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Pesch MH, Leung J, Lanzieri TM, Tinker SC, Rose CE, Danielson ML, Yeargin-Allsopp M, Grosse SD. Autism Spectrum Disorder Diagnoses and Congenital Cytomegalovirus. Pediatrics 2024; 153:e2023064081. [PMID: 38808409 PMCID: PMC11153325 DOI: 10.1542/peds.2023-064081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2023] [Revised: 03/19/2024] [Accepted: 03/21/2024] [Indexed: 05/30/2024] Open
Abstract
OBJECTIVE To examine the association between congenital cytomegalovirus (cCMV) and autism spectrum disorder (ASD) administrative diagnoses in US children. METHODS Cohort study using 2014 to 2020 Medicaid claims data. We used diagnosis codes to identify cCMV (exposure), ASD (outcome), and covariates among children enrolled from birth through ≥4 to <7 years. Covariates include central nervous system (CNS) anomaly or injury diagnosis codes, including brain anomaly, microcephaly within 45 days of birth, cerebral palsy, epilepsy, or chorioretinitis. We used Cox proportional hazards regression models to estimate hazard ratios and 95% confidence intervals, overall and stratified by sex, birth weight and gestational age outcome (low birth weight or preterm birth), and presence of CNS anomaly or injury. RESULTS Among 2 989 659 children, we identified 1044 (3.5 per 10 000) children with cCMV and 74 872 (25.0 per 1000) children with ASD. Of those with cCMV, 49% also had CNS anomaly or injury diagnosis codes. Children with cCMV were more likely to have ASD diagnoses (hazard ratio: 2.5; 95% confidence interval: 2.0-3.2, adjusting for birth year, sex, and region). This association differed by sex and absence of CNS anomaly or injury but not birth outcome. CONCLUSIONS Children with (versus without) cCMV diagnoses in Medicaid claims data, most of whom likely had symptomatic cCMV, were more likely to have ASD diagnoses. Future research investigating ASD risk among cohorts identified through universal cCMV screening may help elucidate these observed associations.
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Affiliation(s)
- Megan H. Pesch
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan, Ann Arbor, Michigan
| | - Jessica Leung
- National Center for Immunization and Respiratory Diseases
| | | | - Sarah C. Tinker
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Charles E. Rose
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Melissa L. Danielson
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marshalyn Yeargin-Allsopp
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Scott D. Grosse
- National Center on Birth Defects and Developmental Disabilities, Centers for Disease Control and Prevention, Atlanta, Georgia
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2
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Nyakonda CN, Wedderburn CJ, Williams SR, Stein DJ, Donald KA. Understanding the impact of congenital infections and perinatal viral exposures on the developing brain using white matter magnetic resonance imaging: a scoping review. BMC Med Imaging 2024; 24:119. [PMID: 38783187 PMCID: PMC11119575 DOI: 10.1186/s12880-024-01282-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 04/24/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Magnetic Resonance Imaging (MRI)-based imaging techniques are useful for assessing white matter (WM) structural and microstructural integrity in the context of infection and inflammation. The purpose of this scoping review was to assess the range of work on the use of WM neuroimaging approaches to understand the impact of congenital and perinatal viral infections or exposures on the developing brain. METHODS This scoping review was conducted according to the Arksey and O' Malley framework. A literature search was performed in Web of Science, Scopus and PubMed for primary research articles published from database conception up to January 2022. Studies evaluating the use of MRI-based WM imaging techniques in congenital and perinatal viral infections or exposures were included. Results were grouped by age and infection. RESULTS A total of 826 articles were identified for screening and 28 final articles were included. Congenital and perinatal infections represented in the included studies were cytomegalovirus (CMV) infection (n = 12), human immunodeficiency virus (HIV) infection (n = 11) or exposure (n = 2) or combined (n = 2), and herpes simplex virus (HSV) infection (n = 1). The represented MRI-based WM imaging methods included structural MRI and diffusion-weighted and diffusion tensor MRI (DWI/ DTI). Regions with the most frequently reported diffusion metric group differences included the cerebellar region, corticospinal tract and association fibre WM tracts in both children with HIV infection and children who are HIV-exposed uninfected. In qualitative imaging studies, WM hyperintensities were the most frequently reported brain abnormality in children with CMV infection and children with HSV infection. CONCLUSION There was evidence that WM imaging techniques can play a role as diagnostic and evaluation tools assessing the impact of congenital infections and perinatal viral exposures on the developing brain. The high sensitivity for identifying WM hyperintensities suggests structural brain MRI is a useful neurodiagnostic modality in assessing children with congenital CMV infection, while the DTI changes associated with HIV suggest metrics such as fractional anisotropy have the potential to be specific markers of subtle impairment or WM damage in neuroHIV.
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Affiliation(s)
- Charmaine Natasha Nyakonda
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Capetown, South Africa.
| | - Catherine J Wedderburn
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
- Neuroscience Institute, University of Cape Town, Capetown, South Africa
| | - Simone R Williams
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Capetown, South Africa
| | - Dan J Stein
- Department of Psychiatry and Mental Health and Neuroscience Institute, University of Cape Town, Cape Town, South Africa
- MRC Unit of Risk and Resilience, University of Cape Town, Cape Town, South Africa
- Neuroscience Institute, University of Cape Town, Capetown, South Africa
| | - Kirsten A Donald
- Department of Paediatrics and Child Health, Red Cross War Memorial Children's Hospital, University of Cape Town, Cape Town, South Africa.
