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Chung PK, Schornagel FAJ, Soede W, van Zwet EW, Kroes ACM, Oudesluys-Murphy AM, Vossen ACTM. Valganciclovir in Infants with Hearing Loss and Clinically Inapparent Congenital Cytomegalovirus Infection: A Nonrandomized Controlled Trial. J Pediatr 2024; 268:113945. [PMID: 38336204 DOI: 10.1016/j.jpeds.2024.113945] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Revised: 12/29/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024]
Abstract
OBJECTIVE To assess the efficacy of valganciclovir in infants with hearing loss and clinically inapparent congenital cytomegalovirus infection (cCMV), as there is no consensus on treatment of this group. STUDY DESIGN A nationwide, nonrandomized controlled trial, comparing 6 weeks of oral valganciclovir to no treatment in infants with cCMV, recruited after newborn hearing screening resulted in referral to an audiologist. The choice whether to treat was left to parents of subjects. Eligible subjects were full term infants aged <13 weeks with sensorineural hearing loss and diagnosed with cCMV through dried blood spot testing. The primary outcome, measured by linear and ordinal logistic regression, was change in best-ear hearing from baseline to follow-up at 18-22 months of age. RESULTS Thirty-seven participants were included in the final analysis, of whom 25 were in the treatment group and 12 in the control group. The majority of subjects in both groups had neuroimaging abnormalities, which were mostly mild. Hearing deterioration was more likely in the control group compared with the treatment group (common OR 0.10, 95% CI 0.02-0.45, P = .003). Mean best-ear hearing deteriorated by 13.7 dB in the control group, compared with improvement of 3.3 dB in the treatment group (difference 17 dB, 95% CI 2.6 - 31.4, P = .02). CONCLUSIONS We investigated treatment in children with hearing loss and clinically inapparent cCMV. Although our study was nonrandomized, it is the first prospective and controlled trial in this population. Valganciclovir-treated children with hearing loss and inapparent cCMV had less hearing deterioration at 18 through 22 months of age than control subjects. EUDRACT REGISTRY NUMBER 2013-003068-30.
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Affiliation(s)
- Pui Khi Chung
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - Fleurtje A J Schornagel
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands; SBOH, Utrecht, The Netherlands
| | - Wim Soede
- Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik W van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Aloys C M Kroes
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
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Leber AL. Maternal and congenital human cytomegalovirus infection: laboratory testing for detection and diagnosis. J Clin Microbiol 2024; 62:e0031323. [PMID: 38391188 PMCID: PMC11005381 DOI: 10.1128/jcm.00313-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2024] Open
Abstract
Human cytomegalovirus (CMV) is the leading cause of congenital infection worldwide and the most common cause of non-genetic sensorineural hearing loss. As there is no vaccine or other specific intervention to prevent congenital CMV infection, there is a need to identify maternal and congenital infections with sensitive and specific testing as early as possible. There is no widely accepted practice for screening during pregnancy or in all newborns for identification of possible cases of congenital CMV. Currently, screening during pregnancy is limited to those identified as at risk followed by fetal and/or neonatal testing when congenital infection is suspected. This review focuses primarily on the current status of laboratory testing for diagnosis of maternal and congenital CMV infections. Primary maternal infection is best diagnosed using serologic testing, including CMV IgM, IgG, and avidity testing, while fetal infection should be assessed by nucleic acid amplification testing (NAAT) of amniotic fluid. Urine and saliva NAATs are the mainstay for diagnosis of congenital CMV in the first 3 weeks of life. Testing of dried blood spots can be useful for diagnosis of congenital CMV outside of the newborn period. The gaps in knowledge such as the prognostic value of viral loads in various sample types are addressed.
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Affiliation(s)
- Amy L. Leber
- Departments of Pathology and Laboratory Medicine and Pediatrics, Nationwide Children’s Hospital, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
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3
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Merav L, Ofek Shlomai N, Oiknine-Djian E, Caplan O, Livneh A, Sido T, Peri A, Shtoyer A, Amir E, Ben Meir K, Daitch Y, Rivkin M, Kripper E, Fogel I, Horowitz H, Greenberger S, Cohen M, Geal-Dor M, Gordon O, Averbuch D, Ergaz-Shaltiel Z, Eventov Friedman S, Wolf DG, Yassour M. Implementation of pooled saliva tests for universal screening of cCMV infection. Nat Med 2024; 30:1111-1117. [PMID: 38459181 PMCID: PMC11031397 DOI: 10.1038/s41591-024-02873-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 02/14/2024] [Indexed: 03/10/2024]
Abstract
Congenital cytomegalovirus (cCMV) is the most common intrauterine infection, leading to neurodevelopmental disabilities. Universal newborn infant screening of cCMV has been increasingly advocated. In the absence of a high-throughput screening test, which can identify all infected newborn infants, the development of an accurate and efficient testing strategy has remained an ongoing challenge. Here we assessed the implementation of pooled saliva polymerase chain reaction (PCR) tests for universal screening of cCMV, in two hospitals of Jerusalem from April 2022 through April 2023. During the 13-month study period, 15,805 infants (93.6% of all live newborn infants) were screened for cCMV using the pooled approach that has since become our routine screening method. The empirical efficiency of the pooling was six (number of tested newborn infants per test), thereby sparing 83% of the saliva tests. Only a minor 3.05 PCR cycle loss of sensitivity was observed for the pooled testing, in accordance with the theoretical prediction for an eight-sample pool. cCMV was identified in 54 newborn infants, with a birth prevalence of 3.4 per 1,000; 55.6% of infants identified with cCMV were asymptomatic at birth and would not have been otherwise targeted for screening. The study demonstrates the wide feasibility and benefits of pooled saliva testing as an efficient, cost-sparing and sensitive approach for universal screening of cCMV.
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Affiliation(s)
- Lior Merav
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Noa Ofek Shlomai
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Esther Oiknine-Djian
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Orit Caplan
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Ayala Livneh
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Tal Sido
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Amir Peri
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Aviad Shtoyer
- Computing Department of Laboratories and Institutes, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Eden Amir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Kerem Ben Meir
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Yutti Daitch
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mila Rivkin
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Esther Kripper
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Irit Fogel
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Hadar Horowitz
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Sraya Greenberger
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Mevaseret Cohen
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel
| | - Miriam Geal-Dor
- Speech and Hearing Center, Hadassah-Hebrew University Medical Center, Jerusalem, Israel
- Department of Communication Disorders, Hadassah Academic College, Jerusalem, Israel
| | - Oren Gordon
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Diana Averbuch
- Hebrew University Faculty of Medicine, Jerusalem, Israel
- Pediatric Infectious Diseases, Pediatric Division, Hadassah Hebrew University Medical Center, Jerusalem, Israel
| | - Zivanit Ergaz-Shaltiel
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Smadar Eventov Friedman
- Department of Neonatology, Hadassah and Hebrew University Medical Center, Jerusalem, Israel
- Hebrew University Faculty of Medicine, Jerusalem, Israel
| | - Dana G Wolf
- Clinical Virology Unit, Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
- Hebrew University Faculty of Medicine, Jerusalem, Israel.
- Lautenberg Center for General and Tumor Immunology, Jerusalem, Israel.
| | - Moran Yassour
- School of Computer Science and Engineering, The Hebrew University of Jerusalem, Jerusalem, Israel.
- Department of Microbiology and Molecular Genetics, IMRIC, Faculty of Medicine, The Hebrew University of Jerusalem, Jerusalem, Israel.
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Almeida S, Gouveia P, Jorge A, Fortuna A, Binda S, Barbi M, Nascimento MSJ, Paixão P. Diagnosing congenital cytomegalovirus infections using archived dried blood spots: A 15-year observational study, Portugal. J Clin Virol 2023; 165:105516. [PMID: 37302249 DOI: 10.1016/j.jcv.2023.105516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/13/2023]
Abstract
BACKGROUND Cytomegalovirus (CMV) is a leading cause of congenital infections. Dried blood spots (DBS) collected in the first week of life (Guthrie cards) have been used in the diagnosis of CMV infection outside the three-week window period following birth. The present work summarizes the results of a 15-year observational study in which DBS from 1388 children were used for a late diagnosis of congenital CMV infection. METHODS Three groups of children were studied: (i) symptomatic (with symptoms at birth or late sequelae) (N = 779); (ii) born to mothers with serological profile of primary CMV infection (N = 75); (iii) without any information (N = 534). A highly sensitive method of DNA extraction (heat-induced) from the DBS was used. CMV DNA was detected by a nested PCR. RESULTS In total CMV DNA was detected in 7.5% (104/1388) of children. Symptomatic children showed a low rate of CMV DNA detection (6.7%) than children born to mothers with serological profile of primary CMV infection (13.3%) (p = 0.034). Sensorial hearing loss and encephalopathy were the two clinical manifestations with the highest CMV detection rate (18.3% and 11.1%, respectively). Children whose mothers had a confirmed primary infection showed a higher rate of CMV detection (35.3%) when compared with children whose mothers had a not confirmed primary infection (6.9%) (p = 0.007). CONCLUSION The present work emphasises the importance of testing DBS in symptomatic children even a long time after symptoms onset and in children born to mothers with serologic diagnosis of maternal primary CMV infection when they miss the diagnosis during the three-week window following birth.
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Affiliation(s)
- Sofia Almeida
- CHUCB: Centro Hospitalar Cova da Beira, Covilhã, Portugal; CICS-UBI: Health Sciences Research Center, Faculty of Health Sciences, Universidade da Beira Interior, Covilhã, Portugal
| | - Paula Gouveia
- CHUCB: Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | - Arminda Jorge
- CHUCB: Centro Hospitalar Cova da Beira, Covilhã, Portugal
| | - Ana Fortuna
- Centro de Genética Médica Doutor Jacinto Magalhães, Centro Hospitalar Universitário de Santo António - Unit for Multidisciplinary Research in Biomedicine and Laboratory for Integrative and Translational Research in Population Health, Institute of Biomedical Sciences Abel Salazar, Portugal
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Barbi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | | | - Paulo Paixão
- Centro de Estudos de Doenças Crónicas, Faculdade de Ciências Médicas, NOVA Medical School, CEDOC, Campo Mártires da Pátria, 130, Lisboa 1169-056, Portugal.
