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Chebib E, Vauloup-Fellous C, Benoit C, Noël Petroff N, Van Den Abbeele T, Maudoux A, Teissier N. Is CMV PCR of inner ear fluid during cochlear implantation a way to diagnose CMV-related hearing loss? Eur J Pediatr 2023; 182:375-383. [PMID: 36369401 DOI: 10.1007/s00431-022-04691-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 10/31/2022] [Accepted: 11/02/2022] [Indexed: 11/13/2022]
Abstract
UNLABELLED To evaluate the diagnostic performance of cytomegalovirus (CMV) polymerase chain reaction (PCR) on inner ear fluid collected during cochlear implantation and to assess its interest in current practice. This monocentric prospective study included consecutive children presenting with severe to profound sensorineural hearing loss (SNHL) who were candidates for unilateral and/or bilateral cochlear implantation. The etiology of the SNHL was determined before cochlear implantation when possible. During the surgery, drop-like samples of inner ear fluid and blood were collected. CMV PCR was then performed on both samples. Between January 2017 and September 2021, 113 children with severe to profound SNHL underwent cochlear implantation with inner ear fluid collection. Among these children, 77 of them presented with a known cause of SNHL (68%) and 36 of them had an unknown cause of SNHL at the time of surgery (32%). Sensitivity and specificity of the CMV PCR on inner ear fluid were 60% (95% CI: [49-71]) and 98% (95% CI: [96-100]), respectively. Positive and negative predictive values were 90% (95% CI: [83-97]) and 92% (95% CI: [86-98]), respectively. A sensitivity analysis according to age at cochlear implantation showed a decrease with age. CONCLUSION Sampling of inner ear fluid during cochlear implant surgery is an interesting, simple and safe way to diagnose CMV-related hearing loss, especially when the diagnosis of congenital infection can no longer be confirmed. However, the sensitivity decreases with age. TRIAL REGISTRATION NCT04724265 What is Known: • Congenital cytomegalovirus infection is the leading infectious cause of neurological disabilities and sensorineural hearing loss in children. In the absence of systematic screening at birth, many cCMV infections go undetected and are often undiagnosed despite the development of sensorineural sequelae. • Nearly 40% of indications for cochlear implantation are of unknown etiology. WHAT IS NEW • Performing CMV PCR on inner ear fluid at the time of cochlear implantation is a safe way with high diagnostic performance (PPV = 90%, NPV = 92%) to detect a CMV-related hearing loss. • This sample may be interesting in cases of unknown cause of hearing loss in order to identify undiagnosed cCMV infections.
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Affiliation(s)
- Emilien Chebib
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France.
| | - Christelle Vauloup-Fellous
- AP-HP Université Paris-Saclay, Hôpital Paul-Brousse, Department of Virology, INSERM U1193, 94804, Villejuif, France.,Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France
| | - Charlotte Benoit
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | - Nathalie Noël Petroff
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | - Thierry Van Den Abbeele
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France
| | - Audrey Maudoux
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France.,Center for Balance Evaluation in Children (EFEE), Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP), Paris University, Paris, France.,Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut de L'Audition, Institut Pasteur, Université de Paris, INSERM-UMRS1120, 63 rue de Charenton, F-75012, Paris, France
| | - Natacha Teissier
- Department of Otolaryngology, Robert Debre Hospital, Assistance Publique Hôpitaux de Paris (APHP) and Université de Paris, 48 Boulevard Sérurier, 75019, Paris, France.,Groupe de Recherche sur les Infections Pendant la Grossesse (GRIG), Paris, France
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Muacevic A, Adler JR. A Review of Sensorineural Hearing Loss in Congenital Cytomegalovirus Infection. Cureus 2022; 14:e30703. [PMID: 36439580 PMCID: PMC9693817 DOI: 10.7759/cureus.30703] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 10/26/2022] [Indexed: 01/25/2023] Open
Abstract
The intrauterine transmission of the TORCH group (toxoplasmosis, rubella cytomegalovirus (CMV), herpes simplex, and HIV) produces severe complications in the fetus, leading to major life challenges for the newborns. CMV is considered one of the leading causes of congenital hearing loss in babies born to infected mothers. The majority of the cases are asymptomatic but a certain proportion show symptoms, which may not be present until later. The human cytomegalovirus (HCMV) infection can also be transferred to the baby postnatally through breastfeeding. Mothers facing primary infection from the CMV have a greater tendency to transmit the infection to the fetus, whereas secondary infection due to reactivation of the virus in females who were affected before pregnancy, delivers asymptomatic babies in most cases. Vertical transmission of HCMV, that is via the placenta from infected mother to fetus, is one of the leading causes of congenital sensorineural hearing loss (SNHL) and neurodevelopmental complications in newborns. It accounts for up to 10% of SNHL cases in newborns, of both unilateral and bilateral types. Antiviral therapy is helpful in such cases if administered within the first month of life, and for hearing impairment, cochlear implants have been used to treat children who develop profound hearing loss. The child can present with hearing loss at birth or it may be late in onset and of progressive type. Suspected children should be evaluated regularly for the early detection of hearing loss and to provide the appropriate treatment.
