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Congenital Cytomegalovirus in Algiers, Algeria, a Descriptive Case Series Study. JOURNAL OF MEDICAL MICROBIOLOGY AND INFECTIOUS DISEASES 2022. [DOI: 10.52547/jommid.10.2.87] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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The frequency of cytomegalovirus non-ELR UL146 genotypes in neonates with congenital CMV disease is comparable to strains in the background population. BMC Infect Dis 2021; 21:386. [PMID: 33902487 PMCID: PMC8077815 DOI: 10.1186/s12879-021-06076-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 04/15/2021] [Indexed: 11/21/2022] Open
Abstract
Background Congenital cytomegalovirus disease (cCMV) is common and can be fatal or cause severe sequelae. Circulating strains of cytomegalovirus carry a high number of variable or disrupted genes. One of these is UL146, a highly diverse gene with 14 distinct genotypes encoding a CXC-chemokine involved in viral dissemination. UL146 genotypes 5 and 6 lack the conserved ELR motif, potentially affecting strain virulence. Here, we investigate whether UL146 genotypes 5 and 6 were associated with congenital CMV infection. Methods Viral DNA was extracted and UL146 sequenced from 116 neonatal dried blood spots (DBS) stored in the Danish National Biobank since 1982 and linked to registered cCMV cases through a personal identifier. These sequences were compared to UL146 control sequences obtained from CMV DNA extracted from 83 urine samples from children with suspected bacterial urinary tract infections. Results Three non-ELR UL146 genotypes (5 and 6) were observed among the cases (2.6%) and two were observed among the controls (2.4%; P > 0.99). Additionally, no significant association with cCMV was found for the other 12 genotypes in a post-hoc analysis, although genotype 8 showed a tendency to be more frequent among cases with 12 observations against three (P = 0.10). All fourteen genotypes were found to have little intra-genotype variation. Viral load, gender, and sample age were not found to be associated with any particular UL146 genotype. Conclusions No particular UL146 genotype was associated with cCMV in this nationwide retrospective case-control study. Associations between CMV disease and disrupted or polymorph CMV genes among immunosuppressed people living with HIV/AIDS and transplant recipients should be investigated in future studies. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-021-06076-w.
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Kidokoro H, Shiraki A, Torii Y, Tanaka M, Yamamoto H, Kurahashi H, Maruyama K, Okumura A, Natsume J, Ito Y. MRI findings in children with congenital cytomegalovirus infection retrospectively diagnosed with dried umbilical cord. Neuroradiology 2020; 63:761-768. [PMID: 33205317 DOI: 10.1007/s00234-020-02603-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 11/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Brain MRI provides important information about suspected congenital CMV infection in neonatally underdiagnosed children. This study aimed to describe MRI findings in children in whom congenital CMV infection was not suspected during the neonatal period and was proven retrospectively. METHODS We enrolled 31 children referred to the pediatric neurology clinic with neurological symptoms who were proven to have congenital CMV infection based on dried umbilical cord samples. Upon diagnosis, MR and CT images were assessed using the van der Knaap scoring system integrated with additional variables. Two investigators independently assessed all images. RESULTS The age at diagnosis was < 12 months in 14, 12-24 months in 11, and > 24 months in 6 patients. The initial symptom triggering clinic referral was delayed development in 22, seizure in 5, deafness in 3, and hemiplegia in 1 patient. Of the 31 children, 30 had a white matter (WM) abnormality predominant in the deep WM of the parietal lobe (n = 25). Anterior temporal lesions were observed in 21 children. Cortical lesions were observed in 7 children, suggestive of polymicrogyria. No child had cerebellar or brainstem abnormalities. Brain CT was performed in 22 of 31 children, and 11 showed punctate cerebral calcification in the periventricular and/or deep WM. CONCLUSION Patients with congenital CMV infection with delayed neurological symptoms show a relatively uniform pattern of parietal-dominant multifocal WM lesions and anterior temporal lesions, with or without polymicrogyria.
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Affiliation(s)
- Hiroyuki Kidokoro
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan.