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Chung PK, Schornagel F, Oudesluys-Murphy AM, de Vries LS, Soede W, van Zwet E, Vossen A. Targeted screening for congenital cytomegalovirus infection: clinical, audiological and neuroimaging findings. Arch Dis Child Fetal Neonatal Ed 2022; 108:302-308. [PMID: 36549893 PMCID: PMC10176415 DOI: 10.1136/archdischild-2022-324699] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 11/27/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To evaluate clinical, audiological and neuroimaging findings in a cohort of infants diagnosed with congenital cytomegalovirus (cCMV) infection after failure at newborn hearing screening. METHODS A prospective observational study in the Netherlands, using the existing newborn hearing screening infrastructure for well babies. Between July 2012 and November 2016, cytomegalovirus (CMV) PCR testing of neonatally obtained dried blood spots (DBS) was offered to all infants who failed newborn hearing screening. Clinical, neuroimaging and audiological data were collected. RESULTS DBS of 1374 infants were successfully tested and 59 were positive for CMV (4.3%). Data of 54 infants were retrieved. Three were small for gestational age and six had microcephaly. Forty-eight (89%) had sensorineural hearing loss (SNHL), of whom half had unilateral SNHL. In both unilaterally and bilaterally affected children, the majority of the impaired ears had severe or profound hearing loss. Neuroimaging abnormalities were found in 40 of 48 (83%) children who had evaluable cranial ultrasound and/or cerebral MRI. The abnormalities were mild in 34, moderate in 3 and severe in 3 infants. The degree of SNHL and the severity of neuroimaging abnormalities were found to be correlated (p=0.002). CONCLUSIONS The yield of targeted cCMV screening following newborn hearing screening failure was eight times higher than the estimated national birth prevalence of cCMV. The majority of this cohort of infants with clinically unsuspected cCMV disease had confirmed SNHL, neuroimaging abnormalities and lower than average birth weights and head circumferences. Newborns who fail newborn hearing screening should be tested for CMV to ensure appropriate clinical, neurodevelopmental and audiological follow-up.
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Affiliation(s)
- Pui Khi Chung
- Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Fleurtje Schornagel
- Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Linda S de Vries
- Willem-Alexander Children's Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - Wim Soede
- Center for Audiology at the Department of Otorhinolaryngology, Leiden University Medical Center, Leiden, The Netherlands
| | - Erik van Zwet
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ann Vossen
- Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
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6
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Ross SA, Kimberlin D. Clinical outcome and the role of antivirals in congenital cytomegalovirus infection. Antiviral Res 2021; 191:105083. [PMID: 33964331 DOI: 10.1016/j.antiviral.2021.105083] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/22/2021] [Accepted: 04/27/2021] [Indexed: 11/15/2022]
Abstract
Congenital cytomegalovirus (cCMV) infection is a leading cause of hearing loss and neurological disabilities in children worldwide. Although a minority of infants with cCMV will have symptoms at a birth, these children are at high risk of long-term sequelae. Most infants with cCMV have no clinical signs at birth (asymptomatic), but 10-15% will develop hearing loss. The diagnosis of cCMV relies on detection of the virus from urine or saliva within the first three weeks of life, with saliva PCR being the preferred method due to ease of collection and high sensitivity of the assay. Measures to prevent mother-to-child transmission of CMV are limited, and antiviral therapy with valganciclovir for 6 months is the standard of care for infants with symptomatic cCMV. As more infants with cCMV are being identified through newborn screening, studies are urgently needed to address antiviral treatment in asymptomatic infants and the implementation of prevention strategies to prevent fetal infection. This article is part of the symposium "New drugs and vaccines for DNA virus infections: a symposium in memory of Mark Prichard."
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Affiliation(s)
- Shannon A Ross
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA; Departments of Microbiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - David Kimberlin
- Departments of Pediatrics, University of Alabama at Birmingham, Birmingham, AL, USA
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7
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Dollard SC, Dreon M, Hernandez-Alvarado N, Amin MM, Wong P, Lanzieri TM, Osterholm EA, Sidebottom A, Rosendahl S, McCann MT, Schleiss MR. Sensitivity of Dried Blood Spot Testing for Detection of Congenital Cytomegalovirus Infection. JAMA Pediatr 2021; 175:e205441. [PMID: 33523119 PMCID: PMC7851756 DOI: 10.1001/jamapediatrics.2020.5441] [Citation(s) in RCA: 58] [Impact Index Per Article: 19.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
IMPORTANCE The sensitivity of dried blood spots (DBS) to identify newborns with congenital cytomegalovirus (cCMV) infection has not been evaluated in screening studies using the current, higher-sensitivity methods for DBS processing. OBJECTIVE To assess the sensitivity of DBS polymerase chain reaction (PCR) for newborn screening for cCMV infection using saliva as the reference standard for screening, followed by collection of a urine sample for confirmation of congenital infection. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study took place at 5 newborn nurseries and 3 neonatal intensive care units in the Minneapolis/Saint Paul area in Minnesota from April 2016 to June 2019. Newborns enrolled with parental consent were screened for cCMV using DBS obtained for routine newborn screening and saliva collected 1 to 2 days after birth. Dried blood spots were tested for CMV DNA by PCR at both the University of Minnesota (UMN) and the US Centers for Disease Control and Prevention (CDC). Saliva swabs were tested by CMV DNA PCR at the UMN laboratory only. Newborns who screened positive by saliva or DBS had a diagnostic urine sample obtained by primary care professionals, tested by PCR within 3 weeks of birth. Analysis began July 2019. EXPOSURES Detection of CMV from a saliva swab using a PCR assay. MAIN OUTCOMES AND MEASURES Number of children with urine-confirmed cCMV and the proportion of them who were CMV positive through DBS screening. RESULTS Of 12 554 individuals enrolled through June 2019 (of 25 000 projected enrollment), 56 newborns were confirmed to have cCMV (4.5 per 1000 [95% CI, 3.3-5.7]). Combined DBS results from either UMN or CDC had a sensitivity of 85.7% (48 of 56; 95% CI, 74.3%-92.6%), specificity of 100.0% (95% CI, 100.0%-100.0%), positive predictive value (PPV) of 98.0% (95% CI, 89.3%-99.6%), and negative predictive value (NPV) of 99.9% (95% CI, 99.9%-100.0%). Dried blood spot results from UMN had a sensitivity of 73.2% (95% CI, 60.4%-83.0%), specificity of 100.0% (100.0%-100.0%), PPV of 100.0% (95% CI, 91.4%-100.0%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Dried blood spot results from CDC had a sensitivity of 76.8% (95% CI, 64.2%-85.9%), specificity of 100.0% (95% CI, 100.0%-100.0%), PPV of 97.7% (95% CI, 88.2%-99.6%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Saliva swab results had a sensitivity of 92.9% (52 of 56; 95% CI, 83.0%-97.2%), specificity of 99.9% (95% CI, 99.9%-100.0%), PPV of 86.7% (95% CI, 75.8%-93.1%), and NPV of 100.0% (95% CI, 99.9%-100.0%). CONCLUSIONS AND RELEVANCE This study demonstrates relatively high analytical sensitivity for DBS compared with previous studies that performed population-based screening. As more sensitive DNA extraction and PCR methods continue to emerge, DBS-based testing should remain under investigation as a potential low-cost, high-throughput option for cCMV screening.
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Affiliation(s)
| | - Maggie Dreon
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Nelmary Hernandez-Alvarado
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis
| | - Minal M. Amin
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Phili Wong
- US Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Erin A. Osterholm
- Division of Neonatology, University of Minnesota Medical School, Minneapolis
| | | | - Sondra Rosendahl
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Mark T. McCann
- Public Health Laboratory, Newborn Screening, Minnesota Department of Health, Saint Paul
| | - Mark R. Schleiss
- Division of Pediatric Infectious Diseases and Immunology, University of Minnesota Medical School, Minneapolis
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Abstract
Congenital cytomegalovirus (cCMV) infection is a leading cause of hearing loss and neurological disabilities in children, with the disease burden and disabilities due to cCMV greater than many other well recognized childhood conditions. A minority of infants with cCMV will have symptoms at birth. Infants with symptomatic cCMV are at higher risk for sequelae than those born without symptoms. The majority of infants with cCMV are asymptomatic at birth, but 10%-15% will develop hearing loss. Although clinical symptoms can help predict which infants will have sensorineural hearing loss, among asymptomatic cCMV there are currently no predictors of adverse outcome. The identification of a biomarker to identify those at highest risk of sequelae is highly desirable to target interventions to those who could potentially benefit. Because there is increasing rationale for establishing both targeted and universal screening programs for cCMV in the United States and worldwide, this is an urgent priority.
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Affiliation(s)
- Nazia Kabani
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Shannon A Ross
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
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Razonable RR, Inoue N, Pinninti SG, Boppana SB, Lazzarotto T, Gabrielli L, Simonazzi G, Pellett PE, Schmid DS. Clinical Diagnostic Testing for Human Cytomegalovirus Infections. J Infect Dis 2021; 221:S74-S85. [PMID: 32134488 DOI: 10.1093/infdis/jiz601] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Human cytomegalovirus (HCMV) infections are among the most common complications arising in transplant patients, elevating the risk of various complications including loss of graft and death. HCMV infections are also responsible for more congenital infections worldwide than any other agent. Congenital HCMV (cCMV) infections are the leading nongenetic cause of sensorineural hearing loss and a source of significant neurological disabilities in children. While there is overlap in the clinical and laboratory approaches to diagnosis of HCMV infections in these settings, the management, follow-up, treatment, and diagnostic strategies differ considerably. As yet, no country has implemented a universal screening program for cCMV. Here, we summarize the issues, limitations, and application of diagnostic strategies for transplant recipients and congenital infection, including examples of screening programs for congenital HCMV that have been implemented at several centers in Japan, Italy, and the United States.
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Affiliation(s)
- Raymund R Razonable
- Division of Infectious Diseases, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA.,William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Swetha G Pinninti
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Suresh B Boppana
- Department of Pediatrics, University of Alabama at Birmingham, Birmingham, Alabama, USA.,Department of Microbiology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tiziana Lazzarotto
- Operative Unit of Microbiology and Virology, Department of Specialized, Experimental, and Diagnostic Medicine, Polyclinic of St Orsola-Malpighi, University of Bologna, Italy
| | - Liliana Gabrielli
- Operative Unit of Microbiology and Virology, Department of Specialized, Experimental, and Diagnostic Medicine, Polyclinic of St Orsola-Malpighi, University of Bologna, Italy
| | - Giuliana Simonazzi
- Operative Unit of Obstetrics and Prenatal Medicine, Department of Medical Surgical Sciences, Polyclinic of St Orsola-Malpighi, University of Bologna, Italy
| | - Philip E Pellett
- Department of Biochemistry, Microbiology and Immunology, Wayne State University School of Medicine, Detroit, Michigan, USA
| | - D Scott Schmid
- Viral Vaccine Preventable Diseases Branch, Division of Viral Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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10
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Pimenta FC, Moiane B, Lessa FC, Venero AKL, Moura I, Larson S, Massora S, Chaúque A, Tembe N, Mucavele H, Verani JR, Whitney CG, Sigaúque B, Carvalho MGS. Dried blood spots for Streptococcus pneumoniae and Haemophilus influenzae detection and serotyping among children < 5 years old in rural Mozambique. BMC Pediatr 2020; 20:326. [PMID: 32615947 PMCID: PMC7331148 DOI: 10.1186/s12887-020-02209-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Accepted: 06/16/2020] [Indexed: 11/26/2022] Open
Abstract
Background Dried blood spots (DBS) have been proposed as potentially tool for detecting invasive bacterial diseases. Methods We evaluated the use of DBS for S. pneumoniae and H. influenzae detection among children in Mozambique. Blood for DBS and nasopharyngeal (NP) swabs were collected from children with pneumonia and healthy aged < 5 years. Bacterial detection and serotyping were performed by quantitative PCR (qPCR) (NP and DBS; lytA gene for pneumococcus and hpd for H. influenzae) and culture (NP). Combined detection rates were compared between children with pneumonia and healthy. Results Of 325 children enrolled, 205 had pneumonia and 120 were healthy. Pneumococci were detected in DBS from 20.5 and 64.2% of children with pneumonia and healthy, respectively; NP specimens were positive for pneumococcus in 80.0 and 80.8%, respectively. H. influenzae was detected in DBS from 22.9% of children with pneumonia and 59.2% of healthy; 81.4 and 81.5% of NP specimens were positive for H. influenzae, respectively. Conclusion DBS detected pneumococcal and H. influenzae DNA in children with pneumonia and healthy. Healthy children were often DBS positive for both bacteria, suggesting that qPCR of DBS specimens does not differentiate disease from colonization and is therefore not a useful diagnostic tool for children.
