loss in three (18%); two (12%) subjects had normal hearing. The diagnosis of cytomegalovirus infection was made at a median age 23 days. Brain imaging was performed at a median age 65 days. Ten (59%) subjects had one or more neuroimaging abnormality. White matter lesions were found in eight (47%) subjects, cysts in three (18%), and stroke in two (12%). Polymicrogyria was identified in two (12%) subjects. Seven (41%) subjects had normal brain MRIs. CONCLUSIONS These results indicate that most infants whose cytomegalovirus infections were identified after failing newborn hearing screening had abnormal brain MRIs. Our results suggest that brain MRIs should be considered in infants with congenital cytomegalovirus infections who are identified through hearing screening programs.
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Reyes A, Taravillo I, Moral N, Moraleda C, Blázquez-Gamero D, Folgueira L. Feasible alternatives to DBS in the retrospective diagnosis of congenital cytomegalovirus infection. J Clin Virol 2020; 129:104504. [PMID: 32604038 DOI: 10.1016/j.jcv.2020.104504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Retrospective diagnosis of congenital cytomegalovirus (cCMV) infection may be challenging mainly because of the high variable sensitivity of PCR on dried blood spots (DBS) samples. OBJECTIVES To compare cytomegalovirus (CMV) viral load (VL) values in different samples obtained at birth from infants with cCMV infection. To evaluate dried umbilical cord (DUC) samples as an alternative to DBS. STUDY DESIGN Saliva and/or urine, peripheral blood (PB), and DBS from 16 infants with confirmed cCMV infection were collected at birth. CMV VL were determined by DNA extraction and real-time polymerase chain reaction (rt-PCR). In two cases, VL was determined from DUC samples. RESULTS Six (37.5 %) of the 16 infants were symptomatic, and 10 (62.5 %) were asymptomatic. The CMV VL found in saliva (median: 1,958,525 [IQR: 597,683-3,483,843] IU/mL) and in urine (median: 691,865 [IQR: 188,489.5-3,175,696] UI/mL) were both higher than those found in PB (median: 1115 [IQR: 364-4,002] IU/mL), p: 0.0001). Symptomatic infants presented 100 % of detectable VL in PB and 50 % in DBS. Asymptomatic infants showed 75 % of detectable VL in PB and 30 % in DBS. The VL in DUC were 22,341, 9754 IU/mL and 994 IU/mL. CONCLUSIONS When VL was detectable in PB, the values were lower than in saliva or urine, in both symptomatic and asymptomatic cases of cCMV. The low sensitivity in DBS samples could be due to low blood volume content, making CMV VL undetectable even when using optimised extraction and PCR protocols. In our limited experience, DUC could play a complementary diagnostic role when DBS VL is undetectable.
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Affiliation(s)
- Alhena Reyes
- Virology Laboratory, Microbiology Department, University Hospital 12 de Octubre, Madrid, Spain.
| | - Irene Taravillo
- Biomedical Research Institute imas12. University Hospital, 12 de Octubre, Madrid, Spain
| | - Noelia Moral
- Virology Laboratory, Microbiology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Cinta Moraleda
- Paediatric Infectious Unit, Paediatric Department, University Hospital 12 de Octubre, Madrid, Spain; Biomedical Research Institute imas12. University Hospital, 12 de Octubre, Madrid, Spain
| | - Daniel Blázquez-Gamero
- Paediatric Infectious Unit, Paediatric Department, University Hospital 12 de Octubre, Madrid, Spain; Biomedical Research Institute imas12. University Hospital, 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain
| | - Lola Folgueira
- Virology Laboratory, Microbiology Department, University Hospital 12 de Octubre, Madrid, Spain; Biomedical Research Institute imas12. University Hospital, 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain
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Noorbakhsh S, Farhadi M, Haghighi F, Minaeian S, Hasanabad MH. Neonatal screening for congenital cytomegalovirus infection in Tehran, Iran, using Guthrie cards. Iran J Microbiol 2020; 12:198-203. [PMID: 32685115 PMCID: PMC7340612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND OBJECTIVES Cytomegalovirus (CMV) constitutes the most common viral cause of congenital infections in newborns worldwide. There are a significant number of asymptomatic newborns with congenital CMV infection in Iran, which may develop long-term sequelae of infection. Unfortunately, limited data exsists from Iran on the rate of congenital CMV infection among neonates. The current study was aimed to investigate the prevalence of congenital CMV infection among Iranian neonates by testing Guthrie cards. MATERIALS AND METHODS Guthrie cards were collected from infants within 2 weeks of life, and total DNA was extracted from samples by thermal shock and evaluated for CMV DNA using nested-PCR assay. CMV infection in newborns was confirmed through a commercial CMV PCR kit. Infected infants underwent further evaluation at the hospital. RESULTS CMV infection was identified in four of 1174 infants (0.34%) which is approximately 3 cases per 1000 live births. Infected infants were asymptomatic at birth and had a normal hearing status similar to other children. There were no factors in relation with CMV infection among newborns. CONCLUSION According to the results of this study, infected infants with congenital CMV infection could identify at early stage by testing Guthrie cards (within 21 days of life). Furthermore, since there is a lack of CMV knowledge in our population, educating and effective counseling by obstetricians/ gynecologists to the pregnant women are recommended.
