51
|
Lanari M, Capretti MG, Lazzarotto T, Gabrielli L, Rizzollo S, Mostert M, Manzoni P. Neuroimaging in CMV congenital infected neonates: how and when. Early Hum Dev 2012; 88 Suppl 2:S3-5. [PMID: 22633509 DOI: 10.1016/s0378-3782(12)70003-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Neonatal congenital infections are an important cause of mortality, morbidity and long-term neurodevelopmental and sensorineural sequelae. Many pathogens can cause in utero infection, and among them, cytomegalovirus (CMV) plays a prominent role. In developed countries, CMV poses major health problems as it is the most common pathogen leading to congenital infection, and the leading cause of nonhereditary deafness in children. Evaluation of central nervous system (CNS) involvement in congenital CMV infected newborns is mandatory to better assess the severity of the disease, to guide adequate treatment, to define prognosis, and to tailor follow-up observations and parents' counselling. Cerebral ultrasonography (cUS), Computed Tomography (CT), and Magnetic Resonance Imaging (MRI) are the currently available techniques to evaluate infants with suspected or proven congenital CMV infection. In congenital CMV infection, their role in early detection and confirmation of cerebral involvement within the first month of life is crucial to initiate specific treatment with antivirals. Neonatologists, paediatricians and radiologists should be aware of the role, the limitations and the inherent risks related to the use of these specific neuroimaging diagnostic tools in these infants. In this article we will discuss from a neonatological perspective the advantages, disadvantages, risks and limitations of each imaging technique.
Collapse
Affiliation(s)
- M Lanari
- Paediatric Department S Maria della Scaletta General Hospital, Imola, Bologna, Italy.
| | | | | | | | | | | | | |
Collapse
|
52
|
Furutate S, Iwasaki S, Nishio SY, Moteki H, Usami SI. Clinical profile of hearing loss in children with congenital cytomegalovirus (CMV) infection: CMV DNA diagnosis using preserved umbilical cord. Acta Otolaryngol 2011; 131:976-82. [PMID: 21612560 PMCID: PMC3490478 DOI: 10.3109/00016489.2011.583268] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Conclusions: Congenital cytomegalovirus (CMV) infection is a major cause of bilateral and unilateral sensorineural hearing loss (SNHL) in children, accounting for 9.0% of SNHL cases. The diagnostic rate using combined genetic deafness test and CMV DNA detection test was determined to be 46.4% in bilateral profound SNHL. Objectives. The present study investigated the prevalence of congenital CMV infection diagnosed retrospectively by detection of CMV DNA in dried umbilical cord specimens from children with unilateral or bilateral SNHL up to the age of 12 years. Methods: Preserved dried umbilical cords were collected from 134 children with bilateral (46 children) or unilateral (88 children) SNHL. DNA was extracted from the dried umbilical cords and CMV DNA was detected by quantitative PCR. Genetic deafness tests based on the invader assay were performed in children with bilateral SNHL. Results: CMV DNA from the dried umbilical cords was detected in 8.7% of the bilateral SNHL and 9.1% of unilateral SNHL. Deafness gene mutations were identified in 21.7% (10/46) of children with bilateral SNHL.
Collapse
Affiliation(s)
| | - Satoshi Iwasaki
- Department of Hearing Implant Science, Shinshu University School of Medicine, Matsumoto, Japan
| | | | - Hideaki Moteki
- Department of Otolaryngology
- Department of Hearing Implant Science, Shinshu University School of Medicine, Matsumoto, Japan
| | | |
Collapse
|
53
|
Koyano S, Inoue N, Oka A, Moriuchi H, Asano K, Ito Y, Yamada H, Yoshikawa T, Suzutani T. Screening for congenital cytomegalovirus infection using newborn urine samples collected on filter paper: feasibility and outcomes from a multicentre study. BMJ Open 2011; 1:e000118. [PMID: 22021766 PMCID: PMC3191411 DOI: 10.1136/bmjopen-2011-000118] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background As congenital cytomegalovirus (CMV) infection causes significant clinical consequences not only at birth but also later as neurological sequelae, it is critical to establish a strategy for screening congenitally infected newborns. Previous studies have identified an insufficient sensitivity in screening methods based on the use of dried blood spots (DBSs). Objectives To evaluate the feasibility of the authors' recently developed method for large-scale screening for congenital CMV infection and to identify risk factors for congenital infection. Methods More than 21 000 newborns were enrolled at 25 sites in six geographically separate areas of Japan. Urine was collected onto filter cards placed in the diapers, which were then analysed by quantitative PCR using the filter disc directly as a template. Clinical and physical findings of the newborns were extracted from their medical records. CMV strains from the cases and their siblings were genetically compared. Viral loads in DBSs obtained from some of the cases were compared with those in the urine filters. Results Congenital CMV infection was identified in 0.31% (95% CI 0.24% to 0.39%) of the newborns, and 30% of the cases (20/66) had typical clinical manifestations and/or showed abnormalities in brain images at birth. Although the positive predictive value of our screening was 94%, the lack of any comparison with a gold standard assay prevented calculation of the negative predictive value. Almost two-thirds of the cases had siblings, a significantly higher frequency than for uninfected newborns. Most of the cases (21/25) excreted CMV strains identical to those of their siblings. CMV DNA was undetectable in three out of 12 retrievable DBS specimens. Conclusions Implementation of an effective large-scale screening programme for congenital CMV infection is feasible. Siblings are the major risk factor for congenital CMV infection, which emphasises the need for education of mothers-to-be as well as vaccine development.