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3
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Keithley EM. Inner ear immunity. Hear Res 2022; 419:108518. [DOI: 10.1016/j.heares.2022.108518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 05/06/2022] [Accepted: 05/10/2022] [Indexed: 11/26/2022]
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A Systematic Review on the Association of Acquired Human Cytomegalovirus Infection with Hearing Loss. J Clin Med 2020; 9:jcm9124011. [PMID: 33322509 PMCID: PMC7764083 DOI: 10.3390/jcm9124011] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Revised: 12/02/2020] [Accepted: 12/10/2020] [Indexed: 01/06/2023] Open
Abstract
Congenital cytomegalovirus (CMV) infection induces a clinical syndrome usually associated with hearing loss. However, the effect of acquired CVM infection in adults and children has not been clearly defined. The objective of this review is to critically appraise scientific evidence regarding the association of acquired CMV infection with postnatal hearing loss or tinnitus. A systematic review of records reporting sensorineural hearing loss (SNHL) or tinnitus and acquired CMV infection including articles published in English was performed. Search strategy was limited to human studies with acquired CMV infection. After screening and quality assessment, nine studies involving 1528 individuals fulfilled the inclusion criteria. A total of 14% of patients with SNHL showed evidence of previous exposure to CMV, while in individuals without SNHL (controls) the percentage rose up to 19.3%. SNHL was reported as unilateral or bilateral in 15.3%, and not specified in 84.7% of cases. The degree of SNHL ranged from mild to profound for both children and adults. None of the records reported tinnitus. The prevalence of children or adults with acquired SNHL with a confirmed acquired CMV infection by Polymerase Chain Reaction (PCR) or IgM anti-CMV antibodies is low. Phenotyping of patients with acquired CMV infection was limited to hearing loss by pure tone audiometry and no additional audiological testing was performed in most of the studies. Additional symptoms deserve more attention, including episodic vertigo or tinnitus, since some patients with the clinical spectrum of Meniere Disease could result from a CMV latent infection.
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Marsico C, Aban I, Kuo H, James SH, Sanchez PJ, Ahmed A, Arav-Boger R, Michaels MG, Ashouri N, Englund JA, Estrada B, Jacobs RF, Romero JR, Sood SK, Whitworth S, Jester PM, Whitley RJ, Kimberlin DW. Blood Viral Load in Symptomatic Congenital Cytomegalovirus Infection. J Infect Dis 2020; 219:1398-1406. [PMID: 30535363 DOI: 10.1093/infdis/jiy695] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2018] [Accepted: 12/03/2018] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Viral loads (VLs) frequently are followed during treatment of symptomatic congenital cytomegalovirus disease, but their predictive value is unclear. METHODS Post hoc analysis of 2 antiviral studies was performed. Seventy-three subjects were treated for 6 weeks and 47 subjects were treated for 6 months. Whole blood VL was determined by real-time polymerase chain reaction before and during therapy. RESULTS Higher baseline VL was associated with central nervous system involvement (3.82 log, range 1-5.65 vs 3.32 log, range 1-5.36; P = .001), thrombocytopenia (3.68 log, range 1-5.65 vs 3.43 log, range 1-5.36; P = .03), and transaminitis at presentation (3.73 log, range 1-5.60 vs 3.39 log, range 1-5.65; P = .009), but with overlap in the amount of virus detected between groups. In subjects treated for 6 months, lower VL at presentation correlated with better hearing outcomes at 12 months, but VL breakpoints predictive of hearing loss were not identified. Sustained viral suppression during 6 months of therapy correlated with better hearing outcomes at 6, 12, and 24 months (P = .01, P = .0007, P = .04), but a majority without viral suppression still had improved hearing. CONCLUSIONS In infants with symptomatic congenital cytomegalovirus disease, higher whole blood VL before initiation of antiviral therapy has no clinically meaningful predictive value for long-term outcomes.