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Affiliation(s)
- Samileh Noorbakhsh
- Pediatric Infectious Diseases Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Farhadi
- Head and Neck Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Faezeh Haghighi
- Cellular and Molecular Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran
| | - Sara Minaeian
- Pediatric Infectious Diseases Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
| | - Morteza Haghighi Hasanabad
- Pediatric Infectious Diseases Research Center, Institute of Immunology and Infectious Diseases, Iran University of Medical Sciences, Tehran, Iran
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Nicloux M, Peterman L, Parodi M, Magny JF. Outcome and management of newborns with congenital cytomegalovirus infection. Arch Pediatr 2020; 27:160-165. [PMID: 32127242 DOI: 10.1016/j.arcped.2020.01.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 12/11/2019] [Accepted: 01/25/2020] [Indexed: 11/25/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the most common non-genetic cause of hearing loss and neurological disorder in children. Its overall prevalence is approximately 0.5% in Europe. In France, systematic screening during pregnancy is not recommended; screening is performed only if there are maternal or fetal symptoms suggestive of this infection. Approximately 90% of infected newborns are asymptomatic at birth, and among them the risk of neurosensory sequelae is 5-15%. By contrast, the prevalence of neurosensory impairment in symptomatic newborns at birth varies from 17% to 60%. Congenital CMV infection must be confirmed at birth before the 21st day of life by polymerase chain reaction (PCR) on saliva or urine samples. A complete clinical examination, blood tests (blood count, liver function test, CMV PCR), hearing tests, brain ultrasound and eye fundus examination should be performed. Neurological and auditory follow-up must be extended well beyond the neonatal period because the occurrence of neurosensory sequelae may be delayed. Oral valganciclovir is the recommended treatment in moderate or severe congenital CMV infections for a period of 6 weeks to 6 months; such treatment requires regular monitoring because of its possible side effects.
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Affiliation(s)
- M Nicloux
- Service de réanimation néonatale, CHU Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - L Peterman
- Service de réanimation néonatale, CHU Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France
| | - M Parodi
- Service d'ORL, CHU Necker-Enfants malades, 75015 Paris, France
| | - J-F Magny
- Service de réanimation néonatale, CHU Necker-Enfants malades, 149, rue de Sèvres, 75015 Paris, France.
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Natale F, De Curtis M, Bizzarri B, Orlando MP, Ralli M, Liuzzi G, Caravale B, Franco F, Gaeta A, Giancotti A, Russo FY, Turchetta R. Isolated auditory neuropathy at birth in congenital cytomegalovirus infection. Ital J Pediatr 2020; 46:3. [PMID: 31906974 PMCID: PMC6945599 DOI: 10.1186/s13052-019-0767-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 12/27/2019] [Indexed: 12/03/2022] Open
Abstract
Background Congenital cytomegalovirus (cCMV) infection is the most frequent non-genetic cause of sensorineural hearing-loss (SNHL) (i.e., hearing loss due to a cochlear and/or auditory nerve damage). It is widely accepted that SNHL at birth, when associated to cCMV symptomatic infection involving the central nervous system, benefits from antiviral therapy started in the neonatal period. Conversely, there is no consensus for antiviral treatment in congenitally infected infants diagnosed with isolated SNHL (i.e., SNHL in an otherwise asymptomatic infant) at birth. Our aim was to assess the frequency and the auditory outcome of isolated SNHL at birth due to auditory neuropathy (AN) (i.e., SNHL in a patient with normal cochlear function and auditory nerve dysfunction) in infants with cCMV infection. Methods We retrospectively reviewed the clinical history of 60 infants, born at term, with cCMV asymptomatic infection, without additional risk factors for SNHL, and exhibiting bilateral “pass” otoacustic emissions (OAE). None of them underwent antiviral therapy. Hearing thresholds were assessed by means of Auditory Brainstem Responses (ABR). AN affected children were followed up until possible normalization of the hearing thresholds or definitive diagnosis of AN. Each infant diagnosed with monolateral or bilateral AN was classified according to the worst ear threshold. Results In our population, the first ABR was performed at a mean age of 5.00 ± 2.79 (SD) months and AN was diagnosed in 16/60 (26.67%) infants; in 4 infants the AN was defined as mild (4/4 monolateral), moderate in 11 (5/11 bilateral), and severe in 1 (bilateral). The mean age at first ABR was 3.69 ± 2.80 (SD) months in the 16 babies with AN and 5.48 ± 2.66 (SD) months in the 44 infants with normal hearing (p = 0.007). All AN cases spontaneously recovered a normal auditory threshold over time. The mean length of the audiological follow-up was 32.44 ± 17.58 (SD) months (range 5–60 months). Conclusion A delayed maturation of the auditory pathways should be considered when a mild/moderate isolated AN at birth is detected in cCMV infected infants. Prospective studies conducted on larger populations, and with a longer audiological follow-up, are needed to confirm our findings.
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Affiliation(s)
- Fabio Natale
- Department of Maternal and Child Sciences and Urology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy.
| | - Mario De Curtis
- Department of Maternal and Child Sciences and Urology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | - Bianca Bizzarri
- Department of Maternal and Child Sciences and Urology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | | | - Massimo Ralli
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppina Liuzzi
- National Institute for Infectious Diseases (INMI) "Lazzaro Spallanzani", Rome, Italy
| | - Barbara Caravale
- Department of Developmental and Social Psychology, "Sapienza" University of Rome, Rome, Italy
| | | | - Aurelia Gaeta
- Department of Public Health and Infectious Diseases, "Sapienza" University of Rome, Rome, Italy
| | - Antonella Giancotti
- Department of Maternal and Child Sciences and Urology, "Sapienza" University of Rome, Viale Regina Elena 324, 00161, Rome, Italy
| | | | - Rosaria Turchetta
- Department of Sense Organs, "Sapienza" University of Rome, Rome, Italy
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Nishida K, Fujioka K, Sugioka Y, Abe S, Ashina M, Fukushima S, Ohyama S, Ikuta T, Tanimura K, Yamada H, Iijima K, Morioka I. Prediction of Neurodevelopmental Impairment in Congenital Cytomegalovirus Infection by Early Postnatal Magnetic Resonance Imaging. Neonatology 2020; 117:460-466. [PMID: 32492677 DOI: 10.1159/000508218] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2019] [Accepted: 04/26/2020] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Congenital cytomegalovirus infection (CCMVI) may result in neurodevelopmental impairments (NDIs) such as hearing loss, developmental delay, epilepsy, and cerebral palsy. We aimed to investigate the potential for brain magnetic resonance imaging (MRI) to predict NDI in patients with CCMVI. METHODS We studied infants with CCMVI who were referred to our hospital from April 2010 to October 2018 and underwent a brain MRI within 3 months since birth. We screened for 6 classic presentations of CCMVI including ventriculomegaly, periventricular cysts, hippocampal dysplasia, cerebellar hypoplasia, migration disorders, and white matter abnormalities. Images were interpreted by a blinded pediatric radiologist. NDI was defined as having a developmental quotient <80, hearing dysfunction, blindness, or epilepsy requiring anti-epileptic drugs at approximately 18 months of corrected age. RESULTS The study involved 42 infants with CCMVI (median gestational age 38 weeks, birthweight 2,516 g). At least one abnormal finding was detected in 28 (67%) infants. Abnormal findings consisted of 3 cerebellar hypoplasia (7%), 7 migration disorders (17%), 26 white matter abnormalities (62%), 12 periventricular cysts (28%), 1 hippocampal dysplasia (2%), and 20 ventriculomegaly (48%). Abnormal findings were significantly more prevalent in infants with clinical symptoms (21/24, 91%) than in those without (7/19, 37%, p < 0.01). For NDI prediction, having ≥2 of ventriculomegaly, periventricular cysts, and white matter abnormality produced the highest Youden index values (0.78). CONCLUSION Infants with CCMVI with at least 2 of the abovementioned specific brain image abnormalities may be at high risk of developing NDI.