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Affiliation(s)
- Fabiana C Pimenta
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, 30329, USA.
| | - Benild Moiane
- Centro de Investigação em Saúde de Manhiça, 1929, Maputo, Mozambique
| | - Fernanda C Lessa
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, 30329, USA
| | | | - Iaci Moura
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, 30329, USA
| | | | - Sergio Massora
- Centro de Investigação em Saúde de Manhiça, 1929, Maputo, Mozambique
| | - Alberto Chaúque
- Centro de Investigação em Saúde de Manhiça, 1929, Maputo, Mozambique
| | - Nelson Tembe
- Centro de Investigação em Saúde de Manhiça, 1929, Maputo, Mozambique
| | - Helio Mucavele
- Centro de Investigação em Saúde de Manhiça, 1929, Maputo, Mozambique
| | - Jennifer R Verani
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, 30329, USA
| | - Cynthia G Whitney
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, 30329, USA
| | - Betuel Sigaúque
- Centro de Investigação em Saúde de Manhiça, 1929, Maputo, Mozambique
| | - Maria G S Carvalho
- Division of Bacterial Diseases, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, 30329, USA
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11
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Prospective multicenter comparison of urine culture with PCR on dried blood spots using 2 different extraction and PCR methods in neonates suspected for congenital cytomegalovirus infection. Diagn Microbiol Infect Dis 2020; 97:115051. [DOI: 10.1016/j.diagmicrobio.2020.115051] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 02/21/2020] [Accepted: 03/24/2020] [Indexed: 11/21/2022]
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12
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Pellegrinelli L, Alberti L, Pariani E, Barbi M, Binda S. Diagnosing congenital Cytomegalovirus infection: don't get rid of dried blood spots. BMC Infect Dis 2020; 20:217. [PMID: 32164599 PMCID: PMC7069171 DOI: 10.1186/s12879-020-4941-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 03/01/2020] [Indexed: 11/22/2022] Open
Abstract
Background Congenital Cytomegalovirus (cCMV) is a serious global public health issue that can cause irreversible fetal and neonatal congenital defects in symptomatic or asymptomatic newborns at birth. In absence of universal cCMV screening, the retrospective diagnosis of cCMV infection in children is only possible by examining Dried Blood Spot (DBS) samples routinely collected at birth and stored for different time spans depending on the newborn screening regulations in force in different countries. In this article, we summarize the arguments in favor of long-term DBS sample storage for detecting cCMV infection. Main text CMV infection is the most common cause of congenital infection resulting in severe defects and anomalies that can be apparent at birth or develop in early childhood. Sensorineural hearing loss is the most frequent consequence of cCMV infection and may have a late onset and progress in the first years of life. The virological diagnosis of cCMV is essential for clinical research and public health practices. In fact, in order to assess the natural history of CMV infection and distinguish between congenital or acquired infection, children should be diagnosed early by analyzing biological samples collected in the first weeks of life (3 weeks by using viral culture and 2 weeks by molecular assays), which, unfortunately, are not always available for asymptomatic or mildly symptomatic children. It now seems possible to overcome this problem since the CMV-DNA present in the blood of congenitally infected newborns can be easily retrieved from the DBS samples on the Guthrie cards routinely collected and stored within 3 days from birth in the neonatal screening program for genetic and congenital diseases. Early collection and long-term storage are inexpensive methods for long-term bio-banking and are the key points of DBS testing for the detection of cCMV. Conclusion DBS sampling is a reliable and inexpensive method for long-term bio-banking, which enables to diagnose known infectious diseases - including cCMV - as well as diseases not jet recognized, therefore their storage sites and long-term storage conditions and durations should be the subject of political decision-making.
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Affiliation(s)
- Laura Pellegrinelli
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy.
| | - Luisella Alberti
- Newborn Screening Laboratory, ASST Fatebenefratelli Sacco-PO Ospedale dei Bambini "V. Buzzi", Milan, Italy
| | - Elena Pariani
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Maria Barbi
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
| | - Sandro Binda
- Department of Biomedical Sciences for Health, University of Milan, Milan, Italy
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13
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Smiljkovic M, Le Meur JB, Malette B, Boucoiran I, Minsart AF, Lamarre V, Tapiero B, Renaud C, Kakkar F. Blood viral load in the diagnostic workup of congenital cytomegalovirus infection. J Clin Virol 2019; 122:104231. [PMID: 31821950 DOI: 10.1016/j.jcv.2019.104231] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/22/2019] [Accepted: 11/28/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND There is limited data on the role of cytomegalovirus (CMV) blood quantitative polymerase chain reaction (qPCR) in the diagnostic workup of congenital CMV (cCMV) infection. OBJECTIVES The objective of this study was to determine if CMV blood qPCR at the time diagnosis could differentiate between symptomatic and asymptomatic infants according to the recent consensus classification. STUDY DESIGN Retrospective study of children diagnosed with cCMV infection at CHU Sainte-Justine, Montreal, Canada, between 2008 and 2016. Cases for whom qPCR was done at baseline (<4 weeks of age) alongside a complete diagnostic workup were included. The association between CMV blood viral load (VL) and clinical severity group was determined. The probability of having moderate to severe symptoms was assessed using univariate logistic regression analysis. RESULTS Forty-seven patients were included in the analysis. Median VL was significantly higher among infants with moderate to severely symptomatic disease vs. those asymptomatic or asymptomatic with isolated sensorineural hearing loss (SNHL) (13 736 vs. 1876 copies/ml, p = 0.004), infants with moderate to severe disease or asymptomatic with isolated SNHL vs. asymptomatic (17 736 vs. 1496 copies/ml, p < 0.001), and in infants with baseline neurological involvement vs. those without (17 317 vs. 2641 copies/ml, p = 0.03). Using logistic regression, an infant would have a >75 % probability of being moderate to severely symptomatic above 18 770 copies/ml, with a threshold of 100 000 copies/ml approaching a 100 % probability. CONCLUSIONS Our baseline assessment of CMV blood VL suggests that that the level of CMV viremia correlates with symptom severity.
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Affiliation(s)
- Mina Smiljkovic
- Division of Infectious Diseases, Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | | | - Brigitte Malette
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Isabelle Boucoiran
- Department of Obstetrics and Gynaecology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada; Department of Social and Preventive Medicine, Université de Montréal, Québec, Canada
| | - Anne-Frédérique Minsart
- Department of Obstetrics and Gynaecology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Valérie Lamarre
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Bruce Tapiero
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Christian Renaud
- Department of Microbiology, CHU Sainte-Justine, Université de Montréal, Montréal, Canada; Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada
| | - Fatima Kakkar
- Division of Infectious Diseases, Department of Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, Canada.
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Development of highly efficient protocols for extraction and amplification of cytomegalovirus DNA from dried blood spots for detection and genotyping of polymorphic immunomodulatory genes. PLoS One 2019; 14:e0222053. [PMID: 31513621 PMCID: PMC6742235 DOI: 10.1371/journal.pone.0222053] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 08/20/2019] [Indexed: 12/17/2022] Open
Abstract
Congenital cytomegalovirus (CMV) infection is a major cause of birth defects ranging from developmental disorders to stillbirth. Most newborns affected by CMV do not present with symptoms at birth but are at risk of sequelae at later stages of their childhood. Stored dried blood spots (DBS) taken at birth can be used for retrospective diagnosis of hereditary diseases, but detection of pathogens is challenged by potentially low pathogen concentrations in the small blood volume available in a DBS. Here we test four different extraction methods for optimal recovery of CMV DNA from DBS at low to high CMV titers. The recovery efficiencies varied widely between the different extractions (from 3% to 100%) with the most efficient method extracting up to 113-fold more CMV DNA than the least efficient and 8-fold more than the reference protocol. Furthermore, we amplified four immunomodulatory CMV genes from the extracted DNA: the UL40 and UL111A genes which occur as functional knockouts in some circulating CMV strains, and the highly variable UL146 and US28 genes. The PCRs specifically amplified the CMV genes at all tested titers with sufficient quality for sequencing and genotyping. In summary, we here report an extraction method for optimal recovery of CMV DNA from DBSs that can be used for both detection of CMV and for genotyping of polymorphic CMV genes in congenital CMV infection.
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15
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Coltella L, Ranno S, Pizzichemi G, Piccioni L, Chiavelli S, Onetti Muda A, Concato C. Real-time PCR versus shell vial culture on urine of patients with suspected congenital cytomegalovirus infection. Future Virol 2019. [DOI: 10.2217/fvl-2019-0078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Aims: Cytomegalovirus (CMV) is the most common cause of congenital infection. Aim of this study is to support quantitative real-time polymerase chain reaction (PCR) versus shell vials culture for CMV screening in urine samples. Patients & methods: A retrospective study was conducted on 255 urine samples belonging to patients admitted to Bambino Gesù Pediatric Hospital, Rome, Italy, with suspected congenital CMV infection. Results & conclusion: Quantitative real-time PCR resulted more standardized, faster, less operator-dependent, less laborious and most of all cost saving and more sensitive than shell vial culture. Since a negative result for CMV in urine means no congenital infection, a more sensitive tool for detection of CMV DNA is essential to improve patient management and to reduce healthcare costs associated to a late diagnosis.