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Affiliation(s)
- Concetta Marsico
- Neonatology Unit, Department of Medical and Surgical Sciences, University of Bologna, Italy
| | - Immaculada Aban
- Department of Biostatistics, Division of Infectious Diseases, University of Alabama at Birmingham
| | - Huichien Kuo
- Department of Biostatistics, Division of Infectious Diseases, University of Alabama at Birmingham
| | - Scott H James
- Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham
| | - Pablo J Sanchez
- Department of Pediatrics, Divisions of Pediatric Infectious Diseases and Neonatology, Nationwide Children's Hospital - Ohio State University College of Medicine, Columbus
| | - Amina Ahmed
- Department of Pediatrics, Carolinas Medical Center, Charlotte, North Carolina
| | | | - Marian G Michaels
- Department of Pediatrics, Children's Hospital of Pittsburgh of UPMC, Pennsylvania
| | - Negar Ashouri
- Infectious Diseases, CHOC Children's Hospital, Orange, California
| | | | | | | | | | - Sunil K Sood
- Steven and Alexandra Cohen Children's Medical Center, New Hyde Park, New York
| | | | - Penelope M Jester
- Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham
| | - Richard J Whitley
- Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham
| | - David W Kimberlin
- Department of Pediatrics, Division of Infectious Diseases, University of Alabama at Birmingham
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Tsuprun V, Keskin N, Schleiss MR, Schachern P, Cureoglu S. Cytomegalovirus-induced pathology in human temporal bones with congenital and acquired infection. Am J Otolaryngol 2019; 40:102270. [PMID: 31402062 DOI: 10.1016/j.amjoto.2019.08.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/31/2019] [Accepted: 08/02/2019] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Publications on histopathology of human temporal bones with cytomegalovirus (CMV) infection are limited. We aim to determine histopathology of the inner ears and the middle ears in human temporal bones with congenital and acquired CMV infections. METHODS Temporal bones from 2 infants with congenital and 2 adults with acquired CMV infection were evaluated by light microscopy. RESULTS Two infants with congenital CMV infection showed striking pathological changes in the inner ear. There was a hypervascularization of the stria vascularis in the cochlea of the first infant, but no obvious loss of outer and inner hair cells was seen in the organ of Corti. However, cytomegalic cells and a loss of outer hair cells were found in the cochlea of the second infant. The vestibular organs of both infants showed cytomegalic cells, mostly located on dark cells. There was a loss of type I and type II hair cells in the macula of the saccule and utricle. Loss of hair cells and degeneration of nerve fibers was also seen in the semicircular canals. Both infants with congenital infection showed abundant inflammatory cells and fibrous structures in the middle ear cavity. No evidence of cytomegalic cells and hair cell loss was found in the cochlea or vestibular labyrinth in acquired CMV infection. CONCLUSIONS In two infants with congenital CMV infection, the cochlea, vestibule, and middle ear were highly affected. Temporal bones of adult donors with acquired viral infection showed histological findings similar to donors of the same age without ear disease.