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Affiliation(s)
- Kosuke Nishida
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumichi Fujioka
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan,
| | - Yusuke Sugioka
- Department of Radiology, Kobe Children's Hospital, Kobe, Japan
| | - Shinya Abe
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Mariko Ashina
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Sachiyo Fukushima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shohei Ohyama
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Toshihiko Ikuta
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kenji Tanimura
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Kazumoto Iijima
- Department of Pediatrics, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
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Kameli R, Amanat M, Rezaei Z, Hosseionpour S, Nikbakht S, Alizadeh H, Ashrafi MR, Omrani A, Garshasbi M, Tavasoli AR. RNASET2-deficient leukoencephalopathy mimicking congenital CMV infection and Aicardi-Goutieres syndrome: a case report with a novel pathogenic variant. Orphanet J Rare Dis 2019; 14:184. [PMID: 31349848 PMCID: PMC6660666 DOI: 10.1186/s13023-019-1155-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2019] [Accepted: 07/09/2019] [Indexed: 11/10/2022] Open
Abstract
Background Ribonucleases (RNases) are crucial for degradation of ribosomal RNA (rRNA). RNASET2 as a subtype of RNASEs is a 256 amino acid protein, encoded by RNASET2 gene located on chromosome six. Defective RNASET2 leads to RNASET2-deficient leukoencephalopathy, a rare autosomal recessive neurogenetic disorder with psychomotor delay as its main clinical symptom. The clinical findings can be similar to congenital cytomegalovirus (CMV) infection and Aicardi-Goutieres syndrome (AGS). Methods Herein, we presented a patient with motor delay, neurological regression, infrequent seizures and microcephaly at 5 months of age. Brain imaging showed white matter involvement, calcification and anterior temporal cysts. Basic metabolic tests, serum and urine CMV polymerase chain reaction (PCR) were requested. According to clinical and imaging findings, screening of RNASET2 and RMND1 genes were performed. The clinical data and magnetic resonance imaging (MRI) findings of previous reported individuals with RNASET2-deficient leukodystrophy were also reviewed and compared to the findings of our patient. Results Brain MRI findings were suggestive of RNASET2-deficient leukoencephalopathy, AGS and CMV infection. Basic metabolic tests were normal and CMV PCR was negative. Molecular study revealed a novel homozygous variant of c.233C > A; p.Ser78Ter in exon 4 of RNASET2 gene compatible with the diagnosis of RNASET2-deficient leukoencephalopathy. Conclusions RNASET2-deficiency is a possible diagnosis in an infant presented with a static leukoencephalopathy and white matter involvement without megalencephaly. Due to overlapping clinical and radiologic features of RNASET2-deficient leukoencephalopathy, AGS and congenital CMV infections, molecular study as an important and helpful diagnostic tool should be considered to avoid misdiagnosis.
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Affiliation(s)
- Reyhaneh Kameli
- Myelin Disorders Clinic, Pediatric Neurology Division, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Man Amanat
- Faculty of Medicine, Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Zahra Rezaei
- Myelin Disorders Clinic, Pediatric Neurology Division, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Sareh Hosseionpour
- Myelin Disorders Clinic, Pediatric Neurology Division, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Sedigheh Nikbakht
- Myelin Disorders Clinic, Pediatric Neurology Division, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Houman Alizadeh
- Department of Pediatrics, Division of Pediatric Radiology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahmoud Reza Ashrafi
- Myelin Disorders Clinic, Pediatric Neurology Division, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Abdolmajid Omrani
- Myelin Disorders Clinic, Pediatric Neurology Division, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
| | - Masoud Garshasbi
- Department of Medical Genetics, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
| | - Ali Reza Tavasoli
- Myelin Disorders Clinic, Pediatric Neurology Division, Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran.