Collapse
Affiliation(s)
- Shin Koyano
- Department of Paediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Naoki Inoue
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Akira Oka
- Department of Paediatrics, Kyorin University, Tokyo, Japan
| | | | - Kimisato Asano
- Department of Obstetrics and Gynecology, Fukushima Medical University, Fukushima, Japan
| | - Yushi Ito
- Department of Maternal and Perinatal Services, National Centre for Child Health and Development, Tokyo, Japan
| | - Hideto Yamada
- Department of Obstetrics and Gynecology, Kobe University Graduate School of Medicine, Hyogo, Japan
| | | | - Tatsuo Suzutani
- Department of Microbiology, Fukushima Medical University, Fukushima, Japan
| | | |
Collapse
|
54
|
Misono S, Sie KCY, Weiss NS, Huang ML, Boeckh M, Norton SJ, Yueh B. Congenital cytomegalovirus infection in pediatric hearing loss. ACTA ACUST UNITED AC 2011; 137:47-53. [PMID: 21242546 DOI: 10.1001/archoto.2010.235] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
OBJECTIVES To compare the prevalence of congenital cytomegalovirus (CMV) infection in Washington State in children with hearing loss (HL) and the general population and to compare the characteristics of HL in children with and without congenital CMV infection. DESIGN Matched case-control; case cohort. SETTING Regional pediatric hospital, Washington State Department of Health (WSDOH). PATIENTS Cases were children 4 years and older with HL born in Washington State. Control individuals matched for demographic characteristics were identified at random through the WSDOH. MAIN OUTCOME MEASURES Congenital CMV status determined using quantitative polymerase chain reaction testing on newborn heel stick blood spots archived by the WSDOH. Audiologic data were used to characterize HL. RESULTS Congenital CMV testing was performed for 222 matched cases and controls. Congenital CMV infection was detected in 1.4% of controls and in 9.9% of cases (odds ratio, 10.5; 95% confidence interval, 2.6-92.4). An estimated 8.9% of HL in children in Washington can be attributed to CMV infection. After inclusion of an additional 132 children with HL (for a total of 354 cases in the case cohort), we observed that children with congenital CMV had more severe HL (P < .001) and higher proportions of progressive (P = .02) and unilateral (P = .002) HL compared with children without congenital CMV infection. In the 35 children with congenital CMV infection, there was no relationship between neonatal CMV load and severity of HL. CONCLUSIONS In Washington State, children with HL had a far higher prevalence of congenital CMV viremia than did the general pediatric population, and CMV infection seems to be responsible for an appreciable fraction of pediatric HL in Washington State.
Collapse
Affiliation(s)
- Stephanie Misono
- Department of Otolaryngology/Head and Neck Surgery, University of Washington, Seattle, 98195, USA.
| | | | | | | | | | | | | |
Collapse
|
55
|
Juanjuan C, Yan F, Li C, Haizhi L, Ling W, Xinrong W, Juan X, Tao L, Zongzhi Y, Suhua C. Murine model for congenital CMV infection and hearing impairment. Virol J 2011; 8:70. [PMID: 21320351 PMCID: PMC3045346 DOI: 10.1186/1743-422x-8-70] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2010] [Accepted: 02/15/2011] [Indexed: 11/28/2022] Open
Abstract
Background Congenital cytomegalovirus (CMV) infection is the leading cause of sensorineural hearing loss (SNHL), and SNHL is the most frequent sequela of congenital CMV infection. But the pathogenic mechanism remains unknown, and there is no ideal CMV intrauterine infection animal model to study the mechanisms by which SNHL develops. Methods We established the congenital murine cytomegalovirus (MCMV) infection model by directly injecting the virus into the placenta on day 12.5 of gestation. Then, we observed the development and the MCMV congenital infection rate of the fetuses on the day they were born. Furthermore, we detected the auditory functions, the conditions of the MCMV infection, and the histological change of the inner ears of 28-day-old and 70-day-old offspring. Results Both the fetal loss rate and the teratism rate of offspring whose placentas were inoculated with MCMV increased, and their body length, head circumference, and weight decreased. The hearing level of offspring both decreased at both 28- and 70-days post birth; the 70-day-old mice developed lower hearing levels than did the 28-day old mice. No significant inflammatory changes in the cochleae of the mice were observed. MCMV DNA signals were mainly detected in the spiral ganglion neurons and the endolymph area, but not in the perilymph area. The number of neurons decreased, and their ultrastructures changed. Moreover, with age, the number of neurons dramatically decreased, and the ultrastructural lesions of neurons became much more severe. Conclusions The results suggest that the direct injection of MCMV into the placenta may efficiently cause fetal infection and disturb the intrauterine development of the fetus, and placental inoculation itself has no obvious adverse effects on offspring. The reduction in the number of spiral ganglion neurons and the ultrastructural lesions of the neurons may be the major cause of congenital CMV infection-induced progressive SNHL.
Collapse
Affiliation(s)
- Chen Juanjuan
- Department of Obstetrics and Gynecology, Affiliated Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, PR China
| | | | | | | | | | | | | | | | | | | |
Collapse
|
56
|
Kanai K, Yamada S, Yamamoto Y, Fukui Y, Kurane I, Inoue N. Re-evaluation of the genome sequence of guinea pig cytomegalovirus. J Gen Virol 2011; 92:1005-1020. [PMID: 21270288 DOI: 10.1099/vir.0.027789-0] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Congenital infection by human cytomegalovirus (HCMV) is a major cause of birth defects and developmental abnormalities. Since guinea pig cytomegalovirus (GPCMV) crosses the placenta and causes infection in utero, GPCMV models are useful for studies of the mechanisms of transplacental transmission. During our characterization of a genomic locus required for GPCMV dissemination in animals, we found that the nucleotide sequence in and around the nearby immediate-early genes in our lineage of GPCMV strain 22122 [designated GPCMV (ATCC-P5)] showed clear differences from that reported previously for the same strain [designated GPCMV (UMN)] passaged extensively in vitro. Since in vitro passaging of HCMV is known to result in genetic alterations, especially in the UL128-UL131A locus, and loss of growth ability in particular cell types, in this study we determined the complete genome sequence of GPCMV (ATCC-P5), which grows efficiently in animals. A total of 359 differences were identified between the genome sequences of GPCMV (UMN) and GPCMV (ATCC-P5), and these resulted in structural differences in 29 protein-encoding regions. In addition, some genes predicted from our analysis but not from GPCMV (UMN) are well conserved among cytomegaloviruses. An additional 18 passages of GPCMV (ATCC-P5) in vitro generated no further marked alterations in these genes or in the locus corresponding to the HCMV UL128-UL131A. Our analyses indicate that the published sequence of GPCMV (UMN) contains a substantial number of sequencing errors and, possibly, some mutations resulting from a long history of passaging in vitro. Our re-evaluation of the genetic content of GPCMV will provide a solid foundation for future studies.