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Rashidimehr S, Saki N, Ghazipur A, Makvandi M, Verma A, Nikakhlagh S, Neisi N. Evaluation of cytomegalovirus DNA in periymphatic fluid in patients with sensorineural hearing loss using PCR technique. ELECTRONIC JOURNAL OF GENERAL MEDICINE 2019. [DOI: 10.29333/ejgm/94221] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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8
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Di Nardo W, Anzivino R, Cattani P, Santangelo R, De Corso E, Paludetti G. Herpes simplex virus-1 and cytomegalovirus DNAs detection in the inner ear of implanted patients with non-congenital infection. Acta Otolaryngol 2017; 137:791-796. [PMID: 28332898 DOI: 10.1080/00016489.2017.1293292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
CONCLUSIONS The detection of cytomegalovirus (CMV) and herpes simplex virus-1 (HSV-1) genome in perilymph of patients with negative serology or clinical history for congenital infections supports the hypothesis that Herpesviridae, even after acquired postnatal infections, could remain in latent phase in the spiral ganglion and damage the cochlea by a possible subsequent reactivation. Further studies are needed to identify the markers of such reactivation. OBJECTIVE To identify the presence of certain viral species in the endolabyrinthic fluid of deaf patients with non-congenital infection. The research of viral DNA within the inner ear is the only direct way to increase our knowledge about the viral role in postnatal damage to the cochlea. METHODS Thirty-six patients (1-69 years) suffering from bilateral sensorineural hearing loss (SNHL) were subjected, during cochlear implant (CI) surgery, to a sample taking of inner ear fluid. Several types of viral genome (HSV, VZV, CMV, EBV and Enterovirus) were investigated in each sample through multiplex polymerase chain reaction (PCR) and reverse transcriptase-polymerase chain reaction (RT-PCR). Radiological exams, serology (specific IgG and IgM) and PCR of peripheral blood were also performed. RESULTS While the research of the viral genome in peripheral blood was negative in all patients, multiplex PCR on endolabyrinthic fluid samples was positive in three patients (two cases of CMV-DNA and one case of HSV-1 DNA).
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Affiliation(s)
- Walter Di Nardo
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - Roberta Anzivino
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - Paola Cattani
- Department of Diagnostic and Laboratory Medicine, Institute of Microbiology, Catholic University of Sacred Heart, Rome, Italy
| | - Rosaria Santangelo
- Department of Diagnostic and Laboratory Medicine, Institute of Microbiology, Catholic University of Sacred Heart, Rome, Italy
| | - Eugenio De Corso
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
| | - Gaetano Paludetti
- Department of Head and Neck Surgery, Institute of Otorhinolaryngology, Catholic University of Sacred Heart, Rome, Italy
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Audiovestibular consequences of congenital cytomegalovirus infection. Eur Ann Otorhinolaryngol Head Neck Dis 2016; 133:413-418. [PMID: 27067701 DOI: 10.1016/j.anorl.2016.03.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the second most frequent cause of mental retardation and sensorineural hearing loss, after genetic factors. Recently, pediatric forensic and fetopathological studies have led to progress in understanding the pathophysiological mechanisms underlying the various neurosensory sequelae. Thanks to the identification of certain prognostic factors of hearing loss, therapeutic protocols based on antiviral molecules are now proposed for target populations. This treatment has shown efficacy in limiting hearing threshold deterioration and even, in some cases, seems to provide partial recovery of hearing in symptomatic congenitally infected CMV neonates. However, optimal treatment duration and administration modalities are not clearly defined. This article reviews recent data concerning audiovestibular sequelae and their management in children congenitally infected by CMV.
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Kato K, Otake H, Tagaya M, Takahashi Y, Ito Y, Hama A, Muramatsu H, Kojima S, Naganawa S, Nakashima T. Progressive hearing loss following acquired cytomegalovirus infection in an immunocompromised child. Am J Otolaryngol 2013; 34:89-92. [PMID: 23084431 DOI: 10.1016/j.amjoto.2012.09.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2012] [Accepted: 09/04/2012] [Indexed: 10/27/2022]
Abstract
We report a rare case of progressive hearing loss after acquired CMV infection in a child with Langerhans cell histiocytosis (LCH). A 5-month-old female was diagnosed as having LCH. When she was 14 months old, she received an unrelated donor umbilical cord blood transfusion for the treatment of intractable LCH. CMV infection was confirmed after the blood transfusion. Because her own umbilical cord had no CMV, the CMV infection was not congenital. When she was 7 years old, mixed hearing loss was noted with bilateral otitis media with effusion. After that time, the sensorineural hearing loss progressed to bilateral profound hearing loss over 3 years. Three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging with gadolinium contrast enhancement revealed a high intensity area in the inner ear that suggested bilateral labyrinthitis. This case demonstrates the possibility that, under the immunodeficiency, the acquired CMV infection causes progressive sensorineural hearing loss.