- Neuroscience Institute, University of Cape Town, Capetown, South Africa.
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3
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Sanami S, Shamsabadi S, Dayhimi A, Pirhayati M, Ahmad S, Pirhayati A, Ajami M, Hemati S, Shirvani M, Alagha A, Abbarin D, Alizadeh A, Pazoki-Toroudi H. Association between cytomegalovirus infection and neurological disorders: A systematic review. Rev Med Virol 2024; 34:e2532. [PMID: 38549138 DOI: 10.1002/rmv.2532] [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: 01/30/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 04/02/2024]
Abstract
Cytomegalovirus (CMV) belongs to the Herpesviridae family and is also known as human herpesvirus type 5. It is a common virus that usually doesn't cause any symptoms in healthy individuals. However, once infected, the virus remains in the host's body for life and can reactivate when the host's immune system weakens. This virus has been linked to several neurological disorders, including Alzheimer's disease, Parkinson's disease, Autism spectrum disorder, Huntington's disease (HD), ataxia, Bell's palsy (BP), and brain tumours, which can cause a wide range of symptoms and challenges for those affected. CMV may influence inflammation, contribute to brain tissue damage, and elevate the risk of moderate-to-severe dementia. Multiple studies suggest a potential association between CMV and ataxia in various conditions, including Guillain-Barré syndrome, chronic inflammatory demyelinating polyneuropathy, acute cerebellitis, etc. On the other hand, the evidence regarding CMV involvement in BP is conflicting, and also early indications of a link between CMV and HD were challenged by subsequent research disproving CMV's presence. This systematic review aims to comprehensively investigate any link between the pathogenesis of CMV and its potential role in neurological disorders and follows the preferred reporting items for systematic review and meta-analysis checklist. Despite significant research into the potential links between CMV infection and various neurological disorders, the direct cause-effect relationship is not fully understood and several gaps in knowledge persist. Therefore, continued research is necessary to gain a better understanding of the role of CMV in neurological disorders and potential treatment avenues.
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Affiliation(s)
- Samira Sanami
- Abnormal Uterine Bleeding Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Shahnam Shamsabadi
- Department of Physiology, Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Amir Dayhimi
- Department of Physiology, Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Pirhayati
- Psychiatric Department, Rasool Akram Hospital, Iran University of Medical Science, Tehran, Iran
| | - Sajjad Ahmad
- Department of Health and Biological Sciences, Abasyn University, Peshawar, Pakistan
- Department of Computer Sciences, Virginia Tech, Blacksburg, Virginia, USA
- Gilbert and Rose-Marie Chagoury School of Medicine, Lebanese American University, Beirut, Lebanon
| | | | - Marjan Ajami
- National Nutrition and Food Technology Research Institute, School of Nutrition Sciences and Food Technology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Sara Hemati
- Department of Environmental Health Engineering, School of Health, Shahrekord University of Medical Sciences, Shahrekord, Iran
| | - Masoud Shirvani
- Department of Neurosurgery, Salamat-Farda Hospital, Tehran, Iran
| | - Ahmad Alagha
- Department of Neurosurgery, Salamat-Farda Hospital, Tehran, Iran
| | - Davood Abbarin
- Department of Neurosurgery, Salamat-Farda Hospital, Tehran, Iran
| | - Akram Alizadeh
- Nervous System Stem Cells Research Center, Semnan University of Medical Sciences, Semnan, Iran
| | - Hamidreza Pazoki-Toroudi
- Department of Physiology, Physiology Research Center, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
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4
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Diaz-Decaro J, Myers E, Mucha J, Neumann M, Lewandowski W, Kaczanowska M, Schmidt E, Natenshon A, Talarico C, Buck PO. A systematic literature review on the humanistic burden of cytomegalovirus. Curr Med Res Opin 2023; 39:739-750. [PMID: 36938652 DOI: 10.1080/03007995.2023.2191477] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Cytomegalovirus (CMV) infection is typically asymptomatic in healthy individuals; however, certain populations are vulnerable to infection and may develop serious sequelae. CMV infection may also have a broad impact on humanistic outcomes, including patient health status and quality of life (QoL). We conducted a systematic literature review (SLR) to describe the global humanistic burden of CMV and congenital CMV (cCMV) infections across all age groups. METHODS Medline, Embase, and LILACS were searched to identify studies on humanistic outcomes following CMV infection, including health status/QoL and any outcomes in domains such as auditory, cognitive ability, developmental status, intelligence, language, memory, mental health, motor performance, social communication, speech, and vocabulary. The SLR included articles published from 2000-2020 and focused geographically on Australia, Europe, Israel, Japan, Latin America, and North America. RESULTS Sixty-three studies met the inclusion criteria. In general, individuals with symptomatic cCMV infection experience a greater burden of disease and more substantial impact on QoL versus those with asymptomatic cCMV infection. Children with hearing loss due to cCMV infection, both symptomatic and asymptomatic, showed improved auditory outcomes following cochlear implantation. Newborns, infants, and children with cCMV infections had worse cognitive outcomes in psychological development, sequential and simultaneous processing, phonological working memory, and attention control versus age-matched controls without cCMV infection. CMV infection was also associated with cognitive decline in elderly populations. CONCLUSIONS CMV infection can have substantial, lifelong, heterogenous impacts on humanistic outcomes, including health status and QoL, which should be considered when developing and implementing treatment and prevention strategies.