Collapse
Affiliation(s)
- Kyosuke Kanai
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Souichi Yamada
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yumiko Yamamoto
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshiko Fukui
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Ichiro Kurane
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Naoki Inoue
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| |
Collapse
|
57
|
Kashiwagi Y, Kawashima H, Nakajima J, Ishida Y, Nishimata S, Miyajima T, Takekuma K, Hoshika A, Inoue N. Efficacy of prolonged valganciclovir therapy for congenital cytomegalovirus infection. J Infect Chemother 2011; 17:538-40. [DOI: 10.1007/s10156-010-0204-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 12/09/2010] [Indexed: 10/18/2022]
|
58
|
Lipitz S, Hoffmann C, Feldman B, Tepperberg-Dikawa M, Schiff E, Weisz B. Value of prenatal ultrasound and magnetic resonance imaging in assessment of congenital primary cytomegalovirus infection. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2010; 36:709-717. [PMID: 20503234 DOI: 10.1002/uog.7657] [Citation(s) in RCA: 70] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/01/2010] [Indexed: 05/29/2023]
Abstract
OBJECTIVE To evaluate the outcome of pregnancies with proven and well-dated primary cytomegalovirus (CMV) infection with and without abnormal fetal ultrasound and magnetic resonance imaging (MRI) findings. METHODS This was a prospective study of 38 singleton pregnancies with proven vertical transmission of CMV and prenatal ultrasound and MRI examinations. Entry requirements included precise dating of the pregnancy and known time of maternal infection. Neonatal follow-up was a strict requirement, all neonates having eye fundus examination, a brain ultrasound scan and a hearing evaluation. All children were followed up by specialists in child development. RESULTS Primary CMV infection occurred during the first trimester in 10 patients, the second trimester in 19 and the third trimester in nine. Twenty-four of 29 patients with first- or second-trimester infections delivered; the other five underwent termination of pregnancy (TOP). Three patients had abnormal sonographic findings with normal MRI. Of these, two had damage to the auditory system. In both cases, infection occurred during the first trimester. In 16 patients with first- or second-trimester infection, both ultrasound and MRI exams were normal; there was one TOP but all other cases had favorable outcome, with normal hearing and developmental evaluations. The outcome of five pregnancies with subtle MRI findings and normal ultrasound exam was also favorable. None of the children infected during the third trimester was affected. CONCLUSION The outcome of congenital primary CMV infection with normal prenatal ultrasound and MRI exams is favorable. The prognostic value of subtle MRI findings is limited and when such findings are isolated, termination of pregnancy is unlikely to be justified.
Collapse
Affiliation(s)
- S Lipitz
- Department of Obstetrics and Gynecology, Sheba Medical Center, Tel-Hashomer, Israel.
| | | | | | | | | | | |
Collapse
|
59
|
Nagamori T, Koyano S, Inoue N, Yamada H, Oshima M, Minematsu T, Fujieda K. Single cytomegalovirus strain associated with fetal loss and then congenital infection of a subsequent child born to the same mother. J Clin Virol 2010; 49:134-6. [PMID: 20685160 DOI: 10.1016/j.jcv.2010.06.021] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2010] [Revised: 06/16/2010] [Accepted: 06/29/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Intrauterine transmission of cytomegalovirus (CMV) can occur even in CMV-seropositive mothers. Previous studies demonstrated re-infection with a newly acquired CMV strain during pregnancy had a major role in such transmission. Although reactivation of latently infected CMV is another plausible cause, no direct evidence has been documented. OBJECTIVES We sought to identify the route(s) and maternal risk factor of CMV infection that occurred in consecutive pregnancies and resulted in symptomatic congenital infections. STUDY DESIGN A newborn identified with congenital CMV infection in our newborn screening program developed hearing loss and subsequent nystagmus. The mother had a history of an elective abortion due to a severe fetal CMV infection 32 months prior to delivery of this newborn. We analyzed maternal serological changes and compared CMV genomic sequences in specimens obtained from the aborted fetus and the present case. We also analyzed immunological functions of the mother. RESULTS Our major findings were as follows: (1) the aborted fetus and the present case were infected with the same strain. (2) The congenital infection that resulted in the abortion was due to a primary infection. (3) CMV DNA was undetectable in the mother's blood from 3 months after the abortion. These results strongly suggested that maternal viral reactivation caused the congenital infection in the present case. However, we could not find impairment of immunological functions in the mother. CONCLUSIONS Viral reactivation in an apparently immunocompetent mother can cause symptomatic congenital CMV infection.
Collapse
|
60
|
Is a 6-week course of ganciclovir therapy effective for chorioretinitis in infants with congenital cytomegalovirus infection? J Pediatr 2010; 157:331-3. [PMID: 20400108 DOI: 10.1016/j.jpeds.2010.02.020] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2009] [Revised: 12/29/2009] [Accepted: 02/16/2010] [Indexed: 11/22/2022]
Abstract
Effective treatment for chorioretinitis caused by congenital cytomegalovirus (CMV) infection remains unknown. We report an infant with congenital CMV infection, who required a 6-month course of antiviral therapy to control his chorioretinitis. Long-term treatment may be necessary for managing congenital CMV-associated chorioretinitis.