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Inner ear lesions in congenital cytomegalovirus infection of human fetuses. Acta Neuropathol 2011; 122:763-74. [PMID: 22033878 DOI: 10.1007/s00401-011-0895-y] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 10/12/2011] [Accepted: 10/13/2011] [Indexed: 10/16/2022]
Abstract
Congenital cytomegalovirus (CMV) infection is the leading cause of non-hereditary congenital sensorineural hearing loss (SNHL). The natural course and the pathophysiology of inner ear lesions during human fetal CMV infection have not yet been reported. Inner ear lesions were investigated in six CMV-infected fetuses aged 19-35 postconceptional weeks and correlated with central nervous system (CNS) lesions. All the fetuses had high viral loads in the amniotic fluid and severe visceral and CNS lesions visible by ultrasound. Diffuse lesions consisting of both cytomegalic cells containing inclusion bodies and inflammation were found within all studied structures including the inner ear, brain, other organs, and placenta, suggesting hematogenous dissemination. Cochlear infection was consistently present and predominated in the stria vascularis (5/6), whereas the supporting cells in the organ of Corti were less often involved (2/6). Vestibular infection, found in 4/6 cases, was florid; the non-sensory epithelia, including the dark cells, were extensively infected. The endolymphatic sac was infected in 1 of 3 cases. The severity of inner ear infection was correlated with the CNS lesions, confirming the neurotropism of CMV. This study documenting infection of the structures involved in endolymph secretion and potassium homeostasis in fetuses with high amniotic fluid viral loads suggests that potassium dysregulation in the endolymphatic compartment of the inner ear may lead to secondary degeneration of the sensory structures. In addition, the occurrence of SNHL depends on the intensity and duration of the viral infection and inflammation.
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12
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Cytomegalovirus DNA retrieval in the inner ear fluids of a congenitally deaf child one month after primary infection: A Case Report. Laryngoscope 2011; 121:828-30. [DOI: 10.1002/lary.21447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2010] [Revised: 11/05/2010] [Accepted: 11/09/2010] [Indexed: 11/07/2022]
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Alarcón Allen A, Baquero-Artigao F. [Review and guidelines on the prevention, diagnosis and treatment of post-natal cytomegalovirus infection]. An Pediatr (Barc) 2010; 74:52.e1-52.e13. [PMID: 20630814 DOI: 10.1016/j.anpedi.2010.05.024] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 05/04/2010] [Indexed: 11/16/2022] Open
Abstract
Postnatal cytomegalovirus (CMV) infection in the newborn can occur from exposure to maternal cervical secretions during birth, ingestion of breast milk, transfusion of blood products or transmission by body fluids of infected people. Breast milk is the main source of infection, given the high rate of CMV-positive mothers excreting CMV in milk. Freezing reduces the risk of CMV transmission by breastfeeding, although it does not eliminate it completely. Pasteurisation prevents such transmission, but it can alter the immunological properties of breast milk. Postnatal CMV infection is usually asymptomatic, as it normally results from viral reactivation in the mother, and the neonate is born with protective antibodies. However, in the very low birth weight premature infant the amount of transferred antibodies is smaller and a symptomatic infection can occur. Symptomatic post-natal CMV infection in the newborn typically causes hepatitis, neutropenia, thrombocytopenia or sepsis-like syndrome. Pneumonitis and enteritis are less common, but very characteristic. Diagnosis is based on urine virus detection at the time of onset of symptoms. Postnatal CMV infection in the newborn generally resolves spontaneously without antiviral treatment. Ganciclovir should be reserved for severe cases. Unlike congenital CMV disease, post-natal CMV infection in the preterm infant does not seem to be associated with hearing loss or abnormal neuro-development in long term follow-up.
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Affiliation(s)
- A Alarcón Allen
- Servicio de Neonatología, Hospital Sant Joan De Déu, Esplugues De Llobregat, Barcelona, Spain.