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Affiliation(s)
| | - Evan Myers
- Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, USA
| | | | | | - Witold Lewandowski
- Certara, Inc., Krakow, Poland
- Certara, Inc., employee at the time of the study
| | | | | | | | - Carla Talarico
- Moderna, Inc., Cambridge, MA, USA
- Moderna, Inc., employee at the time of the study
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5
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Natsume T, Inaba Y, Osawa Y, Fukuyama T. High Incidence of Hippocampal Abnormalities in Pediatric Patients with Congenital Cytomegalovirus Infection. Neuropediatrics 2022; 53:239-245. [PMID: 35098496 PMCID: PMC9444318 DOI: 10.1055/a-1754-1142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection exhibits polymicrogyria, intracranial calcification, white matter lesions, and several types of intracranial lesions on magnetic resonance imaging (MRI), in addition to various developmental disorders and epilepsies. However, little is known on the presence of hippocampal abnormality in this affliction. The aim of this study is to clarify the incidence of hippocampal abnormality in congenital CMV infection. METHODS Seventeen children diagnosed as having congenital CMV infection along with 17 age-matched pediatric controls were retrospectively evaluated by brain MRI and clinical review. The measurement data were obtained from conventional coronal sections in this retrospective study. Hippocampal malrotation (HIMAL) was defined as a hippocampal diameter ratio (i.e., the ratio of the height and width of the hippocampus) of >0.92. RESULTS Hippocampal diameter ratios were significantly higher in the congenital CMV infection group (0.99 [range: 0.70-1.58] on the right side and 0.85 [range: 0.66-1.39] on the left side) than in controls (0.71 [range: 0.58-0.91] and 0.70 [range: 0.50-1.00], respectively). HIMAL was present in 17 of 34 hippocampi (50%) in the congenital CMV infection group and 1 of 34 hippocampi (2.9%) in controls. No correlations were detected between HIMAL and intelligence quotient/developmental quotient or the occurrences of autism spectrum disorder or epilepsy. CONCLUSION This study is the first to demonstrate the incidence of hippocampal abnormality to be significantly higher in congenital CMV infection patients than in age-matched controls. Further study is necessary to clarify the associations of HIMAL with other clinical and developmental features.
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Affiliation(s)
- Takenori Natsume
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Yuji Inaba
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan,Division of Neuropediatrics, Nagano Children's Hospital, Azumino, Japan,Life Science Research Center, Nagano Children's Hospital, Azumino, Japan,Address for correspondence Yuji Inaba, MD, PhD Division of Neuropediatrics, Nagano Children's Hospital3100 Toyoshina, Azumino 399-8288Japan
| | - Yoshihiro Osawa
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan
| | - Tetsuhiro Fukuyama
- Department of Pediatrics, Shinshu University School of Medicine, Matsumoto, Japan,Tetsuhiro Fukuyama, MD, PhD Department of Pediatrics, Shinshu University School of Medicine3-1-1 Asahi, Matsumoto 390-8621Japan
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6
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Cushing SL, Purcell PL, Papaiaonnou V, Neghandi J, Daien M, Blaser SI, Ertl-Wagner B, Wagner M, Sheng M, James AL, Bitnun A, Papsin BC, Gordon KA. Hearing Instability in Children with Congenital Cytomegalovirus: Evidence and Neural Consequences. Laryngoscope 2022; 132 Suppl 11:S1-S24. [PMID: 35302239 DOI: 10.1002/lary.30108] [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: 05/04/2021] [Revised: 02/05/2022] [Accepted: 03/03/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE/HYPOTHESIS Sensorineural hearing loss (SNHL) is a common sequela of congenital cytomegalovirus (cCMV), potentially exacerbating neurocognitive delay. The objectives of this study were to assess: (1) age at which SNHL in children with cCMV; (2) stimulability of the auditory system in children with cCMV following cochlear implantation (CI); and (3) whether features of magnetic resonance imaging (MRI) potentially are predictive of hearing outcomes. METHODS In this retrospective study of a prospectively acquired cohort, 123 children with cCMV who were referred for hearing loss at a single tertiary referral hospital over 20 years were compared with an unmatched comparative group of 90 children with GJB2-related deafness. Outcome measures were results of newborn hearing screening (NHS), behavioral audiograms, and, in a subgroup of cochlear implant (CI) users, responses from the auditory nerve and brainstem evoked by CI at initial activation, as well as lesional volume of FLAIR-hyperintense signal alterations on MRI. RESULTS All but 3 of 123 children with cCMV had confirmed and persistent SNHL. At birth, 113 children with cCMV underwent NHS, 31 (27%) passed in both ears and 23 (20%) passed in one ear (no NHS data in 10 children). At the first audiologic assessment, 32 of 123 (26%) had normal hearing bilaterally; 35 of 123 (28%) had unilateral SNHL; and 57 of 123 (46%) had bilateral SNHL. More than half (67 of 123, 54%) experienced hearing deterioration in at least one ear. Survival analyses suggested that 60% of children who developed SNHL did so by 2.5 years and 80% by 5 years. In the children who passed NHS in one or both ears, 50% developed hearing loss by 3.5 years in the ear, which passed unilaterally (n = 23 ears), and 50% by 5 years in bilateral passes (n = 62 ears). Hearing loss was significant enough in all but one child with isolated high-frequency loss for rehabilitation to be indicated. Hearing thresholds in individual ears were in the CI range in 83% (102 of 123), although