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Torii Y, Yoshida S, Yanase Y, Mitsui T, Horiba K, Okumura T, Takeuchi S, Suzuki T, Kawada JI, Kotani T, Yamashita M, Ito Y. Serological screening of immunoglobulin M and immunoglobulin G during pregnancy for predicting congenital cytomegalovirus infection. BMC Pregnancy Childbirth 2019; 19:205. [PMID: 31221131 PMCID: PMC6585127 DOI: 10.1186/s12884-019-2360-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 06/12/2019] [Indexed: 11/16/2022] Open
Abstract
Background Cytomegalovirus (CMV) is one of the most frequent pathogens for congenital infections. Most cases of congenital CMV infection (cCMV) are asymptomatic at birth, but sensorineural hearing loss (SNHL) or neurodevelopmental delay can appear later in childhood. This prospective study examined the practicability of serological screening for anti-CMV immunoglobulin (Ig) G and anti-CMV IgM in pregnant women. Methods A total of 11,753 pregnant women were examined for CMV IgG and CMV IgM during the first or second trimester. When IgM was positive, IgG was reevaluated more than two weeks later. When IgG was negative, IgG was reevaluated in the second or third trimester. All neonates from mothers with positive/borderline IgM or IgG seroconversion underwent polymerase chain reaction assay for CMV using urine samples to diagnose cCMV. Levels of IgG and IgM were compared between mothers with and without cCMV. Receiver operating characteristic (ROC) curves for IgM titers were analyzed. Results Eight of 500 neonates (1.6%) born from mothers with positive IgG and positive IgM, and 3 of 13 neonates (23.1%) born from mothers with IgG seroconversion were diagnosed with cCMV. Neither IgM titers nor IgG titers differed significantly between cCMV and non-cCMV groups. The area under the ROC curve was 0.716 and the optimal cut-off for IgM was 7.28 index (sensitivity = 0.625, specificity = 0.965, positive predictive value = 0.238, negative predictive value = 0.993). Titers of IgG were not frequently elevated in pregnant women with positive IgM during the observation period, including in those with cCMV. All 11 cCMV cases were asymptomatic at birth and none had shown SNHL or developmental delay as of the last regular visit (mean age, 40 months). Conclusions Seroconversion of CMV IgG and high-titer IgM during early pregnancy are predictors of cCMV. High IgM titer (> 7.28 index) is a predictor despite relatively low sensitivity. Levels of IgG had already plateaued at first evaluation in mothers with cCMV. Maternal screening offered insufficient positive predictive value for diagnosing cCMV, but allowed identifying asymptomatic cCMV cases in an early stage.
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Affiliation(s)
- Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Shigeru Yoshida
- Department of Pediatrics, Kishokai Medical Corporation, 4-122 Koike, Inazawa, 492-8144, Japan
| | - Yoichiro Yanase
- Department of Pediatrics, Kishokai Medical Corporation, 4-122 Koike, Inazawa, 492-8144, Japan
| | - Takashi Mitsui
- Department of Obstetrics and Gynecology, Kishokai Medical Corporation, 4-122 Koike, Inazawa, 492-8144, Japan
| | - Kazuhiro Horiba
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Toshihiko Okumura
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Suguru Takeuchi
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Takako Suzuki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Jun-Ichi Kawada
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Tomomi Kotani
- Department of Obstetrics and Gynecology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan
| | - Mamoru Yamashita
- Department of Obstetrics and Gynecology, Kishokai Medical Corporation, 4-122 Koike, Inazawa, 492-8144, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8550, Japan.
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Quintas-Neves M, Soares-Fernandes JP. Magnetic resonance imaging of cerebellar cysts in a neonate with congenital cytomegalovirus infection. Pediatr Radiol 2019; 49:687-9. [PMID: 30612159 DOI: 10.1007/s00247-018-4326-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 11/03/2018] [Accepted: 12/09/2018] [Indexed: 12/26/2022]
Abstract
Congenital cytomegalovirus infection is one of the most common congenital viral infections in the world. Brain magnetic resonance imaging plays a key role in evaluating brain involvement and establishing prognosis; several characteristic features have been described. We present a description of cerebellar cysts in a neonate with polymerase chain reaction-confirmed cytomegalovirus congenital infection, and discuss the differential diagnosis and potential pathophysiological mechanisms.
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Mathias CR, Joung SJS. Diagnostic challenges in congenital cytomegalovirus infection in pregnancy: A case report. Case Rep Womens Health 2019; 22:e00119. [PMID: 31192993 PMCID: PMC6510697 DOI: 10.1016/j.crwh.2019.e00119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Revised: 04/20/2019] [Accepted: 04/25/2019] [Indexed: 11/26/2022] Open
Abstract
Cytomegalovirus is the most common congenital viral infection. Infection can cause developmental delay, sensorineural deafness and fetal death. Fetal damage is more severe when infection occurs in the first trimester of pregnancy. Prenatal ultrasound findings may be cerebral, such as ventriculomegaly, microcephaly and periventricular leukomalacia, as well as non-cerebral, such as echogenic bowel, ascites and pericardial effusion. We present a case of congenital cytomegalovirus infection in which the only ultrasound sign noted at routine second-trimester scan was low-grade echogenic bowel, a soft marker, which progressed to severe disease in the third trimester, when further investigation was prompted, leading to the diagnosis. Patients need to be counselled regarding the possible perinatal prognosis. Ultrasound markers can often but not always predict severity and, hence, counselling can be a challenge. Conclusion: A meticulous anatomy survey in mid-trimester remains the norm and ultrasound soft markers should prompt comprehensive testing for viral infections in pregnancy. Fetal damage caused by infection with CMV is more severe when the infection occurs in the first trimester of pregnancy. CMV is the most common congenital viral infection causingdevelopmental delay, sensorineural deafness and fetal death. Ultrasound markers can often but not always predict the severity of congenital infection. A meticulous anatomy survey in mid-trimester remains the norm. Ultrasound soft markers should prompt comprehensive testing for viral infections in pregnancy.