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Affiliation(s)
- Luana Coltella
- Unit of Microbiology, Virology & Parasitology, Department of Laboratory, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
| | - Stefania Ranno
- Unit of Microbiology, Virology & Parasitology, Department of Laboratory, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
| | - Giuseppe Pizzichemi
- Unit of Microbiology, Virology & Parasitology, Department of Laboratory, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
| | - Livia Piccioni
- Unit of Microbiology, Virology & Parasitology, Department of Laboratory, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
| | - Stefano Chiavelli
- Unit of Microbiology, Virology & Parasitology, Department of Laboratory, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
| | - Andrea Onetti Muda
- Unit of Microbiology, Virology & Parasitology, Department of Laboratory, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
- Campus Bio-Medico University, Via Alvaro del Portillo 21, 00128 Rome, Italy
| | - Carlo Concato
- Unit of Microbiology, Virology & Parasitology, Department of Laboratory, Bambino Gesù Children's Hospital, IRCCS, Piazza Sant’Onofrio, 4, 00165 Rome, Italy
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16
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Is Polymerase Chain Reaction in Neonatal Dried Blood Spots Reliable for the Diagnosis of Congenital Cytomegalovirus Infection? Pediatr Infect Dis J 2019; 38:520-524. [PMID: 30199483 DOI: 10.1097/inf.0000000000002144] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
BACKGROUND Detection of cytomegalovirus (CMV) DNA by real-time polymerase chain reaction (rt-PCR) in dried blood spots (DBSs) collected for newborn screening has been assessed for retrospective diagnosis of congenital CMV (cCMV) infection, with variable results (sensitivities ranging from 34% to 100%). We aimed to assess the accuracy of this technique in Spain in a large patient series. METHODS Ambispective, multicenter study including patients with confirmed cCMV from the Spanish Registry of cCMV patients. cCMV was established on the presence of CMV DNA in any body fluid, by positive culture findings or by molecular techniques during the first 2 weeks of life. Children in whom cCMV had been excluded were used as negative controls. Neonatal DBS samples were collected from both groups. The presence of CMV DNA was assessed by rt-PCR (RealStar CMV, Altona, Germany) in a central laboratory. RESULTS One-hundred three patients and 81 controls from 10 hospitals were included. The performance of CMV DNA determination in DBS for the diagnosis of cCMV was as follows (95% confidence interval): sensitivity 0.56 (0.47-0.65), specificity 0.98 (0.91-0.99), positive likelihood ratio 22.81 (5.74-90.58) and negative likelihood ratio 0.45 (0.36-0.56). Sensitivity increased with the birth viral load (bVL) log category. In cCMV patients, lower bVL was the single variable associated with a negative DBS rt-PCR result (P = 0.017). CONCLUSIONS The sensitivity of CMV rt-PCR in DBS in our series was low and correlated with the bVL. Thus, a negative DBS result would not rule out cCMV infection, especially in patients with a low viremia level at birth.
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17
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Koontz D, Dollard S, Cordovado S. Evaluation of rapid and sensitive DNA extraction methods for detection of cytomegalovirus in dried blood spots. J Virol Methods 2019; 265:117-120. [PMID: 30639422 DOI: 10.1016/j.jviromet.2019.01.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2018] [Revised: 01/08/2019] [Accepted: 01/10/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Dried blood spots (DBS), collected universally from newborns in the U.S., could be used as a matrix for the detection of cytomegalovirus (CMV) infection in infants. However, sensitivity to detect CMV in DBS as compared to saliva and urine is variable across studies largely due to the DNA extraction method. Thermal shock, a widely used DNA extraction method, is highly sensitive for the detection of CMV in DBS, however, the processing time required is not practical for high-throughput testing. OBJECTIVE To determine if rapid and cost-effective DNA extraction methods amenable to newborn screening (NBS) could achieve the same sensitivity as the thermal shock method. STUDY DESIGN DBS were prepared from CMV positive blood samples from 20 organ transplant recipients. Three DNA extraction methods were compared for relative yield and sensitivity of detection of CMV DNA: thermal shock, KOH Tris buffer, and DNA Extract All. CMV DNA was detected by real-time quantitative polymerase chain reaction (qPCR). RESULTS The KOH Tris and DNA Extract All methods gave higher yields and sensitivity of CMV detection in DBS than thermal shock, which were significantly greater when viral loads were ≤ 10,000 copies/ml blood. Both methods gave faster turnaround times than thermal shock and would be better suited for NBS. CONCLUSIONS The choice of DNA extraction method greatly influences the ability to detect low levels of CMV DNA in DBS. Moreover, development of highly sensitive yet rapid methods for CMV detection could help facilitate future newborn screening of CMV in DBS.
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Affiliation(s)
- D Koontz
- Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA.
| | - S Dollard
- Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
| | - S Cordovado
- Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
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18
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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] [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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19
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Rovito R, Warnatz HJ, Kiełbasa SM, Mei H, Amstislavskiy V, Arens R, Yaspo ML, Lehrach H, Kroes ACM, Goeman JJ, Vossen ACTM. Impact of congenital cytomegalovirus infection on transcriptomes from archived dried blood spots in relation to long-term clinical outcome. PLoS One 2018; 13:e0200652. [PMID: 30024899 PMCID: PMC6053152 DOI: 10.1371/journal.pone.0200652] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Accepted: 06/30/2018] [Indexed: 01/16/2023] Open
Abstract
Congenital Cytomegalovirus infection (cCMV) is the leading infection in determining permanent long-term impairments (LTI), and its pathogenesis is largely unknown due to the complex interplay between viral, maternal, placental, and child factors. The cellular activity, considered to be the result of the response to exogenous and endogenous factors, is captured by the determination of gene expression profiles. In this study, we determined whole blood transcriptomes in relation to cCMV, CMV viral load and LTI development at 6 years of age by using RNA isolated from neonatal dried blood spots (DBS) stored at room temperature for 8 years. As DBS were assumed to mainly reflect the neonatal immune system, particular attention was given to the immune pathways using the global test. Additionally, differential expression of individual genes was performed using the voom/limma function packages. We demonstrated feasibility of RNA sequencing from archived neonatal DBS of children with cCMV, and non-infected controls, in relation to LTI and CMV viral load. Despite the lack of statistical power to detect individual genes differences, pathway analysis suggested the involvement of innate immune response with higher CMV viral loads, and of anti-inflammatory markers in infected children that did not develop LTI. Finally, the T cell exhaustion observed in infected neonates, in particular with higher viral load, did not correlate with LTI, therefore other mechanisms are likely to be involved in the long-term immune dysfunction. Despite these data demonstrate limitation in determining prognostic markers for LTI by means of transcriptome analysis, this exploratory study represents a first step in unraveling the pathogenesis of cCMV, and the aforementioned pathways certainly merit further evaluation.
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Affiliation(s)
- Roberta Rovito
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
- * E-mail:
| | - Hans-Jörg Warnatz
- Otto Warburg Laboratory Gene Regulation and Systems Biology of Cancer, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Szymon M. Kiełbasa
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Hailiang Mei
- Sequencing Analysis Support Core, Leiden University Medical Center, Leiden, The Netherlands
| | - Vyacheslav Amstislavskiy
- Otto Warburg Laboratory Gene Regulation and Systems Biology of Cancer, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | - Ramon Arens
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, The Netherlands
| | - Marie-Laure Yaspo
- Otto Warburg Laboratory Gene Regulation and Systems Biology of Cancer, Max Planck Institute for Molecular Genetics, Berlin, Germany
| | | | - Aloys C. M. Kroes
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jelle J. Goeman
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Ann C. T. M. Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands
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20
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Maternal and child human leukocyte antigens in congenital cytomegalovirus infection. J Reprod Immunol 2018; 126:39-45. [PMID: 29477013 DOI: 10.1016/j.jri.2018.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2017] [Revised: 01/11/2018] [Accepted: 01/16/2018] [Indexed: 01/16/2023]
Abstract
Congenital Cytomegalovirus infection (cCMV) is the most common cause of congenital infections worldwide causing permanent long-term impairment (LTI). cCMV immunopathogenesis remains largely unknown due to the complex interplay between viral, maternal, placental and child factors. The aim of this study was to determine the possible role of particular HLA antigens, of the number of HLA mismatches (mm) and non-inherited maternal antigens (NIMAs) in a large retrospective nation-wide cohort of children with cCMV and their mothers. HLA Class I (HLA-A, HLA-B and HLA-C) and HLA Class II (HLA-DR and HLA-DQ) were assessed in 96 mother-child pairs in relation to a control group of 5604 Dutch blood donors, but no significant differences were observed. Next, although these HLA antigens could not be assessed in relation to symptoms at birth, nor to LTI, due to the low number of cases, they could be evaluated in relation to CMV viral load. HLA-DRB1*04, and potentially HLA-B*51, was shown to have a protective role in the children as its frequency was increased in the low viral load group compared to the high viral load group, and this remained significant after correction. The number of HLA mm and of NIMAs were not associated to symptoms at birth nor to LTI or viral load. In conclusion, although none of the HLA alleles could be put forward as prognostic marker for long-term outcome, our findings give useful insights into cCMV pathogenesis, and identify potential HLAs that correlate with a better viral control.
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21
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Rovito R, Claas FHJ, Haasnoot GW, Roelen DL, Kroes ACM, Eikmans M, Vossen ACTM. Congenital Cytomegalovirus Infection: Maternal-Child HLA-C, HLA-E, and HLA-G Affect Clinical Outcome. Front Immunol 2018; 8:1904. [PMID: 29354123 PMCID: PMC5760553 DOI: 10.3389/fimmu.2017.01904] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 12/13/2017] [Indexed: 01/02/2023] Open
Abstract
Congenital CMV infection (cCMV) is the most common congenital infection causing permanent long-term impairments (LTI). cCMV immunopathogenesis is largely unknown due to the complex interplay between viral, maternal, placental, and child factors. In this study, a large retrospective nationwide cohort of children with cCMV and their mothers was used. HLA-C, HLA-E, and HLA-G were assessed in 96 mother–child pairs in relation to symptoms at birth and LTI at 6 years of age. The mothers were additionally typed for killer cell immunoglobulin-like receptors. The maternal HLA-G 14 bp deletion/deletion polymorphism was associated with a worse outcome, as the immunomodulation effect of higher protein levels may induce less CMV control, with a direct impact on placenta and fetus. The absence of maternal HLA-C belonging to the C2 group was associated with symptoms at birth, as activating signals on decidual NK may override inhibitory signals, contributing to a placental pro-inflammatory environment. Here, the increased HLA-E*0101 and HLA-C mismatches, which were associated with symptoms at birth, may enhance maternal allo-reactivity to fetal Ags, and cause suboptimal viral clearance. Finally, HLA-C non-inherited maternal antigens (NIMAs) were associated with LTI. The tolerance induced in the fetus toward NIMAs may indirectly induce a suboptimal CMV antiviral response throughout childhood. In light of our findings, the potential role of maternal–child HLA in controlling CMV infection and cCMV-related disease, and the clinical value as predictor for long-term outcome certainly deserve further evaluation.
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Affiliation(s)
- Roberta Rovito
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Frans H J Claas
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Geert W Haasnoot
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Dave L Roelen
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Aloys C M Kroes
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
| | - Michael Eikmans
- Department of Immunohematology and Blood Transfusion, Leiden University Medical Center, Leiden, Netherlands
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, Netherlands
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Abstract
Nucleic acid extraction is the first step of any amplification experiment no matter what kind of amplification is used to detect a specific pathogen. Efficient nucleic acid extraction is essential to obtain good results using any molecular test. The optimal extraction method should fulfill the following conditions: speed, short working time, cost-effectiveness, high sensitivity and specificity, good reproducibility, and safety. The methods can be divided into solution or column based according to differences of their principles. The automated extraction instruments have many advantages, and these have proven to be very useful. Moreover, in recent years, fully automated instruments combining NA extraction and amplification have been commercially available. However, the method itself does not provide assurance, and the DNA recovery can be different among various kits or instruments that use the similar principles. Therefore, it is important to carefully evaluate the performance of any extraction method used in the clinical microbiology laboratory even though manufacturers may have reported good validation results with specific organisms.