duration of deafness was sufficient to preclude implantation at our center in 13 children with unilateral SNHL. Hearing aids were indicated in 16% (20 of 123). Responses from the auditory nerve and brainstem to initial CI stimulation were similar in children with cCMV-related SNHL compared with GJB2-related SNHL. Characteristic white matter changes on MRI were seen in all children with cCMV-related SNHL (n = 91), but the lesion volume in each cortical hemisphere did not predict degree of SNHL. CONCLUSIONS cCMV-related SNHL is often not detected by NHS but occurs with high prevalence in early childhood. Electrophysiological measures suggest equivalent stimulability of the auditory nerve and brainstem with CI in children with cCMV and GJB2-related SNHL. Hyperintense white matter lesions on FLAIR MRI are consistently present in children with cCMV-related SNHL but cannot be used to predict its time course or degree. Combined, the data show early and rapid deterioration of hearing in children with cCMV-related SNHL with potential for good CI outcomes if SNHL is identified and managed without delay. Findings support universal newborn screening for cCMV followed by careful audiological monitoring. LEVEL OF EVIDENCE 3 Laryngoscope, 2022.
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Affiliation(s)
- Sharon L Cushing
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Patricia L Purcell
- C.S. Mott Children's Hospital, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Vicky Papaiaonnou
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jaina Neghandi
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Maya Daien
- Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Susan I Blaser
- Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Birgit Ertl-Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Matthias Wagner
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Min Sheng
- Department of Diagnostic Imaging, Division of Paediatric Neuroradiology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Adrian L James
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics (Infectious Diseases), University of Toronto, Toronto, Ontario, Canada
| | - Blake C Papsin
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Karen A Gordon
- Department of Otolaryngology: Head & Neck Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Otolaryngology: Head & Neck Surgery, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Archie's Cochlear Implant Laboratory, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Communication Disorders, Hospital for Sick Children, Toronto, Ontario, Canada
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7
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Escobar Castellanos M, de la Mata Navazo S, Carrón Bermejo M, García Morín M, Ruiz Martín Y, Saavedra Lozano J, Miranda Herrero MC, Barredo Valderrama E, Castro de Castro P, Vázquez López M. Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection. Neurologia 2022; 37:122-129. [PMID: 30857789 DOI: 10.1016/j.nrl.2018.11.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 11/01/2018] [Accepted: 11/15/2018] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AIM The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. PATIENTS AND METHODS We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola' scale. Imaging findings were compared with neurological alterations in the patients' most recent follow-up evaluation at the paediatric neurology department. RESULTS Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P=.04) and 10 had neurological impairment (P=.008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P<.001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola' scale values >2 were correlated with psychomotor retardation (P<.001). CONCLUSIONS Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.
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Affiliation(s)
- M Escobar Castellanos
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España.
| | - S de la Mata Navazo
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - M Carrón Bermejo
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - M García Morín
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - Y Ruiz Martín
- Sección de Radiología, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - J Saavedra Lozano
- Sección de Infectología, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - M C Miranda Herrero
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - E Barredo Valderrama
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - P Castro de Castro
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
| | - M Vázquez López
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, España
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8
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Namiki T, Takano C, Aoki R, Trinh QD, Morioka I, Hayakawa S. Parenchymal calcification is associated with the neurological prognosis in patients with congenital rubella syndrome. Congenit Anom (Kyoto) 2022; 62:38-41. [PMID: 34396588 DOI: 10.1111/cga.12442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/29/2021] [Accepted: 07/20/2021] [Indexed: 11/26/2022]
Abstract
Congenital rubella syndrome (CRS) results from maternal rubella virus infection in early pregnancy. Abnormal neuroimaging findings have been analyzed in a small number of CRS patients in the past; however, their clinical significance has been poorly addressed. Therefore, we have investigated the neuroimaging findings of 31 patients with CRS from previous studies. The most common finding was parenchymal calcification, which was observed in 18 of 31 patients (58.1%). A multivariable logistic regression model showed that it was associated with psychomotor or mental retardation (p = 0.018), suggesting that parenchymal calcification in CRS could be a prognostic factor.