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Affiliation(s)
- Caroline Ruth Mathias
- Department of Obstetrics and Gynaecology, Nepean Hospital, Kingswood 2747, NSW, Australia
| | - Steven Jin Sung Joung
- Department of Obstetrics and Gynaecology, Nepean Hospital, Kingswood 2747, NSW, Australia
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Wagner S, Lledo PM, Lazarini F. Assessing Olfaction Using Ultrasonic Vocalization Recordings in Mouse Pups with a Sono-olfactometer. Bio Protoc 2019; 9:e3170. [PMID: 33654976 DOI: 10.21769/bioprotoc.3170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/29/2019] [Accepted: 01/30/2019] [Indexed: 11/02/2022] Open
Abstract
Olfaction is the first sensory modality to develop during fetal life in mammals, and plays a key role in the various behaviors of neonates such as feeding and social interaction. Odorant cues (i.e., mother or predator scents) can trigger potentiation or inhibition of ultrasonic vocalizations (USV) emitted by pups following their isolation. Here, we report how USV are inhibited by olfactory cues using a sono-olfactometer that has been designed to quantify precisely olfaction in pups congenitally infected by cytomegalovirus. This olfactory-driven behavioral test assesses the USV emitted in presence of unfamiliar odorants such as citral scent or adult male mouse scent. We measure the number of USV emitted as an index of odorant detection during the three periods of the 5-min isolation time of the pup into the sono-olfactometer: first period without any odorant, second period with odorant exposure and last period with exhaust odorant. This protocol can be easily used to reveal olfactory deficits in pups with altered olfactory system due to toxic lesions or infectious diseases.
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Affiliation(s)
- Sébastien Wagner
- Institut Pasteur, Perception and Memory Unit, UMR 3571, CNRS, Paris, F-75015, France
| | - Pierre-Marie Lledo
- Institut Pasteur, Perception and Memory Unit, UMR 3571, CNRS, Paris, F-75015, France
| | - Françoise Lazarini
- Institut Pasteur, Perception and Memory Unit, UMR 3571, CNRS, Paris, F-75015, France
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Riga M, Korres G, Chouridis P, Naxakis S, Danielides V. Congenital cytomegalovirus infection inducing non-congenital sensorineural hearing loss during childhood; a systematic review. Int J Pediatr Otorhinolaryngol 2018; 115:156-164. [PMID: 30368378 DOI: 10.1016/j.ijporl.2018.10.005] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is one of the most important risk factors for delayed onset and progressive hearing loss in children. However, the relevant literature is limited, heterogeneous and currently insufficient to provide guidance toward the effective monitoring of hearing acuity in these children. OBJECTIVES The aim of this study was to provide a systematic review focused on types of hearing loss that may escape diagnosis through universal neonatal hearing screening and/or present significant changes during childhood, such as progressive, fluctuating and late-onset hearing loss. DATA SOURCES A review of the present literature was conducted via the PubMed database of the US National Library of Medicine (www.pubmed.org) and Scopus database (www.scopus.com) with the search terms "late-onset hearing loss cytomegalovirus", "progressive hearing loss cytomegalovirus" and "fluctuating hearing loss cytomegalovirus". STUDY ELIGIBILITY CRITERIA Prospective or retrospective clinical studies were included if they presented a detailed audiological assessment, for a follow-up period of >2years. METHODS The prevalence and time of diagnosis of progressive, fluctuating and late-onset hearing loss were considered as primary outcomes. Results were recorded separately for symptomatic and asymptomatic children, when possible. RESULTS This analysis refers to a population of 181 children with CMV-induced hearing loss, who were diagnosed among 1089 with congenital CMV infection. The prevalence of CMV-induced hearing loss was significantly higher among symptomatic children (p < 0.0001), who were also significantly more likely to develop bilateral hearing loss (p = 0.001). There was not sufficient information on the prevalence, laterality, degree and time of diagnosis of progressive, fluctuating and late-onset hearing loss that could constitute the basis toward the report of specific follow-up guidelines. CONCLUSIONS Further studies are needed in order to understand and quantify the potential effects of congenital CMV infection in the inner ear and hearing acuity. The results presented in the relative studies should be very carefully evaluated and compared to each other, since they correspond to substantially different cohorts, study designs, and result elaboration. Infants with congenital CMV infection should be closely monitored, regarding their hearing acuity at least during their preschool years, although substantial changes in hearing thresholds have been reported as late as the 16th year of age. Parental counseling is of outmost importance in order to minimize the numbers of children lost to follow-up.
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Affiliation(s)
- Maria Riga
- Democritus University of Thrace, University Hospital of Evros, ENT Department, Dragana University Campus, 68100, Alexandroupolis, Greece.
| | - George Korres
- Central Manchester University Hospitals, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
| | - Pantelis Chouridis
- Democritus University of Thrace, University Hospital of Evros, ENT Department, Dragana University Campus, 68100, Alexandroupolis, Greece.
| | - Stephanos Naxakis
- University of Patras, University Hospital of Rio, ENT Department, 26504, Patras, Greece.
| | - Vasilios Danielides
- University of Patras, University Hospital of Rio, ENT Department, 26504, Patras, Greece.
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Hayashi M, Nishiyama I, Moriuchi M, Moriuchi H. A Twenty-Year Retrospective Diagnosis of Congenital Cytomegalovirus Infection. Pediatr Neurol 2018; 86:71-2. [PMID: 30104109 DOI: 10.1016/j.pediatrneurol.2018.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 05/18/2018] [Indexed: 11/20/2022]
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Moteki H, Isaka Y, Inaba Y, Motobayashi M, Nishio SY, Ohira S, Yano T, Iwasaki S, Shiozawa T, Koike K, Usami SI. A rational approach to identifying newborns with hearing loss caused by congenital cytomegalovirus infection by dried blood spot screening. Acta Otolaryngol 2018. [PMID: 29513124 DOI: 10.1080/00016489.2018.1441545] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
OBJECTIVE Congenital cytomegalovirus (cCMV) infection is the most common congenital infection, with the majority of infected newborns having no detectable signs. The aim of this study was to examine the accuracy of our newly developed DBS-based assay as an appropriate mass screening method for cCMV infection. METHODS Between May 2011 and October 2016, newborns delivered at six hospitals in Nagano Prefecture, Japan were enrolled prospectively. We employed dried blood spot (DBS)-based assays with real-time quantitative PCR (qPCR). RESULTS Prior to the clinical study, confirmation analysis was carried out using positive and negative controls. The sensitivity and specificity of this DBS-based qPCR assay for the detection of CMV DNA were 83 and 97%, respectively. During the study period, 9675 newborns were enrolled. The total recovery rate of DBS was 99.92% (9,667/9,675). From our analysis of the 9,667 samples, 47 DBS samples were found positive by the qPCR test (0.48%), and 9620 (99.5%) DBS samples were CMV-negative. CONCLUSIONS The risk of neural disorders associated with cCMV infection is thought likely to increase with CMV viral load in the blood. DBS screening for cCMV may be sufficient in a clinical setting, and offers a realistic and feasible option for universal mass screening.