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Affiliation(s)
- Yi-Wei Tang
- Departments of Laboratory Medicine and Internal Medicine, Memorial Sloan Kettering Cancer Center, New York, NY USA
| | - Charles W. Stratton
- Department of Pathology, Microbiology and Immunology and Medicine, Vanderbilt University Medical Center, Nashville, TN USA
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Rovito R, Korndewal MJ, Schielen PCJI, Kroes ACM, Vossen ACTM. Neonatal screening parameters in infants with congenital Cytomegalovirus infection. Clin Chim Acta 2017; 473:191-197. [PMID: 28847685 DOI: 10.1016/j.cca.2017.08.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2017] [Revised: 08/24/2017] [Accepted: 08/25/2017] [Indexed: 12/30/2022]
Abstract
Congenital Cytomegalovirus infection (cCMV) is the most common cause of congenital infections worldwide that can cause long-term impairment (LTI). The metabolic alterations due to cCMV are largely unknown. This study aims to assess the metabolites included in the neonatal screening in relation to cCMV and cCMV outcome, allowing the identification of prognostic markers for clinical outcome. Essential amino acids, hormones, carnitines and enzymes from Dried Blood Spots (DBS) were analyzed of 102 children with cCMV and 179 children without cCMV, and they were related to symptoms at birth and LTI at 6years of age. In this cohort, the neonatal screening parameters did not change in relation to cCMV, nor to symptoms at birth or LTI. However, metabolic changes were observed in children born preterm, with lower concentrations of essential amino acids in premature infants with cCMV compared to premature controls. Finally, a higher concentration of palmytoilcarnitine (C16) in the group with higher viral load was observed. Though these data demonstrate limitations in the use of neonatal screening data as predictors for long-term cCMV outcome, the metabolism of preterm neonates with cCMV merits further evaluation.
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Affiliation(s)
- Roberta Rovito
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Marjolein J Korndewal
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands; Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute of Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands.
| | - Peter C J I Schielen
- Centre for Infectious Diseases Research, Diagnostics and Screening, National Institute of Public Health and the Environment (RIVM), Antonie van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands..
| | - Aloys C M Kroes
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, The Netherlands.
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Marsico C, Kimberlin DW. Congenital Cytomegalovirus infection: advances and challenges in diagnosis, prevention and treatment. Ital J Pediatr 2017; 43:38. [PMID: 28416012 PMCID: PMC5393008 DOI: 10.1186/s13052-017-0358-8] [Citation(s) in RCA: 122] [Impact Index Per Article: 17.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/08/2017] [Indexed: 11/17/2022] Open
Abstract
Cytomegalovirus (CMV) is the most frequent cause of congenital infection worldwide, with an estimated incidence in developing countries of 0.6-0.7% of all live births. The burden of disease related to congenital CMV in substantial, as it is the leading non-genetic cause of sensorineural hearing loss and an important cause of neurodevelopmental disabilities in children. Despite its clinical significance, congenital CMV infection often goes undetected because the majority of infected infants are asymptomatic at birth and screening programs have not been substantially implemented. Other than behavioral measures, effective interventions aimed at the prevention of maternal infection and of mother-to-child transmission are lacking. Due to a convergence of recent advances in both diagnostic and therapeutic strategies in infants with congenital CMV, though, the field likely will be changing rapidly over just the next few years. Specifically, a highly-sensitive screening test with high throughput potential has been developed, and treatment of infants symptomatically infected with congenital CMV has proven to be well-tolerated and effective in improving long-term hearing and neurodevelopmental outcomes.This review highlights the clinical importance of congenital CMV infection, the developments in laboratory diagnostics, and the benefits of antiviral therapy. It also identifies the global efforts still required in the prevention of maternal infection and in the optimization of antiviral therapy to further reduce the burden of congenital CMV disease.
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Affiliation(s)
- Concetta Marsico
- Department of Medical and Surgical Sciences, Neonatology and Neonatal Intensive Care Unit, St.Orsola-Malpighi Hospital, University of Bologna, via Massarenti 11, 40138 Bologna, Italy
| | - David W. Kimberlin
- Department of Pediatrics, Division of Pediatric Infectious Diseases, University of Alabama at Birmingham, Children’s Harbor Building 303, 1600 7th Avenue South, Birmingham, AL 35233 USA
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Spalletti-Cernia D, Barbato S, Sorrentino R, Vallefuoco L, Rocco C, Di Costanzo P, Giannattasio A, Raimondi F, Mazzarella C, De Mattia R, Portella G. Evaluation of the Automated QIAsymphony SP/AS Workflow for Cytomegalovirus DNA Extraction and Amplification from Dried Blood Spots. Intervirology 2017; 59:211-216. [DOI: 10.1159/000457953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 01/25/2017] [Indexed: 01/31/2023] Open
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Xiong Y, Jeronis S, Hoffman B, Liebermann DA, Geifman-Holtzman O. First trimester noninvasive fetalRHDgenotyping using maternal dried blood spots. Prenat Diagn 2017; 37:311-317. [DOI: 10.1002/pd.5006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Revised: 11/21/2016] [Accepted: 01/09/2017] [Indexed: 01/20/2023]
Affiliation(s)
- Yali Xiong
- Fels Institute for Cancer Research and Molecular Biology; Lewis Katz School of Medicine, Temple University; Philadelphia PA USA
| | - Stacey Jeronis
- Department of Obstetrics, Gynecology and Reproductive Sciences; Lewis Katz School of Medicine, Temple University; Philadelphia PA USA
| | - Barbara Hoffman
- Fels Institute for Cancer Research and Molecular Biology; Lewis Katz School of Medicine, Temple University; Philadelphia PA USA
| | - Dan A. Liebermann
- Fels Institute for Cancer Research and Molecular Biology; Lewis Katz School of Medicine, Temple University; Philadelphia PA USA
| | - Ossie Geifman-Holtzman
- Fels Institute for Cancer Research and Molecular Biology; Lewis Katz School of Medicine, Temple University; Philadelphia PA USA
- Department of Obstetrics and Gynecology; College of Medicine, Drexel University; Philadelphia PA USA
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Abstract
Congenital cytomegalovirus (CMV) remains a leading cause of disability in children. Understanding the pathogenesis of infection from the mother via the placenta to the neonate is crucial if we are to produce new interventions and provide supportive mechanisms to improve the outcome of congenitally infected children. In recent years, some major goals have been achieved, including the diagnosis of primary maternal CMV infection in pregnant women by using the anti-CMV IgG avidity test and the diagnosis and prognosis of foetal CMV infection by using polymerase chain reaction real-time tests to detect and quantify the virus in amniotic fluid. This review summarises recent advances in our understanding and highlights where challenges remain, especially in vaccine development and anti-viral therapy of the pregnant woman and the neonate. Currently, no therapeutic options during pregnancy are available except those undergoing clinical trials, whereas valganciclovir treatment is recommended for congenitally infected neonates with moderately to severely symptomatic disease.
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Affiliation(s)
- Vincent C Emery
- Department of Microbial and Cellular Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, Surrey, UK
| | - Tiziana Lazzarotto
- Department of Specialized, Experimental and Diagnostic Medicine, University of Bologna, Bologna, Italy
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Rovito R, Korndewal MJ, van Zelm MC, Ziagkos D, Wessels E, van der Burg M, Kroes ACM, Langerak AW, Vossen ACTM. T and B Cell Markers in Dried Blood Spots of Neonates with Congenital Cytomegalovirus Infection: B Cell Numbers at Birth Are Associated with Long-Term Outcomes. THE JOURNAL OF IMMUNOLOGY 2016; 198:102-109. [PMID: 27903736 DOI: 10.4049/jimmunol.1601182] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2016] [Accepted: 10/25/2016] [Indexed: 11/19/2022]
Abstract
Congenital CMV infection (cCMV) is the most common congenital infection that can cause long-term impairment (LTI). The pathogenesis of LTI is not completely understood. Fetal immunity may play a role in controlling the infection and preventing LTI, although immune activation may also contribute to fetal immunopathology. In this study, we analyzed various molecular markers of T and B cell numbers in neonatal dried blood spots of 99 children with cCMV and 54 children without cCMV: δRec-ψJα signal joints on TCR excision circles, intron recombination signal sequence k-deleting element signal joints on Igκ-deleting recombination excision circles, genomic intron recombination signal sequence k-deleting element coding joint, genomic Vδ1-Jδ1, and Vδ2-Jδ1 rearrangements. Of this cohort, clinical symptoms at birth and LTI at 6 y of age were recorded. Neonates with cCMV had fewer TCR excision circles in their blood than non-infected controls. Furthermore, cCMV infection was associated with increased numbers of γδ T cells and B cells, and these numbers were positively correlated with CMV viral load in the dried blood spots. Infected children with a better long-term outcome had higher numbers of B cells at birth than those who developed LTI; no difference in B cell replication was observed. The potential protective role of B cells in controlling cCMV-related disease and the clinical value of this marker as a predictor of long-term outcome merit further evaluation.
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Affiliation(s)
- Roberta Rovito
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands;
| | - Marjolein J Korndewal
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands.,Centre for Infectious Diseases, Epidemiology and Surveillance, National Institute of Public Health and the Environment, 3720 BA, Bilthoven, the Netherlands
| | - Menno C van Zelm
- Department of Immunology and Pathology, Central Clinical School, Monash University, Melbourne, VIC 3800, Australia
| | - Dimitrios Ziagkos
- Medical Statistics and Bioinformatics, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands; and
| | - Els Wessels
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Mirjam van der Burg
- Department of Immunology, Erasmus MC University Medical Centre Rotterdam, 3015 CN, Rotterdam, the Netherlands
| | - Aloys C M Kroes
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
| | - Anton W Langerak
- Department of Immunology, Erasmus MC University Medical Centre Rotterdam, 3015 CN, Rotterdam, the Netherlands
| | - Ann C T M Vossen
- Department of Medical Microbiology, Leiden University Medical Center, 2333 ZA Leiden, the Netherlands
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Uematsu M, Haginoya K, Kikuchi A, Hino-Fukuyo N, Ishii K, Shiihara T, Kato M, Kamei A, Kure S. Asymptomatic congenital cytomegalovirus infection with neurological sequelae: A retrospective study using umbilical cord. Brain Dev 2016; 38:819-26. [PMID: 27068877 DOI: 10.1016/j.braindev.2016.03.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 03/08/2016] [Accepted: 03/18/2016] [Indexed: 10/22/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection causes various neurological sequelae. However, most infected infants are asymptomatic at birth, and retrospective diagnosis is difficult beyond the neonatal period. OBJECTIVE This study aimed to investigate the aspects of neurological sequelae associated with asymptomatic congenital CMV infection. METHODS We retrospectively analyzed 182 patients who were suspected of having asymptomatic congenital CMV infection with neurological symptoms in Japan. Congenital CMV infection was diagnosed by quantitative polymerase chain reaction amplification of CMV from dried umbilical cord DNA. RESULTS Fifty-nine patients (32.4%) who tested positive for CMV were confirmed as having congenital CMV infection. Among 54 congenital CMV patients, major neurological symptoms included intellectual disability (n=51, 94.4%), hearing impairment (n=36, 66.7%) and cerebral palsy (n=21, 38.9%), while microcephaly (n=16, 29.6%) and epilepsy (n=14, 25.9%) were less common. In a brain magnetic resonance imaging (MRI) study, cortical dysplasia was observed in 27 CMV-positive patients (50.0%), and all patients (100%) had cerebral white matter (WM) abnormality. Intracranial calcification was detected by CT in 16 (48.5%) of 33 CMV-positive patients. Cerebral palsy, cortical dysplasia and a WM abnormality with a diffuse pattern were associated with marked intellectual disability. CONCLUSIONS Brain MRI investigations are important for making a diagnosis and formulating an intellectual prognosis. Analysis of umbilical cord tissue represents a unique and useful way to retrospectively diagnose congenital CMV infection.