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Affiliation(s)
| | - Chika Takano
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan.,Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Ryoji Aoki
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Quang Duy Trinh
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
| | - Ichiro Morioka
- Department of Pediatrics and Child Health, Nihon University School of Medicine, Tokyo, Japan
| | - Satoshi Hayakawa
- Division of Microbiology, Department of Pathology and Microbiology, Nihon University School of Medicine, Tokyo, Japan
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9
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Gorenstein L, Katorza E, Bar-Yosef O, Hoffmann C, Shrot S. Quantitative and qualitative analysis of fetal temporal lobe T2 signal in cytomegalovirus infected fetuses and normal controls. Quant Imaging Med Surg 2021; 11:4399-4407. [PMID: 34603994 DOI: 10.21037/qims-21-22] [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: 01/07/2021] [Accepted: 05/11/2021] [Indexed: 11/06/2022]
Abstract
Background Temporal lobe T2 hyperintensity has been described in association with prenatal cytomegalovirus (CMV) infection on fetal MRI. However, these findings are often perplexing with high inter-observer variability. Our objective was to evaluate temporal lobe T2 signal quantitatively in prenatal CMV infection. Methods In this retrospective study, 119 fetuses, of which 51 fetuses with suspected CMV exposure (29-36 weeks of gestation) based on maternal seroconversion and age-matched 68 normal controls, were included. Mean and maximal temporal lobe T2 signal were evaluated quantitatively by measuring the T2 signal in the temporal lobes relative to the amniotic fluid's signal. Intra-observer, inter-observer variability and diagnostic performance were assessed. The occurrence of neonatal sensorineural hearing loss (SNHL) was recorded. Results Relative temporal lobe T2 signal did not change along with the examined gestational age. Of our suspected CMV cohort, 29 fetuses were positive for fetal CMV infection on polymerase chain reaction (PCR) analysis. There were no statistically significant differences in the relative mean or maximal temporal lobes T2 signal between CMV positive, CMV negative fetuses, or normal controls. No correlation was found between neonatal SNHL and temporal lobe T2 signal. Conclusions When temporal lobe T2 signal is analyzed quantitatively, CMV infected fetuses do not present an increased signal than age-matched controls. Thus, reported subjective temporal T2 hyperintensities should be interpreted carefully and should have a limited effect on pregnancy management, especially as an isolated finding. Our study illustrates the importance of quantitative imaging in diagnostic neuroradiology.
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Affiliation(s)
- Larisa Gorenstein
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eldad Katorza
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Antenatal Diagnostic Unit, Sheba Medical Center, Ramat-Gan, Israel
| | - Omer Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.,Pediatric Neurology Unit, Edmond and Lily Safra Children's Hospital, Sheba Medical Center, Ramat-Gan, Israel
| | - Chen Hoffmann
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Shai Shrot
- Section of Neuroradiology, Division of Diagnostic Imaging, Sheba Medical Center, Ramat-Gan, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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10
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Escobar Castellanos M, de la Mata Navazo S, Carrón Bermejo M, García Morín M, Ruiz Martín Y, Saavedra Lozano J, Miranda Herrero MC, Barredo Valderrama E, Castro de Castro P, Vázquez López M. Association between neuroimaging findings and neurological sequelae in patients with congenital cytomegalovirus infection. NEUROLOGÍA (ENGLISH EDITION) 2021; 37:122-129. [PMID: 34531153 DOI: 10.1016/j.nrleng.2018.11.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 11/15/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is an important cause of disability. There is little evidence on the prognostic value of lesions identified in neuroimaging studies. AIM The study aimed to assess the severity of lesions detected with brain MRI and transfontanellar ultrasound and their relationship with long-term neurological deficits. PATIENTS AND METHODS We performed a retrospective, analytical, observational study of 36 patients with congenital CMV infection. Neuroimaging studies were reviewed and classified according to the modified Noyola' scale. Imaging findings were compared with neurological alterations in the patients' most recent follow-up evaluation at the paediatric neurology department. RESULTS Thirty-six patients were studied (transfontanellar ultrasound: 30; brain MRI: 29). Twenty of 30 patients showed ultrasound abnormalities; of these, 11 showed alterations on brain MR images (P = .04) and 10 had neurological impairment (P = .008). Transfontanellar ultrasound had a sensitivity of 83.3%, 90% CI: 58-100 and a specificity of 44.4%, 90% CI: 18.7-70.2 for predicting neurological sequelae. Brain MRI displayed abnormalities in 20 of 29 patients, of whom 16 had neurological impairment (P < .001). MRI had a sensitivity of 94%, 95% CI: 80-100 and a specificity of 66.6%, 95% CI: 36-97.5 for predicting neurological sequelae. Modified Noyola' scale values > 2 were correlated with psychomotor retardation (P < .001). CONCLUSIONS Our findings validate previous studies reporting a statistical significant correlation between the extension of neuroimaging lesions and severity of neurological deficits.