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Affiliation(s)
- Hideaki Moteki
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuichi Isaka
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Inaba
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Mitsuo Motobayashi
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ya Nishio
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Ohira
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Takuya Yano
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Satoshi Iwasaki
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tanri Shiozawa
- Department of Obstetrics and Gynecology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Kenichi Koike
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shin-Ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Matsumoto, Japan
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Abstract
Congenital cytomegalovirus is the most common viral congenital infection, and affects up to 2% of neonates. Significant sequelae may develop after congenital cytomegalovirus, including hearing loss, cognitive defects, seizures, and death. Zika virus is an emerging virus with perinatal implications; a congenital Zika virus syndrome has been identified, and includes findings such as microcephaly, fetal nervous system abnormalities, and neurologic sequelae after birth. Screening, diagnosis, prevention, and treatment of these perinatal infections are reviewed in this article.
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Abstract
INTRODUCTION Cytomegalovirus (CMV) is the most common and serious cause of congenital infections in developed countries since it is capable of infecting the fetus after both primary and recurrent maternal infection, and can be spread for years by infected children. Areas covered: Animal and human pregnancy studies about the prevention of congenital CMV infection and disease by CMV-specific hyperimmune globulin (HIG). Commercial HIG is manufactured from the plasma of selected donors with high anti-CMV antibody avidity and titers. Expert commentary: Currently available experimental and clinical studies and case reports support the possible effectiveness and safety of HIG infusions in pregnancy for the prevention of congenital CMV disease. The knowledge about the potential efficacy of preventive or therapeutic HIG administration should be enlarged by multi-center randomized studies, which may be favored by the implementation of CMV screening. Meanwhile, if ultrasound examinations show signs of fetal injury, or CMV is detected in the amniotic fluid, the patients should be advised about the possible option of HIG therapy.
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Affiliation(s)
- Giovanni Nigro
- a Pediatric School , University of L'Aquila , L'Aquila , Italy.,b Non-profit Onlus CMV Association Mother to Infant Cytomegalovirus Infection (AMICI) , Rome , Italy
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Simonazzi G, Curti A, Cervi F, Gabrielli L, Contoli M, Capretti MG, Rizzo N, Guerra B, Farina A, Lazzarotto T. Perinatal Outcomes of Non-Primary Maternal Cytomegalovirus Infection: A 15-Year Experience. Fetal Diagn Ther 2017; 43:138-142. [PMID: 28697499 DOI: 10.1159/000477168] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 04/21/2017] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To evaluate perinatal outcomes in case of non-primary maternal cytomegalovirus (CMV) infection. METHODS We performed a retrospective cohort study of pregnant women with active CMV infection referred to our unit over a 15-year period (January 2000 to December 2014). Non-primary infection was diagnosed on the basis of the results of confirmatory serological and virological tests (avidity test, immunoblotting, real-time PCR-DNA). The vertical transmission rate and the percentage of symptomatic congenital infection were determined in this group of patients. RESULTS A total of 205 pregnant women were enrolled. Congenital infection occurred in 7 (3.4%) fetuses/neonates. Symptomatic disease was present at birth in 3 of the 7 congenitally infected neonates (1.5%). Two out of 3 symptomatic newborns presented a pathologic second-trimester ultrasound scan. CONCLUSION Maternal immunity offers substantial protection against intrauterine transmission of CMV infection, but not against disease once the fetus is infected.
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Affiliation(s)
- Giuliana Simonazzi
- Division of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences, St. Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
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Mirarab A, Mohebbi A, Moradi A, Javid N, Vakili MA, Tabarraei A. Frequent pUL27 Variations in HIV-Infected Patients. Intervirology 2017; 59:262-266. [PMID: 28402975 DOI: 10.1159/000471484] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Drug-resistant isolates of human cytomegalovirus (HCMV) have led to the development of new anti-HCMV drugs. Maribavir (MBV) is a novel inhibitor of the HCMV viral kinase. Resistance to MBV is mapped to gene UL27, a viral nuclear protein. In this study, we investigated UL27 polymorphisms in MBV-naive HIV-positive and HCMV congenitally infected clinical samples. METHODS DNA was extracted from 20 CMV-positive HIV (9/20) and congenitally infected (11/20) patients and used for UL27 polymerase chain reaction amplification. Sanger sequencing and multiple sequence alignment of products was performed. RESULTS K90 was the most prevalent polymorphism in both HIV-positive and congenitally infected patients. Polymorphisms Q54, D123, and R107 (10%) were seen in more than one sample. There were significantly more polymorphisms in the HIV-positive samples (p = 0.038). CONCLUSION HCMV pUL27 is highly variable in adult immunocompromised HIV-positive patients.