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Affiliation(s)
- Mitsugu Uematsu
- Department of Pediatrics, Tohoku University School of Medicine, Japan.
| | - Kazuhiro Haginoya
- Department of Pediatric Neurology, Takuto Rehabilitation Center for Children, Japan
| | - Atsuo Kikuchi
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Naomi Hino-Fukuyo
- Department of Pediatrics, Tohoku University School of Medicine, Japan
| | - Keiko Ishii
- Department of Medical Microbiology, Mycology and Immunology, Tohoku University School of Medicine, Japan
| | | | - Mitsuhiro Kato
- Department of Pediatrics, Yamagata University Faculty of Medicine, Japan
| | - Atsushi Kamei
- Department of Pediatrics, Iwate Medical University, Japan
| | - Shigeo Kure
- Department of Pediatrics, Tohoku University School of Medicine, Japan
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Disease burden of congenital cytomegalovirus infection at school entry age: study design, participation rate and birth prevalence. Epidemiol Infect 2015; 144:1520-7. [PMID: 26554756 DOI: 10.1017/s0950268815002708] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Congenital cytomegalovirus infection (cCMV) may lead to symptoms at birth and long-term consequences. We present a nationwide, retrospective cohort study on the outcome of cCMV up to age 6 years. For this study we identified cCMV, using polymerase chain reaction, by analysing dried blood spots, which are taken shortly after birth for neonatal screening. The group of children with cCMV were compared to a group of children who were cCMV negative at birth. Data were collected about their health and development up to age 6 years. Parents of 73 693 children were invited to participate, and 32 486 (44·1%) gave informed consent for testing of their child's dried blood spot for CMV. Of the 31 484 dried blood spots tested, 156 (0·5%) were positive for cCMV. Of these, four (2·6%) children had been diagnosed with cCMV prior to this study. This unique retrospective nationwide study permits the estimation of long-term sequelae of cCMV up to the age of 6 years. The birth prevalence of cCMV in this study was 0·5%, which is in line with prior estimates. Most (97·4%) children with cCMV had not been diagnosed earlier, indicating under-diagnosis of cCMV.
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31
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Ogawa H, Matsui T, Baba Y, Yamada N, Suzuki Y, Suzutani T. Presence of cytomegalovirus in the perilymphatic fluid of patients with profound sensorineural hearing loss caused by congenital cytomegalovirus infection. Acta Otolaryngol 2015; 136:132-5. [PMID: 26484748 DOI: 10.3109/00016489.2015.1099733] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Not all patients diagnosed with congenital infection using umbilical cord assay were found to be positive for CMV-DNA by perilymphatic fluid assay. In addition, a CMV-DNA-positive result was observed in one patient who had not been diagnosed with congenital infection. Sampling of perilymphatic fluid from a large population of patients with congenital SNHL caused by congenital CMV infection or of unknown etiology is required to determine the prevalence of CMV-related profound HL. OBJECTIVES Sensorineural hearing loss (SNHL) is one of the most frequent manifestations in patients with congenital cytomegalovirus (CMV) infection. Using dried umbilical cord, a PCR-based assay was recently developed for the retrospective detection of congenital CMV infection. This study analyzed the presence of CMV in the perilymphatic fluid and evaluated differences in the effect of cochlear implantation between CMV-positive and -negative groups. METHOD Perilymphatic fluid was collected from each patient at the time of cochlear implantation and analyzed for the presence of CMV using a PCR method. RESULTS The perilymphatic fluid in two of the five patients suffering from congenital CMV infection and in one of the 17 patients without congenital CMV infection was found to be positive for CMV.
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Affiliation(s)
- Hiroshi Ogawa
- a Department of Otorhinolaryngology , Fukushima Medical University Aizu Medical Center , Aizuwakamatsu , Japan
| | - Takamichi Matsui
- b Department of Otolaryngology , Fukushima Medical University , Fukushima , Japan
| | - Yoko Baba
- b Department of Otolaryngology , Fukushima Medical University , Fukushima , Japan
| | - Naoko Yamada
- c Fukushima Rehabilitation Center for Children , Fukushima , Japan
| | - Yukie Suzuki
- c Fukushima Rehabilitation Center for Children , Fukushima , Japan
| | - Tatsuo Suzutani
- d Department of Microbiology , Fukushima Medical University , Fukushima , Japan
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32
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Koontz D, Baecher K, Amin M, Nikolova S, Gallagher M, Dollard S. Evaluation of DNA extraction methods for the detection of Cytomegalovirus in dried blood spots. J Clin Virol 2015; 66:95-9. [PMID: 25866346 DOI: 10.1016/j.jcv.2015.03.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2014] [Revised: 02/24/2015] [Accepted: 03/14/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Dried blood spots (DBS) are collected universally from newborns and may be valuable for the diagnosis of congenital Cytomegalovirus (CMV) infection. The reported analytical sensitivity for DBS testing compared to urine or saliva varies greatly across CMV studies. The purpose of this study was to directly compare the performance of various DNA extraction methods for identification of CMV in DBS including those used most often in CMV studies. STUDY DESIGN Whatman(®) Grade 903 filter paper cards were spotted with blood samples from 25 organ transplant recipients who had confirmed CMV viremia. Six DNA extraction methods were compared for relative yield of viral and cellular DNA: 2 manual solution-based methods (Gentra Puregene, thermal shock), 2 manual silica column-based methods (QIAamp DNA Mini, QIAamp DNA Investigator), and 2 automated methods (M48 MagAttract Mini, QIAcube Investigator). DBS extractions were performed in triplicate followed by real-time quantitative PCR (qPCR). RESULTS For extraction of both viral and cellular DNA, two methods (QIAamp DNA Investigator and thermal shock) consistently gave the highest yields, and two methods (M48 MagAttract Mini and QIAamp DNA Mini) consistently gave the lowest yields. There was an average 3-fold difference in DNA yield between the highest and lowest yield methods. CONCLUSION The choice of DNA extraction method is a major factor in the ability to detect low levels of CMV in DBS and can largely account for the wide range of DBS sensitivities reported in studies to date.
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Affiliation(s)
- D Koontz
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA.
| | - K Baecher
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
| | - M Amin
- Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
| | - S Nikolova
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
| | - M Gallagher
- Newborn Screening and Molecular Biology Branch, Centers for Disease Control and Prevention, 4770 Buford Hwy. NE, Atlanta, GA 30341, USA
| | - S Dollard
- Measles, Mumps, Rubella, and Herpesvirus Laboratory Branch, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA 30329, USA
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The design and evaluation of a shaped filter collection device to sample and store defined volume dried blood spots from finger pricks. Malar J 2015; 14:45. [PMID: 25652763 PMCID: PMC4327959 DOI: 10.1186/s12936-015-0558-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Accepted: 01/10/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Dried blood spots are a common medium for collecting patient blood prior to testing for malaria by molecular methods. A new shaped filter device for the quick and simple collection of a designated volume of patient blood has been designed and tested against conventional blood spots for accuracy and precision. METHODS Shaped filter devices were laser cut from Whatman GB003 paper to absorb a 20 μl blood volume. These devices were used to sample Plasmodium falciparum infected blood and the volume absorbed was measured volumetrically. Conventional blood spots were made by pipetting 20 μl of the same blood onto Whatman 3MM paper. DNA was extracted from both types of dried blood spot using Qiagen DNA blood mini or Chelex extraction for real-time PCR analysis, and PURE extraction for malaria LAMP testing. RESULTS The shaped filter devices collected a mean volume of 21.1 μl of blood, with a coefficient of variance of 8.1%. When used for DNA extraction by Chelex and Qiagen methodologies the mean number of international standard units of P. falciparum DNA recovered per μl of the eluate was 53.1 (95% CI: 49.4 to 56.7) and 32.7 (95% CI: 28.8 to 36.6), respectively for the shaped filter device, and 54.6 (95% CI: 52.1 to 57.1) and 12.0 (95% CI: 9.9 to 14.1), respectively for the 3MM blood spots. Qiagen extraction of 200 μl of whole infected blood yielded 853.6 international standard units of P. falciparum DNA per μl of eluate. CONCLUSIONS A shaped filter device provides a simple way to quickly sample and store a defined volume of blood without the need for any additional measuring devices. Resultant dried blood spots may be employed for DNA extraction using a variety of technologies for nucleic acid amplification without the need for repeated cleaning of scissors or punches to prevent cross contamination of samples and results are comparable to traditional DBS.
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Evaluation of a new protocol for retrospective diagnosis of congenital toxoplasmosis by use of Guthrie cards. J Clin Microbiol 2014; 52:2963-70. [PMID: 24899036 DOI: 10.1128/jcm.00106-14] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
The aim of this study was to assess the diagnostic value of IgM Western blotting (WB), IgA enzyme immunoassay (EIA), and DNA amplification by real-time PCR on Guthrie cards to retrospectively establish the diagnosis of congenital toxoplasmosis (CT). To this purpose, Guthrie cards were collected from 18 infants born to mothers with primary Toxoplasma gondii infection during pregnancy. Moreover, the analytical sensitivity of T. gondii PCR was assessed by testing mock dried blood specimens set up with several known DNA dilutions. IgM WB was demonstrated to be the most sensitive method. When the results of T. gondii DNA detection and specific IgM recovery were combined, retrospective CT diagnosis by using Guthrie cards was established in 3 out of 6 infected infants (sensitivity, 50%; 95% confidence interval, 26.8% to 73.2%). No positive PCR or serologic results were found in the group of 12 uninfected infants, demonstrating the excellent specificity of the three methods (95% confidence interval, 78.1% to 99.5%). The findings of the present study suggest that, in cases of missed diagnosis of CT at birth, analysis of Guthrie cards for children with compatible clinical findings after the perinatal period, in particular the combination of recovery of specific IgM antibodies and T. gondii DNA amplification, could be helpful. Nevertheless, since suboptimal conditions of storage of dried blood specimens can seriously affect sensitivity, negative results cannot rule out CT diagnosis. In contrast, because of the excellent specificity shown by IgM serologic testing and T. gondii DNA amplification on Guthrie cards, positive results obtained by either of the two methods should be considered diagnostic.