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Affiliation(s)
- M Escobar Castellanos
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain.
| | - S de la Mata Navazo
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - M Carrón Bermejo
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - M García Morín
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - Y Ruiz Martín
- Sección de Radiología, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - J Saavedra Lozano
- Sección de Infectología, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - M C Miranda Herrero
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - E Barredo Valderrama
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - P Castro de Castro
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
| | - M Vázquez López
- Sección de Neuropediatría, Hospital Materno Infantil Gregorio Marañón, Madrid, Spain
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11
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de Juan Gallach A, Alemany Albert M, Marco Hernández AV, Boronat González N, Cernada Badía M, Tomás Vila M. Neurological sequelae in patients with congenital cytomegalovirus. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2020. [DOI: 10.1016/j.anpede.2019.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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12
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Gaur P, Ffrench-Constant S, Kachramanoglou C, Lyall H, Jan W. Is it not time for international guidelines to combat congenital cytomegalovirus infection? A review of central nervous system manifestations. Clin Radiol 2020; 75:644.e7-644.e16. [PMID: 32216960 DOI: 10.1016/j.crad.2020.02.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 02/18/2020] [Indexed: 12/31/2022]
Abstract
Cytomegalovirus (CMV) is the most commonly transmitted virus in utero with a prevalence of up to 1.5%. The infection has potentially debilitating and devastating consequences for the infected fetus, being a leading cause for neurological disability worldwide. Once acquired, it often goes undetected with only an assumed 10% of infected neonates displaying the classic clinical or imaging features. Viral DNA polymerase chain reaction (PCR) of saliva or urine obtained within the first 21 days of life is required to make the diagnosis. As the majority of infected neonates are initially asymptomatic, diagnosis is often delayed. An abnormal routine neonatal hearing test and characteristic antenatal cranial ultrasound imaging findings may raise the suspicion of congenital CMV (cCMV) in the asymptomatic group. Ultimately, the aim is to facilitate early diagnosis and timely treatment. In this article, we highlight diagnostic and treatment challenges of the commonest congenital infection, we present the current available central nervous system imaging severity grading systems, and highlight the need for an internationally agreed diagnostic grading system that can aid treatment decision-making.
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Affiliation(s)
- P Gaur
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - S Ffrench-Constant
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - C Kachramanoglou
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - H Lyall
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK
| | - W Jan
- Imperial College Healthcare NHS Trust, St Mary's Hospital, Praed Street, London, W2 1NY, UK.
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13
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de Juan Gallach A, Alemany Albert M, Marco Hernández AV, Boronat González N, Cernada Badía M, Tomás Vila M. [Neurological sequelae in patients with congenital cytomegalovirus]. An Pediatr (Barc) 2020; 93:111-117. [PMID: 32111550 DOI: 10.1016/j.anpedi.2019.12.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Revised: 11/19/2019] [Accepted: 12/09/2019] [Indexed: 12/01/2022] Open
Abstract
INTRODUCTION The infection due to cytomegalovirus is the most common congenital infection in developed countries, and on of the main causes of psychomotor impairment and neurosensory hearing loss of infectious origin. The present study has its objectives to describe the clinical-analytical and neuroimaging of patients with secondary neurological sequelae secondary to the congenital cytomegalovirus infection and then compare them with the group of patients with a congenital cytomegalovirus infection that did not have neurological symptoms during their follow-up. MATERIAL AND METHODS A retrospective, observational, cohort study was conducted that included all the cases of congenital cytomegalovirus infection from 2003 until 2018 and the short-medium term neurological sequelae were evaluated. Prenatal, perinatal, and postnatal data of patients with neurological sequelae were compared against those that did not present with any. RESULTS A total of 60 patients with congenital cytomegalovirus infection were recorded during the study period, with 65% having neurological involvement during their follow-up period (62.2% with psychomotor impairment, 61.5% with microcephaly, 46.2% loss of hearing, 27.8% motor disorders, 20.5% epilepsy, and 5.6% with chorioretinitis). In the patient group that had sequelae, the presence of clinical symptoms during the neonatal period, as well as changes in the neuroimaging study, were the most common, with both being statistically significant compared to the asymptomatic group. The patients with neurological involvement also had a higher score on the Noyola et al. neuroimaging scale. CONCLUSIONS The symptoms at birth, and certain findings in the neuroimaging, like the changes in the white matter or neuronal migration disorders, could predict neurocognitive sequelae in patients with congenital cytomegalovirus infection.
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Affiliation(s)
- Alba de Juan Gallach
- Unidad de Neuropediatría y Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España.
| | - Marta Alemany Albert
- Unidad de Neuropediatría y Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | | | - Nuria Boronat González
- Unidad de Neuropediatría y Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - María Cernada Badía
- Unidad de Neuropediatría y Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
| | - Miguel Tomás Vila
- Unidad de Neuropediatría y Neonatología, Hospital Universitario y Politécnico La Fe, Valencia, España
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14
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Lucignani G, Rossi Espagnet MC, Napolitano A, Figà Talamanca L, Calò Carducci FI, Auriti C, Longo D. A new MRI severity score to predict long-term adverse neurologic outcomes in children with congenital Cytomegalovirus infection. J Matern Fetal Neonatal Med 2019; 34:859-866. [PMID: 31096816 DOI: 10.1080/14767058.2019.1620725] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Congenital cytomegalovirus (CMV) infection is one of the main causes of deafness in childhood. It frequently causes serious long-term neurological sequelae. In children who are asymptomatic at birth, tests to accurately predict these sequelae are still unavailable. AIMS We describe different brain MRI patterns of congenital CMV infection correlated with clinical data and propose a new MRI severity score to early predict long-term neurological sequelae. MATERIALS AND METHODS We explored clinical records and neuroimaging data of 224 neonates and children with congenital Cytomegalovirus infection, 180 of them did not meet inclusion criteria. Forty-four babies met inclusion criteria and were enrolled in the study. We retrospectively collected clinical data concerning hospitalization, 2 years outpatient follow-up and brain MRI findings of those 44 children, symptomatic and asymptomatic at birth. Clinical data were then correlated with children's brain MRI examinations. We defined neurological and sensorial impairment (hearing or visual) as "adverse neurological outcomes". Brain MRI score was constructed assigning different values to white matter and ventricular dilation. RESULTS In 44 children enrolled in the study we found that 28/35 (80%) with abnormal and 2/9 (22,2%) with normal MRI examination developed adverse neurological outcomes (OR = 3.6) (95% IC 1.0-12.0). Infants who were symptomatic at birth showed a probability of MRI brain lesions 3.2 times higher than those who were asymptomatic. Ten out of 17 (59%) children who were asymptomatic at birth showed MRI-WM alterations or ventriculomegaly. CONCLUSIONS Brain MRI abnormalities, such as WM alterations and ventriculomegaly, expressed as MRI score higher than 2 are associated with an increased probability of long-term adverse neurological outcome in congenitally CMV infected infants, symptomatic and asymptomatic at birth.