Collapse
|
61
|
Boppana SB, Ross SA, Novak Z, Shimamura M, Tolan RW, Palmer AL, Ahmed A, Michaels MG, Sánchez PJ, Bernstein DI, Britt WJ, Fowler KB. Dried blood spot real-time polymerase chain reaction assays to screen newborns for congenital cytomegalovirus infection. JAMA 2010; 303:1375-82. [PMID: 20388893 PMCID: PMC2997517 DOI: 10.1001/jama.2010.423] [Citation(s) in RCA: 243] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
CONTEXT Reliable methods to screen newborns for congenital cytomegalovirus (CMV) infection are needed for identification of infants at increased risk of hearing loss. Since dried blood spots (DBS) are routinely collected for metabolic screening from all newborns in the United States, there has been interest in using DBS polymerase chain reaction (PCR)-based methods for newborn CMV screening. OBJECTIVE To determine the diagnostic accuracy of DBS real-time PCR assays for newborn CMV screening. DESIGN, SETTING, AND PARTICIPANTS Between March 2007 and May 2008, infants born at 7 US medical centers had saliva specimens tested by rapid culture for early antigen fluorescent foci. Results of saliva rapid culture were compared with a single-primer (March 2007-December 2007) and a 2-primer DBS real-time PCR (January 2008-May 2008). Infants whose specimens screened positive on rapid culture or PCR had congenital infection confirmed by the reference standard method with rapid culture testing on saliva or urine. MAIN OUTCOME MEASURES Sensitivity, specificity, and positive and negative likelihood ratios (LRs) of single-primer and 2-primer DBS real-time PCR assays for identifying infants with confirmed congenital CMV infection. RESULTS Congenital CMV infection was confirmed in 92 of 20,448 (0.45%; 95% confidence interval [CI], 0.36%-0.55%) infants. Ninety-one of 92 infants had positive results on saliva rapid culture. Of the 11,422 infants screened using the single-primer DBS PCR, 17 of 60 (28%) infants had positive results with this assay, whereas, among the 9026 infants screened using the 2-primer DBS PCR, 11 of 32 (34%) screened positive. The single-primer DBS PCR identified congenital CMV infection with a sensitivity of 28.3% (95% CI, 17.4%-41.4%), specificity of 99.9% (95% CI, 99.9%-100%), positive LR of 803.7 (95% CI, 278.7-2317.9), and negative LR of 0.7 (95% CI, 0.6-0.8). The positive and negative predictive values of the single-primer DBS PCR were 80.9% (95% CI, 58.1%-94.5%) and 99.6% (95% CI, 99.5%-99.7%), respectively. The 2-primer DBS PCR assay identified infants with congenital CMV infection with a sensitivity of 34.4% (95% CI, 18.6%-53.2%), specificity of 99.9% (95% CI, 99.9%-100.0%), positive LR of 3088.9 (95% CI, 410.8-23 226.7), and negative LR of 0.7 (95% CI, 0.5-0.8). The positive and negative predictive values of the 2-primer DBS PCR were 91.7% (95% CI, 61.5%-99.8%) and 99.8% (95% CI, 99.6%-99.9%), respectively. CONCLUSION Among newborns, CMV testing with DBS real-time PCR compared with saliva rapid culture had low sensitivity, limiting its value as a screening test.
Collapse
Affiliation(s)
- Suresh B Boppana
- UAB Department of Pediatrics, CHB 114, 1600 Sixth Ave S, Birmingham, AL 35233, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
62
|
Korver AMH, de Vries JJC, Konings S, de Jong JW, Dekker FW, Vossen ACTM, Frijns JHM, Oudesluys-Murphy AM. DECIBEL study: Congenital cytomegalovirus infection in young children with permanent bilateral hearing impairment in the Netherlands. J Clin Virol 2010; 46 Suppl 4:S27-31. [PMID: 19836301 DOI: 10.1016/j.jcv.2009.09.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2009] [Accepted: 08/13/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND A significant number of asymptomatic newborns infected with congenital cytomegalovirus (CMV) will present with permanent childhood hearing impairment (PCHI) during early childhood. OBJECTIVES To investigate the role of congenital CMV infection in causing PCHI in the Netherlands, and assess the efficacy of two different hearing screening strategies and the developmental outcome following each strategy. STUDY DESIGN We included 192 children with PCHI at the age of 3-5 years, who were offered hearing screening in their first year of life. Dried blood spots from 171 children were available for CMV detection using real-time PCR. The results of eight previously tested samples were also available. Clinical baseline characteristics were collected from medical records and the Child Development Inventory was used to investigate the developmental outcome. RESULTS The rate of congenital CMV among the 179 children was 8% (14/179) and 23% (9/39) among children with profound PCHI. Two of eight CMV-positive children with PCHI at the age of 3-5 years had passed the newborn hearing screening (NHS) test. Developmental outcome measures showed a significantly greater delay in language comprehension in children with both PCHI and congenital CMV infection (the largest in symptomatic children) than in the children with PCHI without congenital CMV infection. CONCLUSIONS Congenital CMV infection is important in the etiology of PCHI. Universal NHS is not a guarantee of normal hearing and development in childhood for children with congenital CMV infection. This is a problem which might be solved by universal congenital CMV screening.
Collapse
Affiliation(s)
- A M H Korver
- Willem-Alexander Children and Youth Center, Sub-department of Social Pediatrics, Leiden University Medical Center, The Netherlands.
| | | | | | | | | | | | | | | | | |
Collapse
|
63
|
Choi KY, Schimmenti LA, Jurek AM, Sharon B, Daly K, Khan C, McCann M, Schleiss MR. Detection of cytomegalovirus DNA in dried blood spots of Minnesota infants who do not pass newborn hearing screening. Pediatr Infect Dis J 2009; 28:1095-8. [PMID: 19820425 DOI: 10.1097/inf.0b013e3181af6230] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Up to 15% of infants with asymptomatic congenital cytomegalovirus (CMV) infection will experience some degree of sensorineural hearing loss. Many infants who fail newborn hearing screening (NHS) are likely to have congenital CMV infection, but may escape definitive virologic identification because diagnostic evaluation may not commence until several weeks or months of age, making differentiation between congenital and postnatal CMV infection difficult. Early diagnosis linking virologic identification of congenital CMV infection to infants failing NHS may improve diagnostic precision and enhance opportunities for therapeutic intervention. METHODS The goal of this study was to compare newborn dried blood spots from Minnesota infants who had failed NHS, and were designated for referral, with control infants who passed NHS, for the presence of CMV DNA by real-time PCR, using hybridization probes for the CMV gene UL54. RESULTS Of 479 infants with a failed NHS (bilateral failure), 13 had CMV DNA present in the blood spot (2.7%). This compared with only 2/479 positive results from a control group of infants who passed the NHS (0.4%; P = 0.007, Fisher exact test). Comparisons of the glycoprotein B (gB) genotype as well as direct DNA sequencing of selected positives revealed that PCR positive samples represented unique clinical isolates. The mean viral load among the 15 positive samples was 1.6 x 10(3) genomes/microgram of total DNA. CONCLUSIONS Newborn bloodspot CMV screening by real-time PCR may be a useful and rapid adjunct to functional NHS and may enable more rapid etiologic diagnosis of sensorineural hearing loss in newborns.