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Piccirilli G, Chiereghin A, Gabrielli L, Lazzarotto T. Diagnosis and monitoring of cytomegalovirus infection by the quantification of viral load in dried blood spots samples. Expert Rev Mol Diagn 2014; 14:139-42. [PMID: 24483296 DOI: 10.1586/14737159.2014.883278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cytomegalovirus (CMV) represents the major infectious cause of birth defects, as well as an important pathogen for immune-compromised individuals. Several studies described the use of dried blood spots (DBS) for the detection of CMV DNA for late diagnosis of congenital CMV infection in cases of strong clinical suspicion. In the article under evaluation, Limaye et al. perform for the first time the quantification of CMV in pairs of finger-stick DBS and plasma samples collected from transplant patients. The work concluded that finger-stick DBS could be an alternative sample type for quantification of CMV load that correlates well with plasma levels. Prospective trials to evaluate the use of DBS for monitoring CMV load in transplant recipients will be required.
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Affiliation(s)
- Giulia Piccirilli
- Operative Unit of Clinical Microbiology, St. Orsola-Malpighi General Hospital, University of Bologna , Via Massarenti 9, 40138 Bologna , Italy
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[Can we rule out a congenital cytomegalovirus infection when the result of polymerase chain reaction in dried blood spots is negative?]. Enferm Infecc Microbiol Clin 2013; 32:570-3. [PMID: 24268671 DOI: 10.1016/j.eimc.2013.09.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2013] [Revised: 09/24/2013] [Accepted: 09/27/2013] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The detection of cytomegalovirus (CMV) DNA by real time polymerase chain reaction (rt-PCR) in dried blood spots collected routinely for metabolic screening has been assessed for the retrospective diagnosis of congenital CMV (cCMV) infection in many studies, but not in Spain. The aim of this study is to analyze the diagnostic accuracy of this technique in our hospital. METHODS A cross-sectional retrospective observational study was conducted including all patients born between January, 2007 and September, 2012 with confirmed cCMV infection. The assessment of CMV DNA was made by using rt-PCR in dried blood spots of these patients. RESULTS Fourteen patients were included: 4/14 were symptomatic and 4/14 had sequelae. The detection of CMV DNA by rt-PCR was positive in only 7 patients. A statistically significant relationship between low viral load at birth and negative rt-PCR in dried blood spots was demonstrated. CONCLUSIONS Despite the low number of patients included, our data highlight an important amount of false negative results in the DNA CMV detection by rt-PCR in these samples for the retrospective diagnosis of cCMV infection, especially in cases with low viral load at birth.
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Leruez-Ville M, Ngin S, Guilleminot T, Kfutwah A, Moussa S, Tran T, Nerrienet E. Detection of cytomegalovirus DNA on dried blood spots collected from infants infected with HIV: An in-house method adaptable in resource-limited settings. J Virol Methods 2013; 193:503-7. [DOI: 10.1016/j.jviromet.2013.07.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 07/08/2013] [Accepted: 07/15/2013] [Indexed: 10/26/2022]
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Atkinson C, Emery VC, Griffiths PD. Development of a novel single tube nested PCR for enhanced detection of cytomegalovirus DNA from dried blood spots. J Virol Methods 2013; 196:40-4. [PMID: 24184085 DOI: 10.1016/j.jviromet.2013.10.029] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 10/16/2013] [Accepted: 10/18/2013] [Indexed: 11/27/2022]
Abstract
Newborn screening for congenital cytomegalovirus (CCMV) using dried blood spots (DBS) has been proposed because many developed countries have DBS screening programmes in place for other diseases. The aim of this study was to develop a rapid, single tube nested polymerase chain reaction (PCR) method for enhanced detection of CMV from DBS compared to existing (single target) real time PCRs. The new method was compared with existing real time PCRs for sensitivity and specificity. Overall sensitivity of the single target PCR assays in both asymptomatic and symptomatic infants with laboratory confirmed congenital CMV was 69% (CMV PCR or culture positive before day 21 of life). In contrast, the single tube nested assay had an increased sensitivity of 81% with100% specificity. Overall the assay detected CMV from a DBS equivalent to an original blood sample which contained 500IU/ml. In conclusion this single tube nested methodology allows simultaneous amplification and detection of CMV DNA in 1.5h removing the associated contamination risk of a two step nested PCR. Owing to its increased sensitivity, it has the potential to be used as a screening assay and ultimately allow early identification and intervention for children with congenital CMV.
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Affiliation(s)
- C Atkinson
- Centre for Virology, UCL Medical School, Rowland Hill Street, London NW3 2PF, UK.
| | - V C Emery
- Centre for Virology, UCL Medical School, Rowland Hill Street, London NW3 2PF, UK; Department of Microbial and Cellular Science, University of Surrey, Guildford, UK
| | - P D Griffiths
- Centre for Virology, UCL Medical School, Rowland Hill Street, London NW3 2PF, UK
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Abstract
Toxoplasma gondii, rubella, cytomegalovirus and herpes simplex virus have in common that they can cause congenital (TORCH) infection, leading to fetal and neonatal morbidity and mortality. During the last decades, TORCH screening, which is generally considered to be single serum testing, has been increasingly used inappropriately and questions have been raised concerning the indications and cost-effectiveness of TORCH testing. The problems of TORCH screening lie in requesting the screening for the wrong indications, wrong interpretation of the single serum results and in case there is a good indication for diagnosis of congenital infection, sending in the wrong materials. This review provides an overview of the pathogenesis, epidemiology and clinical consequences of congenital TORCH infections and discusses the indications for, and interpretation of, TORCH screens.
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Affiliation(s)
- Eveline P de Jong
- Department of Paediatrics, Juliana Children’s Hospital, HAGA Hospital, The Hague, The Netherlands
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Ross RS, Stambouli O, Grüner N, Marcus U, Cai W, Zhang W, Zimmermann R, Roggendorf M. Detection of infections with hepatitis B virus, hepatitis C virus, and human immunodeficiency virus by analyses of dried blood spots--performance characteristics of the ARCHITECT system and two commercial assays for nucleic acid amplification. Virol J 2013; 93:309-21. [PMID: 23497102 DOI: 10.1016/j.antiviral.2011.12.011] [Citation(s) in RCA: 106] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Revised: 12/09/2011] [Accepted: 12/19/2011] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Nowadays, dried blood spots (DBS) are primarily used to obtain diagnostic access to risk collectives such as intravenous drug users, who are prone to infections with hepatitis B virus (HBV), hepatitis C virus (HCV), and human immunodeficiency virus (HIV). Before DBS analyses can be used in this diagnostic context, however, a comprehensive evaluation of its performance characteristics must be conducted. To the best of our knowledge, the current study presents for the first time such essential data for the Abbott ARCHITECT system, which is currently the worldwide leading platform in this field of infection diagnostics. METHODS The investigation comprised 1,762 paired serum/DBS samples and a total of 3,524 determinations with the Abbott ARCHITECT HBsAg, anti-HBc, anti-HBs, anti-HCV and HIV-1-p24-antigen/anti-HIV 1/2 assays as well as with the artus HBV LC PCR and VERSANT HCV RNA qualitative (TMA) tests. RESULTS In the context of DBS testing, a specificity of 100% was recorded for the seven serological and molecular biological assays. The analytical sensitivity of HBsAg, anti-HBc, anti-HBs, anti-HCV, HIV-1-p24-antigen/anti-HIV 1/2, HBV DNA, and HCV RNA detections in DBS eluates was 98.6%, 97.1%, 97.5%, 97.8%, 100%, 93%, and 100%, respectively. DISCUSSION/CONCLUSIONS The results obtained indicate that it is today possible to reliably detect HBsAg, anti-HBc, anti-HBs, anti-HCV and HIV-1-p24 antigen/anti-HIV 1/2 with state-of-the-art analytical systems such as the Abbott ARCHITECT in DBS eluates even when a comparatively high elution volume of 1,000 μl is used. They also provide evidence for the inherent analytical limits of DBS testing, which primarily concern the anti-HBc/anti-HBs system for individuals with HIV infections and nucleic acid tests with relatively low analytical sensitivity.
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Affiliation(s)
- R Stefan Ross
- Institute of Virology, National Reference Centre for Hepatitis C, University Hospital Essen, University of Duisburg-Essen, Essen, Germany.
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Abstract
Since thermostable Taq DNA polymerase was discovered in 1987, nucleic acid amplification techniques have made great strides and contributed greatly to progress in the life sciences. These techniques were introduced into the clinical laboratory and have produced great changes in diagnostic tools and tests. In particular, there have been many innovative molecular testing developments in the field of diagnostic microbiology.
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Manicklal S, Emery VC, Lazzarotto T, Boppana SB, Gupta RK. The "silent" global burden of congenital cytomegalovirus. Clin Microbiol Rev 2013; 26:86-102. [PMID: 23297260 PMCID: PMC3553672 DOI: 10.1128/cmr.00062-12] [Citation(s) in RCA: 662] [Impact Index Per Article: 60.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Human cytomegalovirus (CMV) is a leading cause of congenital infections worldwide. In the developed world, following the virtual elimination of circulating rubella, it is the commonest nongenetic cause of childhood hearing loss and an important cause of neurodevelopmental delay. The seroprevalence of CMV in adults and the incidence of congenital CMV infection are highest in developing countries (1 to 5% of births) and are most likely driven by nonprimary maternal infections. However, reliable estimates of prevalence and outcome from developing countries are not available. This is largely due to the dogma that maternal preexisting seroimmunity virtually eliminates the risk for sequelae. However, recent data demonstrating similar rates of sequelae, especially hearing loss, following primary and nonprimary maternal infection have underscored the importance of congenital CMV infection in resource-poor settings. Although a significant proportion of congenital CMV infections are attributable to maternal primary infection in well-resourced settings, the absence of specific interventions for seronegative mothers and uncertainty about fetal prognosis have discouraged routine maternal antibody screening. Despite these challenges, encouraging results from prototype vaccines have been reported, and the first randomized phase III trials of prenatal interventions and prolonged postnatal antiviral therapy are under way. Successful implementation of strategies to prevent or reduce the burden of congenital CMV infection will require heightened global awareness among clinicians and the general population. In this review, we highlight the global epidemiology of congenital CMV and the implications of growing knowledge in areas of prevention, diagnosis, prognosis, and management for both low (50 to 70%)- and high (>70%)-seroprevalence settings.