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Affiliation(s)
| | - Maria Camilla Rossi Espagnet
- Neuroradiology Unit, Imaging Department, Ospedale Pediatrico Bambino Gesu, Rome, Italy.,NESMOS Department, Neuroradiology Unit, Sapienza University of Rome, Rome, Italy
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15
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Congenital Cytomegalovirus Infection in Children with Autism Spectrum Disorder: Systematic Review and Meta-Analysis. J Autism Dev Disord 2019; 48:1483-1491. [PMID: 29185167 DOI: 10.1007/s10803-017-3412-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Association of congenital cytomegalovirus (CMV) infection with autism spectral disorder (ASD) has been suggested since 1980s. Despite the observed association, its role as a risk factor for ASD remains to be defined. In the present review, we systematically evaluated the available evidence associating congenital CMV infection with ASD using PubMed, Web of Science, Cochrane Library, and Embase databases. Any studies on children with CMV infection and ASD were evaluated for eligibility and three observational studies were included in meta-analysis. Although a high prevalence of congenital CMV infection in ASD cases (OR 11.31, 95% CI 3.07-41.66) was indicated, too few events (0-2 events) in all included studies imposed serious limitations. There is urgent need for further studies to clarify this issue.
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16
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10-year follow-up of congenital cytomegalovirus infection complicated with severe neurological findings in infancy: a case report. BMC Pediatr 2018; 18:369. [PMID: 30470211 PMCID: PMC6260854 DOI: 10.1186/s12887-018-1348-8] [Citation(s) in RCA: 6] [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: 04/05/2018] [Accepted: 11/16/2018] [Indexed: 12/01/2022] Open
Abstract
Background Congenital cytomegalovirus (cCMV) infection leads to sensorineural hearing loss (SNHL) and neurodevelopmental delays. However, the long-term outcomes of cCMV infection with severe neurological manifestations in infancy remain unclear. Case presentation The patient was a one-month-old girl visited owing to abnormalities in neonatal hearing screening. Central nervous system involvement including intracranial calcification and extensive white matter abnormalities was identified. Right SNHL (50 dB) was detected by auditory brain response (ABR) testing. The cause of her hearing loss was determined to be cCMV infection by polymerase chain reaction (PCR) using a dried blood spot. At 1.5 months of age, the patient was treated with intravenous ganciclovir (GCV) for 5 weeks followed by oral valganciclovir (VGCV) for an additional 6 weeks. Cytomegalovirus (CMV) loads in her urine continued to be detected until she was 10 years old. Fortunately, during this time, her right hearing loss did not deteriorate, and her left hearing remained normal. Furthermore, the extensive abnormal areas of white matter observed at 1 month of age mostly disappeared by the time the patient was 9 years old. Her neurodevelopmental score was normal, and motor milestones were not delayed as of 10 years of age. Conclusions Here, we report the 10-year follow-up of a patient with cCMV who showed normal neurodevelopment, no progression of hearing loss, and ameliorating magnetic resonance imaging (MRI) findings, despite having various complications and severe neurological findings during infancy. Electronic supplementary material The online version of this article (10.1186/s12887-018-1348-8) contains supplementary material, which is available to authorized users.
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17
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Neuroimaging Profiles and Neurodevelopmental Outcome in Infants With Congenital Cytomegalovirus Infection. Pediatr Infect Dis J 2018; 37:1028-1033. [PMID: 30222696 DOI: 10.1097/inf.0000000000001974] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The accurate stratification of infants with congenital cytomegalovirus (CMV) infection at risk for more severe outcome may help in the management of patients. Aim of this study was to investigate the ability of a comprehensive neuroimaging investigation in predicting the long-term neurodevelopmental outcome in patients with congenital CMV. We analyzed the prognostic accuracy of a traditional score and a recently proposed scale applied to head ultrasound (HUS), computed tomography (CT) and magnetic resonance imaging (MRI). METHODS All consecutive neonates born from 2002 to 2015 with congenital CMV infection were considered eligible for the study. Neuroimaging findings were scored according to both scores. RESULTS One hundred seventy infants were included (112 symptomatic patients). One-hundred eighteen infants received both HUS, CT and MRI. CT and MRI were normal in all 56 asymptomatic patients, while 32% of them presented an abnormal HUS. The prevalence of abnormal findings differed according to the neuroimaging study. The sensitivity of the new neuroimaging score in detecting patients at risk for poor neurologic outcome was higher than the traditional one for all neuroimaging examinations. CT and MRI showed higher positive predictive value compared with HUS. No neuroimaging examination showed a negative predictive value equal to 100%. CONCLUSIONS Although HUS is the safest neuroimaging technique, it performs less well in detecting some brain abnormalities that can be associated with a poor neurodevelopmental outcome. A comprehensive neuroimaging evaluation is mandatory in infants with congenital CMV infection to decide for treatment and make a prognostic evaluation.