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Affiliation(s)
- Azam Mirarab
- Student Research Committee, Golestan University of Medical Sciences, Gorgan, Iran
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Giannattasio A, Di Costanzo P, Milite P, De Martino D, Capone E, Romano A, Bravaccio C, Capasso L, Raimondi F. Is lenticulostriated vasculopathy an unfavorable prognostic finding in infants with congenital cytomegalovirus infection? J Clin Virol 2017; 91:31-35. [PMID: 28412596 DOI: 10.1016/j.jcv.2017.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Revised: 03/30/2017] [Accepted: 04/03/2017] [Indexed: 10/19/2022]
Abstract
BACKGROUND Lenticulostriated vasculopathy (LSV) detected in head ultrasound (HUS) has been related to neurological and hearing sequelae in infants with congenital cytomegalovirus (cCMV) infection. OBJECTIVE To assess the role of LSV in predicting neurodevelopmental and hearing outcomes in infants with cCMV infection. STUDY DESIGN We enrolled consecutive infants who were affected by cCMV infection and underwent HUS within the first month of life. Data on clinical onset and course, laboratory findings, visual/hearing functions and neurodevelopmental outcome were collected. As controls, infants with suspected intrauterine exposure to Toxoplasma and with no confirmed congenital toxoplasmosis were considered. RESULTS Data from 161 infants with cCMV infection (105 symptomatic) and 133 controls were analyzed. HUS was normal in 66 (41%) cCMV patients. Among these, 28 (42.4%) were symptomatic and 38 (57.6%) asymptomatic infants. The percentage of patients with no HUS abnormalities was higher in asymptomatic (38/56, 67.9%) than in symptomatic infants (28/105, 26.7%) (p<0.05). LSV, as isolated or associated with other brain abnormalities, was diagnosed in 64/161 (39.7%) patients with cCMV compared to 24/133 (18%) controls (p<0.05). In cCMV group, LSV was found in 51 (48.6%) symptomatic infants and in 13 (72.2%) asymptomatic patients (p>0.05). Overall, in the whole population of 95 patients with cCMV and abnormal HUS results, LSV (alone or with other findings) did not represent a risk factor for unfavorable neurological and hearing outcome. Similar results were obtained when we limited the analysis to the group of symptomatic cCMV patients. CONCLUSIONS Although LSV is a common HUS finding in infants with cCMV infection, its presence is not predictive of an adverse outcome. Our data suggest that HUS as a single neuroimaging investigation is unreliable in selecting candidates to antiviral therapy, mainly in presence of LSV as isolated finding.
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Affiliation(s)
- Antonietta Giannattasio
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy.
| | - Pasquale Di Costanzo
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Paola Milite
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Daniela De Martino
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Eleonora Capone
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Antonia Romano
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Carmela Bravaccio
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Letizia Capasso
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
| | - Francesco Raimondi
- Department of Translational Medical Sciences-Section of Neonatology, University Federico II, Naples, Italy
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Gantt S, Bitnun A, Renaud C, Kakkar F, Vaudry W. Diagnosis and management of infants with congenital cytomegalovirus infection. Paediatr Child Health 2017; 22:72-74. [PMID: 29479184 DOI: 10.1093/pch/pxx002] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Congenital cytomegalovirus infection (cCMV) is the most common congenital infection, occurring in approximately 0.5% of live births. Most infected newborns are asymptomatic, but up to 20% develop sensorineural hearing loss or other permanent neurologic sequelae. The presentation of newborns with symptomatic cCMV is highly variable, and the infection is usually not diagnosed in the absence of a screening program. Newborn cCMV screening programs are estimated to be beneficial and cost-effective, and are increasingly being implemented. Diagnosis requires direct detection of virus in a sample obtained before 3 weeks of life, and is best performed by polymerase chain reaction (PCR) of saliva or urine, either of which is more sensitive than dried blood spot. Antiviral treatment of selected newborns with cCMV-related disease appears to improve hearing and neurocognitive outcomes. All infected infants should be evaluated promptly to determine appropriate therapy, and receive close audiologic and developmental follow-up.
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Affiliation(s)
- Soren Gantt
- University of British Columbia and BC Children's Hospital, Vancouver, British Columbia
| | - Ari Bitnun
- University of Toronto and Sick Kids Hospital, Toronto, Ontario
| | - Christian Renaud
- Université de Montréal and Hôpital Ste. Justine, Montreal, Quebec
| | - Fatima Kakkar
- Université de Montréal and Hôpital Ste. Justine, Montreal, Quebec
| | - Wendy Vaudry
- University of Alberta and Stollery Children's Hospital, Edmonton, Alberta
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Kaneko M, Ohhashi M, Minematsu T, Muraoka J, Kusumoto K, Sameshima H. Maternal immunoglobulin G avidity as a diagnostic tool to identify pregnant women at risk of congenital cytomegalovirus infection. J Infect Chemother 2016; 23:173-176. [PMID: 28034524 DOI: 10.1016/j.jiac.2016.12.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2016] [Revised: 11/22/2016] [Accepted: 12/05/2016] [Indexed: 11/17/2022]
Abstract
BACKGROUND The immunoglobulin (Ig) G avidity index (AI) is useful to detect primary cytomegalovirus (CMV) infection. However, because IgG matures with time, this index is not useful to detect a primary infection, unless measured at an appropriate time. OBJECTIVES We aimed to clarify the difference between using IgG AI and IgM positivity according to the stage of pregnancy to identify congenital CMV infection risk. STUDY DESIGN We collected the serum samples from 1115 pregnant women who underwent maternal screening for primary infection (n = 956) and were referred to our hospital because of CMV IgM positivity (n = 155) or had abnormal fetal ultrasonography findings (n = 4). The same sera samples were used to measure CMV IgM, IgG, and IgG AI. An IgG AI of <35% was defined as low. Neonatal urine collected within 5 days after birth was examined by polymerase chain reaction to confirm congenital infection. RESULTS Fourteen mothers gave birth to infected neonates. The sensitivity, specificity, and negative predictive values of the low IgG AI group with IgM-positive samples to discriminate between women with congenital infection at ≤14 weeks of gestation were 83.3, 83.8, and 99.1, respectively, which were higher than those of other subjects. Uni- and multivariate analyses revealed that IgM positivity and low IgG AI were independent variables associated with congenital infection at any stage of pregnancy, except low IgG AI at ≥15 weeks of gestation. CONCLUSION Low IgG AI with IgM positivity at ≤14 weeks of gestation was a good indicator of congenital infection, which should prove useful in obstetric practice.