Collapse
Affiliation(s)
- K Yeon Choi
- Department of Pediatrics, University of Minnesota Medical School, Minneapolis, MN 55455-0374, USA
| | | | | | | | | | | | | | | |
Collapse
|
64
|
Tagawa M, Tanaka H, Moriuchi M, Moriuchi H. Retrospective diagnosis of congenital cytomegalovirus infection at a school for the deaf by using preserved dried umbilical cord. J Pediatr 2009; 155:749-51. [PMID: 19840618 DOI: 10.1016/j.jpeds.2009.04.033] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Revised: 03/05/2009] [Accepted: 04/13/2009] [Indexed: 11/27/2022]
Abstract
A retrospective diagnosis of congenital cytomegalovirus infection was made for 3 of 26 students (12%) with either bilateral profound or severe sensorineural hearing loss at a School for the Deaf in Japan by detecting viral DNA with real-time polymerase chain reaction from dried umbilical cords that had been preserved at home.
Collapse
Affiliation(s)
- Masato Tagawa
- Department of Pediatrics, Nagasaki University Hospital, Department of Molecular Microbiology and Immunology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | | | | | | |
Collapse
|
65
|
Ishibashi K, Tokumoto T, Shirakawa H, Hashimoto K, Kushida N, Yanagida T, Shishido K, Aikawa K, Yamaguchi O, Toma H, Tanabe K, Suzutani T. Association between antibody response against cytomegalovirus strain-specific glycoprotein H epitopes and HLA-DR. Microbiol Immunol 2009; 53:412-6. [PMID: 19563400 DOI: 10.1111/j.1348-0421.2009.00134.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The gH of CMV is a major target for strain-specific neutralizing antibodies. To verify whether there is a correlation between HLA-DR type and strain-specific antibodies, antibodies against CMV gH in potential donors and recipients for renal transplantation were investigated. Among 471 subjects, 404 (86%) showed reactivity to CMV gH, but no antibodies against gH were detected in 67 (14%) subjects. The positive rates were over 80% in most HLA subpopulations. Fewer subjects with HLA-DR10 and DR11 had antibodies to CMV gH than did those without HLA-DR10 and DR11. HLA-DR10 and DR11 may be associated with fewer/non-responders for strain-specific neutralizing antibodies.
Collapse
Affiliation(s)
- Kei Ishibashi
- Department of Urology, Fukushima Medical University, Fukushima, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
66
|
Yamada S, Nozawa N, Katano H, Fukui Y, Tsuda M, Tsutsui Y, Kurane I, Inoue N. Characterization of the guinea pig cytomegalovirus genome locus that encodes homologs of human cytomegalovirus major immediate-early genes, UL128, and UL130. Virology 2009; 391:99-106. [PMID: 19559454 DOI: 10.1016/j.virol.2009.05.034] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2009] [Revised: 05/21/2009] [Accepted: 05/22/2009] [Indexed: 11/30/2022]
Abstract
We reported previously that the guinea pig cytomegalovirus (CMV) stock purchased from the American Type Culture Collection contained two types of strains, one containing and the other lacking a 1.6 kb locus, and that the 1.6 kb locus was required for efficient viral growth in animals but not in cell culture. In this study, we characterized the genetic contents of the locus, and found that i) the 1.6 kb locus encodes homologs of human CMV UL128 and UL130, GP129 and GP131, respectively, ii) these genes are expressed with late gene kinetics, iii) GP131 protein (pGP131) localized to cell surface only in the presence of glycoproteins H and L, and iv) pGP131 is a virion component. Therefore, it is plausible that pGP131 forms a complex with glycoproteins H and L and becomes a virion component as does UL130 protein (pUL130). Since pUL130 is one of the glycoproteins essential for infection of endothelial and epithelial cells in human and primates, functional and immunological analyses of this GPCMV homolog of pUL130 may help to illuminate the in vivo role of pUL130.
Collapse
Affiliation(s)
- Souichi Yamada
- Department of Virology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | | | | | | | | | | | | | | |
Collapse
|
67
|
Jakubíková J, Kabátová Z, Pavlovcinová G, Profant M. Newborn hearing screening and strategy for early detection of hearing loss in infants. Int J Pediatr Otorhinolaryngol 2009; 73:607-12. [PMID: 19185924 DOI: 10.1016/j.ijporl.2008.12.006] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2008] [Revised: 12/12/2008] [Accepted: 12/12/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE More than 80% of permanent hearing losses (HL) in children are congenital. Newborn hearing screening (NHS) is the best method for early detection of suspected hearing loss. If the NHS is not universal more than 30% permanent hearing losses are not identified. There are various methods of NHS: otoacoustic emissions (TEOAE, DPOAE) and automatic auditory brainstem response (AABR). After hearing screening, and when hearing loss is suspected, tympanometry and audiological methods then used for determination of hearing threshold; these include ABR, ASSR or/and behavioral methods. The goal of this study is to evaluate the influence of UNHS on the early detection of hearing loss in children before and after the implementation of obligatory universal newborn hearing screening in Slovakia, and also on the etiologic evaluation of hearing impaired infants identified by screening. METHOD In Slovakia NHS started in 1998 and was provided in ENT departments. From May 1, 2006 UNHS has been mandatory in Slovakia, using two stages TEOAE in all newborn departments in Slovakia (64 newborn departments). In year 2005--42% of newborns in Slovakia were screened, in 2006--66% newborns and in 2007--94, 99% (three small newborn departments do not yet have equipment for OAE screening). For determination of hearing thresholds ASSR are used in two ENT departments and ABR in the other four ENT departments. RESULTS Comparing the number of identified cases with bilateral severe permanent HL or deafness before and after UNHS, 22.8% more cases of PHL were identified in the first year of UNHS. Also the average age of diagnosis of PHL was lower. In the year 2007, 94% of newborns were screened. We found 0.947/1000 newborns with bilateral severe PHL (35.9%) more than before UNHS). After audiologic and etiologic assessment of the 76 infants who failed screening, 5 (6.58%) were found to have normal hearing, 16 (22.54%) had unilateral and 55 (77.46%) had bilateral SNHL. A non-syndromic genetic cause was present in 25.45% of cases, syndromic in 9%, perinatal cause (31%), congenital CMV infection in 7.27%, bilateral cochlear anomalies without other abnormality in 1.83% and unknown etiology in 25.45%.