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Neuropathogenesis of congenital cytomegalovirus infection: disease mechanisms and prospects for intervention. Clin Microbiol Rev 2009; 22:99-126, Table of Contents. [PMID: 19136436 DOI: 10.1128/cmr.00023-08] [Citation(s) in RCA: 316] [Impact Index Per Article: 21.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Congenital cytomegalovirus (CMV) infection is the leading infectious cause of mental retardation and hearing loss in the developed world. In recent years, there has been an improved understanding of the epidemiology, pathogenesis, and long-term disabilities associated with CMV infection. In this review, current concepts regarding the pathogenesis of neurological injury caused by CMV infections acquired by the developing fetus are summarized. The pathogenesis of CMV-induced disabilities is considered in the context of the epidemiology of CMV infection in pregnant women and newborn infants, and the clinical manifestations of brain injury are reviewed. The prospects for intervention, including antiviral therapies and vaccines, are summarized. Priorities for future research are suggested to improve the understanding of this common and disabling illness of infancy.
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Schraff SA, Schleiss MR, Brown DK, Meinzen-Derr J, Choi KY, Greinwald JH, Choo DI. Macrophage inflammatory proteins in cytomegalovirus-related inner ear injury. Otolaryngol Head Neck Surg 2007; 137:612-8. [PMID: 17903579 DOI: 10.1016/j.otohns.2007.03.044] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2007] [Revised: 03/14/2007] [Accepted: 03/29/2007] [Indexed: 12/20/2022]
Abstract
OBJECTIVE Inner ear inflammation triggered by CMV infection may play a role in CMV-related auditory pathogenesis. The purpose of the study was to determine if a virally encoded macrophage inflammatory protein played a role in CMV-related hearing loss. DESIGN Mutagenesis was performed with deletion of a guinea pig CMV macrophage inflammatory protein. Intracochlear inoculations were performed on three groups of animals (n = 18). Group 1 received sterile viral media, Group 2 received wild-type CMV virus, and Group 3 received "knockout" (KO) virus with a deleted immunomodulation gene. Baseline and postinoculation ABRs were obtained. ELISA and PCR were performed and temporal bones examined. SUBJECTS Eighteen guinea pigs. RESULTS The KO group had significantly better hearing than the WT group. There were no significant differences between the KO and sham groups. The WT group had significant hearing loss at all frequencies. Inflammation and fibrosis were noted in the WT temporal bones only. CONCLUSIONS Virally encoded macrophage inflammatory proteins appear to play a significant role in CMV-related hearing loss.
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Affiliation(s)
- Scott A Schraff
- Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229-3039, USA.
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Katano H, Sato Y, Tsutsui Y, Sata T, Maeda A, Nozawa N, Inoue N, Nomura Y, Kurata T. Pathogenesis of cytomegalovirus-associated labyrinthitis in a guinea pig model. Microbes Infect 2006; 9:183-91. [PMID: 17208485 DOI: 10.1016/j.micinf.2006.11.004] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2006] [Revised: 11/08/2006] [Accepted: 11/10/2006] [Indexed: 11/22/2022]
Abstract
Cytomegalovirus infects fetuses through the placenta, resulting in various congenital disorders in newborns, including hearing loss. We developed a monoclonal antibody to guinea pig cytomegalovirus (GPCMV) that was available for immunohistochemistry, and investigated the expression of the GPCMV antigen in animal models of direct and congenital infections. Injection of GPCMV, directly to the inner ear, increased the sound pressure level and resulted in labyrinthitis with severe inflammation. Immunohistochemistry detected GPCMV-infected cells mainly in the scala tympani, scala vestibule and spinal ganglion, but rarely in the cochlear duct. Injection of GPCMV to 5-week pregnant guinea pigs resulted in severe labyrinthitis in fetuses. Immunohistochemistry detected GPCMV-infected cells in the perilymph area and spinal ganglion, but not in the endolymph area, including hair cells. These data suggest that the virus spreads via the perilymph and neural routes in the inner ear of both models of direct and congenital infections.
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Affiliation(s)
- Harutaka Katano
- Department of Pathology, National Institute of Infectious Diseases, 1-23-1 Toyama, Shinjuku, Tokyo 162-8640, Japan.
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Abstract
Cytomegalovirus (CMV), a member of the herpes virus family, is the most common cause of congenital infection in humans, affecting 0.5-3% of all newborns worldwide. Congenital cytomegalovirus infection is the leading infectious cause of deafness, learning disabilities, and mental retardation in children. The high prevalence of cytomegalovirus in the general population, unpredictability of transmission, and asymptomatic nature of the disease in otherwise healthy women challenge prevention and treatment efforts.
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Affiliation(s)
- Elizabeth G Damato
- Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH 44106-4904, USA.
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