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Affiliation(s)
- Sheetal Manicklal
- Division of Medical Virology, Department of Clinical Laboratory Sciences, National Health Laboratory Service, Groote Schuur Hospital/University of Cape Town, Cape Town, South Africa
| | - Vincent C. Emery
- Division of Infection and Immunity, University College London, London, United Kingdom
| | - Tiziana Lazzarotto
- Operative Unit of Microbiology, St. Orsola Malpighi General Hospital/University of Bologna, Bologna, Italy
| | - Suresh B. Boppana
- Pediatrics and Microbiology, University of Alabama School of Medicine, Birmingham, Alabama, USA
| | - Ravindra K. Gupta
- Division of Infection and Immunity, University College London, London, United Kingdom
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de Vries JJC, Vesseur A, Rotteveel LJC, Korver AMH, Rusman LG, Wessels E, Kroes ACM, Mylanus EA, Oudesluys-Murphy AM, Frijns JHM, Vossen ACTM. Cytomegalovirus DNA detection in dried blood spots and perilymphatic fluids from pediatric and adult cochlear implant recipients with prelingual deafness. J Clin Virol 2012; 56:113-7. [PMID: 23141930 DOI: 10.1016/j.jcv.2012.10.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Accepted: 10/17/2012] [Indexed: 12/01/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is the leading cause of non-genetic congenital hearing loss. The contribution of congenital CMV to prelingual deafness and the pathophysiology is largely unknown. OBJECTIVE (1) To analyze the prevalence of congenital CMV among cochlear implant (CI) recipients with prelingual deafness. (2) To genotype CMV present in dried blood spots (DBS) and in the inner ear years after birth. STUDY DESIGN Children and adults with prelingual deafness who received a CI in 2010-2011 were included prospectively. Perilymphatic fluids were collected during CI surgery and, in the pediatric cases, DBS were retrieved for CMV DNA detection. Furthermore, a cohort of children with prelingual deafness who received a CI between 2003 and 2008 were included retrospectively. CMV detection in DBS and perilymph was followed by gB and gH genotyping. RESULTS Seventysix pediatric CI recipients were included. Seventy DBS were tested for CMV DNA, resulting in a prevalence of congenital CMV of 14% (10/70). Perilymphatic fluid was available from 29 pediatric CI recipients. One perilymph fluid, of a 21-month old girl with congenital CMV, asymptomatic at birth, was CMV DNA positive. The CMV strain in the perilymph was genotypically identical to the strain present in her DBS (gB1/gH2). Perilymph samples from 21 adult CI recipients were CMV DNA negative. CONCLUSIONS Our study stresses the important contribution of congenital CMV among pediatric CI recipients. Furthermore, our genotyping data support the hypothesis that CMV-related hearing loss is associated with ongoing viral replication in the inner ear up to years after birth.
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Affiliation(s)
- Jutte J C de Vries
- Department of Medical Microbiology, Leiden University Medical Center, Leiden, The Netherlands.
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Lang PO, Govind S, Dramé M, Aspinall R. Comparison of manual and automated DNA purification for measuring TREC in dried blood spot (DBS) samples with qPCR. J Immunol Methods 2012; 384:118-27. [DOI: 10.1016/j.jim.2012.07.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 07/24/2012] [Accepted: 07/24/2012] [Indexed: 12/16/2022]
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Forman M, Valsamakis A, Arav-Boger R. Dried urine spots for detection and quantification of cytomegalovirus in newborns. Diagn Microbiol Infect Dis 2012; 73:326-9. [PMID: 22658885 DOI: 10.1016/j.diagmicrobio.2012.04.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Revised: 04/20/2012] [Accepted: 04/26/2012] [Indexed: 10/28/2022]
Abstract
Dried urine spots (DUS) have been reported to provide a simple screening tool for congenital cytomegalovirus (CMV) infection. We developed a standardized method for CMV quantification from DUS. Two applications of 20 μL urine remained within the rim of the filter paper disc and were used to determine the analytical performance of Towne CMV spiked into urine and applied on the discs. The measurable range spanned 3.7 to ≥8.0 log(10) copies/mL. The detection limit was 22 DNA copies/disc. Urine samples from congenitally infected newborns and negative controls were either diluted 1:10 or applied on filter paper at the same volume. DNA copy number from DUS correlated well with copy number from 1:10 diluted urine, although there was a trend for lower levels from DUS (0.3 log(10) difference). Our standardized method for CMV detection and quantification may facilitate CMV studies in resource-limited areas and allow for longitudinal monitoring of viral loads in treated infants.
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Affiliation(s)
- Michael Forman
- Department of Pathology, Johns Hopkins Medical Institutions, Baltimore, MD, USA
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Stevens DS, Crudder CH, Domingo GJ. Post-extraction stabilization of HIV viral RNA for quantitative molecular tests. J Virol Methods 2012; 182:104-10. [PMID: 22433512 DOI: 10.1016/j.jviromet.2012.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2011] [Revised: 02/13/2012] [Accepted: 03/05/2012] [Indexed: 11/19/2022]
Abstract
Two approaches to stabilize viral nucleic acid in processed clinical specimens were evaluated. HIV-1 RNA extracted from clinical specimens was stabilized in a dry matrix in a commercial product (RNAstable, Biomatrica, San Diego, CA, USA) and in a reverse-transcription reaction mixture in liquid form as cDNA. As few as 145 HIV-1 genome copies of viral RNA are reliably stabilized by RNAstable at 45°C for 92 days and in the cDNA format at 45°C for 7 days as determined by real-time PCR. With RNAstable the R(2) at days 1, 7, and 92 were 0.888, 0.871, and 0.943 when compared to baseline viral load values. The cDNA generated from the same clinical specimens was highly stable with an R(2) value of 0.762 when comparing viral load determinations at day 7 to baseline values. In conclusion viral RNA stabilized in a dry RNAstable matrix is highly stable for long periods of time at high temperatures across a substantial dynamic range. Viral RNA signal can also be stabilized in liquid in the form of cDNA for limited periods of time. Methods that reduce reliance on the cold chain and preserve specimen integrity are critical for extending the reach of molecular testing to low-resource settings. Products based on anhydrobiosis, such as the RNAstable should be evaluated further to support viral pathogen diagnosis.
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de Vries JJC, Barbi M, Binda S, Claas ECJ. Extraction of DNA from dried blood in the diagnosis of congenital CMV infection. Methods Mol Biol 2012; 903:169-75. [PMID: 22782817 DOI: 10.1007/978-1-61779-937-2_10] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Viral DNA detection in dried blood spotted on filter paper, dried blood spots (DBS), is valuable in the diagnosis of viral infections, with at the moment congenital cytomegalovirus (CMV) being the most common application. CMV detection in clinical samples taken within the first 2-3 weeks after birth differentiates congenital CMV infection from the in general harmless postnatal acquired cytomegalovirus infection. DBS render the possibility to diagnose congenital CMV infection retrospectively, e.g., when late-onset hearing loss, the most frequently encountered symptom of congenital CMV infection, becomes manifest. Additionally, CMV DNA detection in DBS can be of usage in recently advocated newborn screening on congenital CMV infection. The procedure of CMV DNA detection in DBS consists of two separate steps: (1) DNA extraction from the DBS, followed by (2) CMV DNA amplification. Here, we describe two efficient methods for the extraction of DNA from DBS. Sensitivity, specificity, and applicability of the methods for high-throughput usage are discussed.
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Affiliation(s)
- Jutte J C de Vries
- Department of Medical Microbiology, Clinical Microbiological Laboratory, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
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de Vries JJC, van der Eijk AA, Wolthers KC, Rusman LG, Pas SD, Molenkamp R, Claas EC, Kroes ACM, Vossen ACTM. Real-time PCR versus viral culture on urine as a gold standard in the diagnosis of congenital cytomegalovirus infection. J Clin Virol 2011; 53:167-70. [PMID: 22177273 DOI: 10.1016/j.jcv.2011.11.006] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 11/09/2011] [Accepted: 11/16/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Cytomegalovirus (CMV) infection is the most common cause of congenital infection. Whereas CMV PCR has replaced viral culture and antigen detection in immunocompromised patients because of higher sensitivity, viral culture of neonatal urine is still referred to as the gold standard in the diagnosis of congenital CMV infection. OBJECTIVE To compare real-time CMV PCR with shell vial culture on urine in the diagnosis of congenital CMV, in a multicenter design. STUDY DESIGN A series of neonatal urines (n=340), received for congenital CMV diagnostics and routinely assessed with shell vial CMV culture, was retrospectively tested by real-time CMV PCR. RESULTS The proportion of newborns found to be congenitally infected by real-time CMV PCR was 8.2% (28/340, 95%CI 5.6-11.8%), and 7.4% (25/340, 95%CI 4.9-10.8%) by rapid culture. When considering rapid culture as reference, real-time PCR was highly sensitive (100%), whereas sensitivity of rapid culture was 89.3% when considering real-time PCR as reference. CONCLUSIONS Our results, supported by analytical and clinical data on CMV DNA detection in neonatal urine, suggest enhanced sensitivity of recent PCR techniques when compared to viral culture. There is considerable rationale to favor real-time CMV PCR as a gold standard in the diagnosis of congenital CMV infection. A large-scale study combining both laboratory and clinical data is required to determine the exact time frame for sampling of neonatal urine when using real-time PCR.
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Affiliation(s)
- Jutte J C de Vries
- Department of Medical Microbiology, Leiden University Medical Center, P.O. Box 9600, 2300 RC Leiden, The Netherlands.
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Rapid genotyping of cytomegalovirus in dried blood spots by multiplex real-time PCR assays targeting the envelope glycoprotein gB and gH genes. J Clin Microbiol 2011; 50:232-7. [PMID: 22116158 DOI: 10.1128/jcm.05253-11] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Genotyping of cytomegalovirus (CMV) is useful to examine potential differences in the pathogenicity of strains and to demonstrate coinfection with multiple strains involved in CMV disease in adults and congenitally infected newborns. Studies on genotyping of CMV in dried blood spots (DBS) are rare and have been hampered by the small amount of dried blood available. In this study, two multiplex real-time PCR assays for rapid gB and gH genotyping of CMV in DBS were developed. Validation of the assays with 39 CMV-positive plasma samples of transplant recipients and 21 urine specimens of congenitally infected newborns was successful in genotyping 100% of the samples, with gB1 and gB3 being the most prevalent genotypes. Multiple gB and gH genotypes were detected in 36% and 33% of the plasma samples, respectively. One urine sample from a newborn with symptomatic congenital CMV was positive for gB1 and gB2. DBS of congenitally infected newborns (n = 41) were tested using 9 μl of dried blood, and genotypes were detected in 81% (gB) and 73% (gH) of the samples, with gB3 being the most prevalent genotype. No clear association of specific genotypes with clinical outcome was observed. In conclusion, the CMV gB and gH PCR assays were found to be rapid, sensitive for detecting mixed infections, and suitable for direct usage on DBS. These assays are efficient tools for genotyping of CMV in DBS of congenitally infected newborns.
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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.
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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
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