Collapse
Affiliation(s)
- Janka Jakubíková
- Pediatric Otorhinolaryngology Department of Medical Faculty of Commenius University and Children's University Hospital, Limbova 1, 833 40 Bratislava, Slovak Republic.
| | | | | | | |
Collapse
|
68
|
Neuropathogenesis of congenital cytomegalovirus infection: disease mechanisms and prospects for intervention. Clin Microbiol Rev 2009; 22:99-126, Table of Contents. [PMID: 19136436 DOI: 10.1128/cmr.00023-08] [Citation(s) in RCA: 316] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Congenital cytomegalovirus (CMV) infection is the leading infectious cause of mental retardation and hearing loss in the developed world. In recent years, there has been an improved understanding of the epidemiology, pathogenesis, and long-term disabilities associated with CMV infection. In this review, current concepts regarding the pathogenesis of neurological injury caused by CMV infections acquired by the developing fetus are summarized. The pathogenesis of CMV-induced disabilities is considered in the context of the epidemiology of CMV infection in pregnant women and newborn infants, and the clinical manifestations of brain injury are reviewed. The prospects for intervention, including antiviral therapies and vaccines, are summarized. Priorities for future research are suggested to improve the understanding of this common and disabling illness of infancy.
Collapse
|
69
|
Yan H, Koyano S, Inami Y, Yamamoto Y, Suzutani T, Mizuguchi M, Ushijima H, Kurane I, Inoue N. Genetic linkage among human cytomegalovirus glycoprotein N (gN) and gO genes, with evidence for recombination from congenitally and post-natally infected Japanese infants. J Gen Virol 2008; 89:2275-2279. [DOI: 10.1099/vir.0.83685-0] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Investigation of sequence polymorphisms in the glycoprotein N (gN; gp4273), gO (gp4274) and gH (gp4275) genes of human cytomegalovirus (HCMV) strains collected from 63 Japanese children revealed that their gO genotype distribution differed slightly from that of Caucasian populations and that there was a significant linkage between the gN and gO genotypes. Linkage of these genotypes in strains obtained from Caucasian populations has been reported, so our similar findings in Japanese infants are consistent with this, and suggest generality of this linkage. Sequence analysis suggests that recombination between two strains of different linkage groups occurred approximately 200 bp upstream of the 3′-end of the gO gene. Further studies are required to elucidate differences in biological characteristics among the linkage groups and the selective constraints that maintain the linkage.
Collapse
Affiliation(s)
- Hainian Yan
- Department of Developmental Medical Sciences, Institute of International Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Shin Koyano
- Department of Pediatrics, Asahikawa Medical College, Hokkaido, Japan
| | - Yuhki Inami
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yumiko Yamamoto
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Tatsuo Suzutani
- Department of Microbiology, Fukushima Medical University, Fukushima, Japan
| | - Masashi Mizuguchi
- Department of Developmental Medical Sciences, Institute of International Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Hiroshi Ushijima
- Department of Developmental Medical Sciences, Institute of International Health, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Ichiro Kurane
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| | - Naoki Inoue
- Department of Virology I, National Institute of Infectious Diseases, Tokyo, Japan
| |
Collapse
|
70
|
Ishibashi K, Tokumoto T, Shirakawa H, Hashimoto K, Kushida N, Yanagida T, Shishido K, Aikawa K, Yamaguchi O, Toma H, Tanabe K, Suzutani T. Strain-specific seroepidemiology and reinfection of cytomegalovirus. Microbes Infect 2008; 10:1363-9. [PMID: 18761415 DOI: 10.1016/j.micinf.2008.08.001] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2008] [Revised: 07/14/2008] [Accepted: 08/04/2008] [Indexed: 11/24/2022]
Abstract
Although there have been some reports describing the serostatus of cytomegalovirus, strain-specific antibody responses and their distribution remain unknown. In this study, ELISA using fusion proteins encompassing epitope of glycoprotein H from both AD169 and Towne strains was used to test 352 blood donors. Of these 352 donors, 207 were analyzed for strain-specific glycoprotein H antibodies. Of the 44 donors whose serum contained antibodies against both AD169 and Towne, 27 (60%) were aged 50 years or over (p = 0.0003). This may indicate serological evidence of reinfection with cytomegalovirus in the elder population. The nucleotide sequence analysis of cytomegalovirus glycoprotein H from the peripheral blood of the cytomegalovirus-positive renal transplant recipients showed that our strain-specific ELISA can reveal cytomegalovirus reinfection after transplantation.