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Affiliation(s)
- Masatoki Kaneko
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Japan; Graduate School of Nursing Science, Faculty of Medicine, University of Miyazaki, Japan.
| | - Masanao Ohhashi
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Japan
| | | | - Junsuke Muraoka
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Japan
| | - Kazumi Kusumoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Japan
| | - Hiroshi Sameshima
- Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, Japan
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Plachter B. Prospects of a vaccine for the prevention of congenital cytomegalovirus disease. Med Microbiol Immunol 2016; 205:537-47. [PMID: 27519596 DOI: 10.1007/s00430-016-0472-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 08/03/2016] [Indexed: 02/07/2023]
Abstract
Congenital human cytomegalovirus (HCMV) infection is one leading cause of childhood disabilities. Prevention of congenital HCMV disease by vaccination has consequently been identified as a priority public healthcare goal. Several vaccine candidates have been introduced in the past that aimed at the prevention of primary HCMV infection in pregnancy. None of these has provided complete protection, and no licensed vaccine is thus far available. An additional level of complexity has been reached by recent studies indicating that the burden of HCMV transmission and disease following non-primary infections in pregnancy may be higher than previously anticipated. Substantial progress in our understanding of the immunobiology of HCMV infection in pregnancy has fostered studies to test revised or novel vaccine strategies. Preventing HCMV transmission has been identified a surrogate endpoint, rendering the conduction of vaccine studies feasible with reasonable effort. Identification of the glycoprotein complex gH/gL/UL128-131 as a mediator of HCMV host cell tropism and evaluation of that complex as a major target of the neutralizing antibody response made manufacturers consider vaccine candidates that include these proteins. Detailed structural analyses of the neutralizing determinants on HCMV glycoprotein B (gB) have revived interest in using this protein in its pre-fusion conformation for vaccine purposes. Studies in pregnant women and in animal models have provided evidence that addressing the T lymphocyte response by vaccination may be crucial to prevent HCMV transmission to the offspring. CD4 T lymphocytes may be of particular importance in this respect. A simultaneous targeting of both the humoral and cellular immune response against HCMV by vaccination thus appears warranted in order to prevent congenital HCMV infection. There is, however, still need for further research to be able to define an immunological correlate of protection against HCMV transmission during pregnancy. This brief review will highlight recent developments in our understanding of the natural history and immunobiology of HCMV infection in pregnancy and their possible impact on the strategies for the development of an HCMV vaccine.
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De Kegel A, Maes L, Dhooge I, van Hoecke H, De Leenheer E, Van Waelvelde H. Early motor development of children with a congenital cytomegalovirus infection. Res Dev Disabil 2016; 48:253-261. [PMID: 26630616 DOI: 10.1016/j.ridd.2015.11.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/22/2015] [Accepted: 11/16/2015] [Indexed: 06/05/2023]
Abstract
BACKGROUND Congenital cytomegalovirus (cCMV) infection is the most important etiology of non-hereditary childhood hearing loss and an important cause of neurodevelopmental delay. The current study aimed to investigate the early motor development of symptomatic and asymptomatic cCMV infected children with and without sensorineural hearing loss (SNHL). METHODS Sixty-four children with a cCMV infection, without cerebral palsy, were compared to a control group of 107 normal hearing children. They were assessed around the ages of 6, 12, and 24 months with the Peabody Developmental Motor Scales-2 (PDMS-2), Alberta Infant Motor Scales (AIMS), and Ghent Developmental Balance Test (GDBT). The cCMV infected children were subdivided into a symptomatic (n=26) and asymptomatic cCMV group (n=38) but also into a cCMV group with SNHL (n=19) and without SNHL (n=45). RESULTS Symptomatic cCMV infected children and cCMV infected children with SNHL performed significantly weaker for all gross motor outcome measures. CONCLUSION A congenital CMV infection is a risk factor for a delay in the early motor development. Follow-up will be necessary to gain insight into the exact cause of this motor delay and to define the predictive value of early motor assessment of cCMV infected children.
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Affiliation(s)
- Alexandra De Kegel
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium; Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium
| | - Leen Maes
- Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.
| | - Ingeborg Dhooge
- Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Helen van Hoecke
- Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Els De Leenheer
- Department of Otorhinolaryngology, University Hospital Ghent, Ghent, Belgium; Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium
| | - Hilde Van Waelvelde
- Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Shigemi D, Yamaguchi S, Otsuka T, Kamoi S, Takeshita T. Seroprevalence of cytomegalovirus IgG antibodies among pregnant women in Japan from 2009-2014. Am J Infect Control 2015; 43:1218-21. [PMID: 26277571 DOI: 10.1016/j.ajic.2015.06.026] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2015] [Revised: 06/21/2015] [Accepted: 06/22/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Human cytomegalovirus (CMV) is a major cause of congenital infection. The seroprevalence of maternal CMV IgG antibodies among Japanese women is decreasing. In this study, we assessed the rate of and risk factors for CMV infection. This article includes a description of a method for the prevention of CMV infection. METHODS Medical records of 7,074 women who delivered a baby at our hospital were retrospectively reviewed. For seronegative patients, preventive educational materials were provided, and CMV IgG antibody levels were reassessed during late pregnancy. Congenital infection in neonates from seroconverted mothers was determined by urine analysis. RESULTS The overall CMV IgG seropositivity rate was 69.1%. The prevalence of CMV IgG increased with age and parity. In a multivariate logistic regression analysis, parity remained an independent determinant of CMV IgG seropositivity. The seroconversion rate for CMV IgG antibody during pregnancy was 0.37%. Neonatal congenital CMV infection occurred in 37.5% of seroconverted women. The risk of primary CMV infection in mothers during their first pregnancy was 7.0%, with an average follow-up period of 2.1 years. CONCLUSION We found that parity was an independent determinant of CMV IgG seropositivity, suggesting that child-rearing may be a high risk factor for maternal CMV infection. The provision of information on hygiene may be an effective and inexpensive method for preventing CMV infection.
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