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18
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Kwak M, Yum MS, Yeh HR, Kim HJ, Ko TS. Brain Magnetic Resonance Imaging Findings of Congenital Cytomegalovirus Infection as a Prognostic Factor for Neurological Outcome. Pediatr Neurol 2018; 83:14-18. [PMID: 29681488 DOI: 10.1016/j.pediatrneurol.2018.03.008] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 03/18/2018] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this study is to predict the neurological outcomes of patients with congenital cytomegalovirus infection by analysis of magnetic resonance images of the brain. METHODS From June 2007 to June 2016, 31 patients were diagnosed with symptomatic congenital cytomegalovirus infection at Asan Medical Center. The medical records and magnetic resonance imaging (MRI) findings of these patients were reviewed, and the relationships between MRI findings and neurological outcomes were analyzed. RESULTS Of the 31 patients, 17 were male and 12 were born prematurely (gestation age less than 37 weeks). Twenty-one patients presented with delayed development, 11 with microcephaly, and 10 with sensorineural hearing loss. Eleven patients developed epilepsy. The most common abnormal findings on brain MRI were ventriculomegaly (N = 21, 67.7%) and polymicrogyria (N = 14, 45.2%). Delayed development significantly correlated with the presence of polymicrogyria (P = 0.001). Epilepsy was significantly associated with polymicrogyria (P = 0.012), ventriculomegaly (P = 0.045), calcification (P = 0.006), and white matter abnormalities (P = 0.018). Sensorineural hearing loss was not associated with any abnormal findings on brain MRI. Based on these data, a new brain magnetic resonance cytomegalovirus scoring scale was built and this scoring scale can predict the development of epilepsy with odds ratio 3.62 (confidence interval 1.52 to 8.67, P = 0.004). CONCLUSIONS In patients with congenital cytomegalovirus infections, brain MRI abnormalities could predict poor developmental outcomes and epilepsy, but not sensorineural hearing loss. Stratified magnetic resonance findings can be suggested as the predictors of neurological outcomes in individuals with congenital cytomegalovirus infections.
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Affiliation(s)
- Minsun Kwak
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Mi-Sun Yum
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea.
| | - Hye-Ryun Yeh
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Hyun-Jin Kim
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Tae-Sung Ko
- Department of Pediatrics, Asan Medical Center Children's Hospital, University of Ulsan College of Medicine, Seoul, Republic of Korea
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19
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Usami SI, Kitoh R, Moteki H, Nishio SY, Kitano T, Kobayashi M, Shinagawa J, Yokota Y, Sugiyama K, Watanabe K. Etiology of single-sided deafness and asymmetrical hearing loss. Acta Otolaryngol 2017; 137:S2-S7. [PMID: 28366032 DOI: 10.1080/00016489.2017.1300321] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONCLUSIONS The present study revealed that various etiologies are involved in single-sided deafness (SSD), and that the cause of SSD and asymmetrical hearing loss (AHL) differed greatly between congenital/early-onset cases and adult cases. Clarification of the etiology is the first step toward providing appropriate intervention. OBJECTIVES The study aimed to clarify the etiology of SSD and AHL patients. METHODS The etiology of a total of 527 SSD or AHL patients who visited Shinshu University Hospital between 2006 and 2016 were analyzed by imaging as well as serological tests for mumps virus, and CMV DNA testing. RESULTS In our cohort of congenital/early-onset SSD (n = 210), the most prevalent cause in children was cochlear nerve deficiency (43.7%; 87 of 199 patients undergoing CT and/or MRI), followed by CMV infection, mumps infection, anomalies of the inner ear, ANSD, and other rare etiologies. In contrast, half of the adult SSD patients presented with idiopathic sensorineural hearing loss, followed by various types of otitis media, cerebellopontine angle tumor and other rare etiologies.
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Affiliation(s)
- Shin-ichi Usami
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Nagano, Japan
| | - Ryosuke Kitoh
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
| | - Hideaki Moteki
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Nagano, Japan
| | - Shin-ya Nishio
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
- Department of Hearing Implant Sciences, Shinshu University School of Medicine, Nagano, Japan
| | - Tomohiro Kitano
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
| | - Masafumi Kobayashi
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
| | - Jun Shinagawa
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
| | - Yoh Yokota
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
| | - Kenjiro Sugiyama
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
| | - Kizuki Watanabe
- Department of Otorhinolaryngology, Shinshu University School of Medicine, Nagano, Japan
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