Collapse
Affiliation(s)
- Kei Ishibashi
- Department of Microbiology, Fukushima Medical University, Fukushima, Japan.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
71
|
Nozawa N, Yamamoto Y, Fukui Y, Katano H, Tsutsui Y, Sato Y, Yamada S, Inami Y, Nakamura K, Yokoi M, Kurane I, Inoue N. Identification of a 1.6 kb genome locus of guinea pig cytomegalovirus required for efficient viral growth in animals but not in cell culture. Virology 2008; 379:45-54. [PMID: 18656220 DOI: 10.1016/j.virol.2008.06.018] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2008] [Revised: 03/10/2008] [Accepted: 06/10/2008] [Indexed: 11/17/2022]
Abstract
Guinea pig cytomegalovirus (GPCMV) provides a useful model for studies of congenital CMV infection. During characterization of the GPCMV genome sequence, we identified two types of strains in a virus stock purchased from ATCC. One of them, GPCMV/del, lacks a 1.6 kb locus that positionally corresponds to murine CMV (MCMV) M129-M133. Growth of GPCMV/del in cell culture was marginally better than that of the other strain, GPCMV/full, which harbors the 1.6 kb locus. However, in animals infected intraperitoneally with virus stocks containing both strains, GPCMV/full disseminated more efficiently than GPCMV/del, including 200-fold greater viral load in salivary glands. Viral DNA, transcripts of the immediate-early 2 gene homolog, and viral antigens were more abundant in animals infected with GPCMV/full than in those infected with GPCMV/del. Although the observed phenomena have some similarity with the growth properties of MCMV strains defective in mck-1/mck-2(M129/131) and those defective in sgg(M132), no M129-M132 homologs were found in the 1.6 kb locus. Since one of the ORFs in the locus has a weak sequence similarity with HCMV UL130, which relates to cell tropism, further studies will be required to learn the mechanism for efficient GPCMV growth in animal.
Collapse
Affiliation(s)
- Naoki Nozawa
- Department of Virology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
72
|
Westerberg BD, Atashband S, Kozak FK. A systematic review of the incidence of sensorineural hearing loss in neonates exposed to Herpes simplex virus (HSV). Int J Pediatr Otorhinolaryngol 2008; 72:931-7. [PMID: 18420284 DOI: 10.1016/j.ijporl.2008.03.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2007] [Revised: 03/03/2008] [Accepted: 03/04/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To develop evidence-based guidelines for appropriate audiological monitoring of children born following exposure to or infection with Herpes simplex virus (HSV) for development of immediate or delayed-onset of sensorineural hearing loss (SNHL). DATA SOURCES A Medline search of the 1966-July 2007 database was supplemented by search of the additional database Embase (1980-July 2007). Manual search was conducted of references of identified papers and book chapters. STUDY SELECTION Articles were sought that were longitudinal in design, to include an inception cohort of children infected with (or exposed to) HSV who were entered at a similar point at birth and followed over time with serial audiometry to identify hearing loss if it developed. DATA EXTRACTION Patient information and audiometric data extraction from relevant articles was performed independently by all three researchers. Discrepancies were resolved by mutual consensus. DATA SYNTHESIS Data was analyzed using descriptive statistics. RESULTS Three papers reported five children with SNHL following apparent disseminated HSV-2 infections in which other obvious clinical sequelae of HSV infection and co-morbid conditions were present. Audiometric information is lacking regarding onset and progression. There are no reports of delayed-onset SNHL following perinatal or asymptomatic HSV infection. CONCLUSIONS The development of SNHL in children with exposure to HSV occurs rarely. Routine serological screening for HSV infection in otherwise healthy neonates newly diagnosed with SNHL is unjustified. There is insufficient data to define the incidence and natural history of SNHL in children with HSV infections. Carefully designed and conducted studies are needed to address this issue.
Collapse
Affiliation(s)
- Brian D Westerberg
- St Paul's Rotary Hearing Clinic, Surgery/Otolaryngology, Providence 2, Vancouver, BC, Canada.
| | | | | |
Collapse
|
73
|
Induction of cytomegalovirus-infected labyrinthitis in newborn mice by lipopolysaccharide: a model for hearing loss in congenital CMV infection. J Transl Med 2008; 88:722-30. [PMID: 18475257 DOI: 10.1038/labinvest.2008.39] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Congenital cytomegalovirus (CMV) infection is the most common infectious cause of sensorineural hearing loss in children. Here, we established an experimental model of hearing loss after systemic infection with murine CMV (MCMV) in newborn mice. Although almost no viral infection was observed in the inner ears and brains by intraperitoneal (i.p.) infection with MCMV in newborn mice, infection in these regions was induced in combination with intracerebral (i.c.) injection of bacterial lipopolysaccharide (LPS). The susceptibility of the inner ears was higher than that of the brains in terms of viral titer per unit weight. In the labyrinths, the viral infection was associated with the mesenchymal vessels and accompanied by inflammatory cells induced by LPS, causing hematogenous targets of infection in the labyrinths. Viral infection also spread in the perilymph regions such as the scala tympani and scala vestibuli, probably from infected brains via meningogenic and cochlear nerve routes. Viral infection was not observed in the scala media in the endolymph, including the Corti organ. However, viral infection was observed in the spiral limbus, including the stria vascularis. These results suggest that hearing loss caused by labyrinthitis after congenital CMV infection may be enhanced by inflammation caused by systemic bacterial infection in the neonatal period.
Collapse
|
74
|
Detection of cytomegalovirus DNA in preserved umbilical cords from patients with sensorineural hearing loss. Eur Arch Otorhinolaryngol 2008; 266:351-5. [DOI: 10.1007/s00405-008-0745-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2007] [Accepted: 06/02/2008] [Indexed: 11/24/2022]
|
75
|
Establishment of a cell-based assay for screening of compounds inhibiting very early events in the cytomegalovirus replication cycle and characterization of a compound identified using the assay. Antimicrob Agents Chemother 2008; 52:2420-7. [PMID: 18458124 DOI: 10.1128/aac.00134-08] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
To simplify the detection of infectious human cytomegalovirus (HCMV), we generated a cell line that produced luciferase in a dose-dependent manner upon HCMV infection. Using this cell line, we identified anti-HCMV compounds from a diverse library of 9,600 compounds. One of them, 1-(3,5-dichloro-4-pyridyl)piperidine-4-carboxamide (DPPC), was effective against HCMV (Towne strain) infection of human lung fibroblast cells at a 50% effective concentration of 2.5 microM. DPPC also inhibited the growth of clinical HCMV isolates and guinea pig and mouse cytomegaloviruses. Experiments using various time frames for treatment of the cells with DPPC demonstrated that DPPC was effective during the first 24 h after HCMV infection. DPPC treatment decreased not only viral DNA replication but also IE1 and IE2 expression at mRNA and protein levels in the HCMV-infected cells. However, DPPC did not inhibit the attachment of HCMV particles to the cell surface. DPPC is a unique compound that targets the very early phase of cytomegalovirus infection, probably by disrupting a pathway that is important after viral entry but before immediate-early gene expression.
Collapse
|
76
|
|
77
|
Abstract
Children with permanent unilateral or mild bilateral hearing loss have been a focus of concern by audiologists, educators, and physicians for at least 2 decades. These children are known to be at risk for psychoeducational difficulties. However, despite this concern, little has been learned about the causative factors of these hearing losses and how those factors might be contributing to child development. This review of known causes of permanent unilateral and mild bilateral hearing loss in children is meant to draw attention to the importance of the search for etiologic factors. That is, the identification of the hearing loss should not signal the end of the diagnostic process but, rather, the beginning of a search for causation. With the combined efforts of audiologists, otolaryngologists, pediatricians, geneticists, and other medical professionals, we may enhance our understanding of the primary causes of unilateral and mild bilateral hearing loss and, perhaps, create links between causative factors and psychosocial and psychoeducational outcomes.
Collapse
Affiliation(s)
- Anne Marie Tharpe
- Vanderbilt Bill Wilkerson Center, Vanderbilt University Medical Center, Nashville 37232-8242, Tennessee.
| | | |
Collapse
|
78
|
Genetic variations in the gB, UL144 and UL149 genes of human cytomegalovirus strains collected from congenitally and postnatally infected Japanese children. Arch Virol 2008; 153:667-74. [PMID: 18273679 DOI: 10.1007/s00705-008-0044-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2007] [Accepted: 01/28/2008] [Indexed: 12/15/2022]
Abstract
Human cytomegalovirus (CMV) is the leading cause of intrauterine viral infection. The association of genetic polymorphisms in some particular genes with the incidence and severity of congenital infection has been controversial. To address this issue, we analyzed the genotypes of the glycoprotein B (gB), UL144 and UL149 genes of CMV clinical strains obtained from 33 congenitally and 31 postnatally infected Japanese children. Our results demonstrated that (1) CMV strains with any combination of genotypes could be vertically transmitted from mother to fetus, potentially causing neurological abnormalities, (2) the gB3 genotype was more prevalent in the congenital cases than in postnatally infected children (P < 0.05), particularly in congenital cases with sensorineural hearing loss (P = 0.009), (3) there was no relationship between gB genotype and viral load in the urine and dried umbilical cord specimens in the congenital cases, and (4) the UL144 and UL149 genotype distributions had no bias for congenial infection. In future studies, it would be interesting to see whether the gB genotypes serve as a prognostic indicator of CMV-associated diseases.
Collapse
|
79
|
Abstract
Although the use of dried blood spots has been proposed for screening of newborns with congenital cytomegalovirus infection, viral loads in blood were significantly smaller than those in urine (P < 0.001), and DNA recovery from dried blood spots using the thermal shock procedure was inefficient. In contrast, our urine-based screening program identified asymptomatic cases with low viral loads in blood.
Collapse
|
80
|
Grosse SD, Ross DS, Dollard SC. Congenital cytomegalovirus (CMV) infection as a cause of permanent bilateral hearing loss: A quantitative assessment. J Clin Virol 2008; 41:57-62. [DOI: 10.1016/j.jcv.2007.09.004] [Citation(s) in RCA: 205] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2007] [Revised: 09/07/2007] [Accepted: 09/10/2007] [Indexed: 10/22/2022]
|
81
|
Bartel-Friedrich S, Fuchs M, Amaya B, Rasinski C, Meuret S, Kösling S. [Large endolymphatic duct and sac syndrome : part 2: clinical manifestations]. HNO 2008; 56:225-30. [PMID: 18214403 DOI: 10.1007/s00106-007-1665-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE The aim of this study was to clarify the clinical course of large endolymphatic duct and sac syndrome (LEDS). Although LEDS is the most common form of radiologically detectable inner ear malformation associated with sensorineural hearing loss (SNHL), it is relatively unknown in the German-speaking countries. We hoped to derive useful pointers for clinical care. METHODS We evaluated the clinical audiometric records and imaging findings of 169 patients with clinically suspected inner ear malformation seen between 1994 and 2003. Following identification of all LEDS cases, we serially investigated the anamnestic and functional data with regard to severity and course. RESULTS Among 169 patients, 17 (median age 12 years; 12 females) showed LEDS. A total of 28 ears were affected. Clinically, most cases were of prelingual or perilingual onset and displayed steady or fluctuatingly progressive severe SNHL with emphasis on the high frequencies or deafness. Episodes of sudden hearing loss were relatively frequent. No correlation could be demonstrated between the severity of morphological changes and the degree of SNHL. CONCLUSION Progression of SNHL and episodes of sudden hearing loss were seen mainly in late childhood or adolescence. This should be taken into account when informing and advising patients and planning therapy.
Collapse
Affiliation(s)
- S Bartel-Friedrich
- Abteilung Phoniatrie und Pädaudiologie, Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Kopf- und Halschirurgie, Universitätsklinikum der Martin-Luther-Universität Halle-Wittenberg, Deutschland.
| | | | | | | | | | | |
Collapse
|
82
|
Nozawa N, Koyano S, Yamamoto Y, Inami Y, Kurane I, Inoue N. Real-time PCR assay using specimens on filter disks as a template for detection of cytomegalovirus in urine. J Clin Microbiol 2007; 45:1305-7. [PMID: 17287318 PMCID: PMC1865828 DOI: 10.1128/jcm.02502-06] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Since congenital cytomegalovirus (CMV) infection causes late-onset sequelae, the identification of CMV-infected newborns is important. For this purpose, we established a simple real-time PCR assay using a filter disk. Combined with the collection of urine using filter papers placed in the diaper, this assay can make CMV screening more feasible and cost-effective.
Collapse
Affiliation(s)
- Naoki Nozawa
- Department of Virology I, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku-ku, Tokyo 162-8640, Japan
| | | | | | | | | | | |
Collapse
|