| | - Anna Shiraki
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yuka Torii
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Masaharu Tanaka
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Hiroyuki Yamamoto
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | | | - Koichi Maruyama
- Division of Pediatric Neurology, Aichi Developmental Disability Center, Kasugai, Japan
| | - Akihisa Okumura
- Department of Pediatrics, Aichi Medical University, Nagakute, Japan
| | - Jun Natsume
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
| | - Yoshinori Ito
- Department of Pediatrics, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi, 466-8560, Japan
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Reyes A, Taravillo I, Moral N, Moraleda C, Blázquez-Gamero D, Folgueira L. Feasible alternatives to DBS in the retrospective diagnosis of congenital cytomegalovirus infection. J Clin Virol 2020; 129:104504. [PMID: 32604038 DOI: 10.1016/j.jcv.2020.104504] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 05/26/2020] [Accepted: 06/08/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Retrospective diagnosis of congenital cytomegalovirus (cCMV) infection may be challenging mainly because of the high variable sensitivity of PCR on dried blood spots (DBS) samples. OBJECTIVES To compare cytomegalovirus (CMV) viral load (VL) values in different samples obtained at birth from infants with cCMV infection. To evaluate dried umbilical cord (DUC) samples as an alternative to DBS. STUDY DESIGN Saliva and/or urine, peripheral blood (PB), and DBS from 16 infants with confirmed cCMV infection were collected at birth. CMV VL were determined by DNA extraction and real-time polymerase chain reaction (rt-PCR). In two cases, VL was determined from DUC samples. RESULTS Six (37.5 %) of the 16 infants were symptomatic, and 10 (62.5 %) were asymptomatic. The CMV VL found in saliva (median: 1,958,525 [IQR: 597,683-3,483,843] IU/mL) and in urine (median: 691,865 [IQR: 188,489.5-3,175,696] UI/mL) were both higher than those found in PB (median: 1115 [IQR: 364-4,002] IU/mL), p: 0.0001). Symptomatic infants presented 100 % of detectable VL in PB and 50 % in DBS. Asymptomatic infants showed 75 % of detectable VL in PB and 30 % in DBS. The VL in DUC were 22,341, 9754 IU/mL and 994 IU/mL. CONCLUSIONS When VL was detectable in PB, the values were lower than in saliva or urine, in both symptomatic and asymptomatic cases of cCMV. The low sensitivity in DBS samples could be due to low blood volume content, making CMV VL undetectable even when using optimised extraction and PCR protocols. In our limited experience, DUC could play a complementary diagnostic role when DBS VL is undetectable.
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Affiliation(s)
- Alhena Reyes
- Virology Laboratory, Microbiology Department, University Hospital 12 de Octubre, Madrid, Spain.
| | - Irene Taravillo
- Biomedical Research Institute imas12. University Hospital, 12 de Octubre, Madrid, Spain
| | - Noelia Moral
- Virology Laboratory, Microbiology Department, University Hospital 12 de Octubre, Madrid, Spain
| | - Cinta Moraleda
- Paediatric Infectious Unit, Paediatric Department, University Hospital 12 de Octubre, Madrid, Spain; Biomedical Research Institute imas12. University Hospital, 12 de Octubre, Madrid, Spain
| | - Daniel Blázquez-Gamero
- Paediatric Infectious Unit, Paediatric Department, University Hospital 12 de Octubre, Madrid, Spain; Biomedical Research Institute imas12. University Hospital, 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain
| | - Lola Folgueira
- Virology Laboratory, Microbiology Department, University Hospital 12 de Octubre, Madrid, Spain; Biomedical Research Institute imas12. University Hospital, 12 de Octubre, Madrid, Spain; Department of Medicine, School of Medicine, Complutense University, Madrid, Spain
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Nagel A, Dimitrakopoulou E, Teig N, Kern P, Lücke T, Michna D, Korn K, Steininger P, Shahada K, Neumann K, Überla K. Characterization of a universal screening approach for congenital CMV infection based on a highly-sensitive, quantitative, multiplex real-time PCR assay. PLoS One 2020; 15:e0227143. [PMID: 31917817 PMCID: PMC6952102 DOI: 10.1371/journal.pone.0227143] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Accepted: 12/12/2019] [Indexed: 11/18/2022] Open
Abstract
The majority of congenital cytomegalovirus (cCMV) infections are asymptomatic at birth and therefore not diagnosed. Approximately 10–15% of these infants develop late-onset hearing loss and other developmental disorders. Implementation of a universal screening approach at birth may allow early initiation of symptomatic interventions due to a closer follow-up of infants at risk and offers the opportunity to consider treatment of late-onset disease. Real-time PCR assays for the detection of CMV DNA in buccal swab samples demonstrated feasibility and good clinical sensitivity in comparison to a rapid culture screening assay. Because most cCMV infections remain asymptomatic, a universal screening assay that stratifies CMV infected infants according to low and high risk of late-onset cCMV disease could limit the parental anxiety and reduce follow-up costs. We therefore developed and characterized a screening algorithm based on a highly-sensitive quantitative real-time PCR assay that is compatible with centralized testing of samples from universal screening and allows to determine CMV DNA load of saliva samples either as International Units (IU)/ml saliva or IU/105 cell equivalents. 18 of 34 saliva samples of newborns that tested positively by the screening algorithm were confirmed by detection of CMV DNA in blood and/or urine samples obtained during the first weeks of life. All screening samples that could not be confirmed had viral loads of <2.3x105 IU/ml saliva (median: 6.8x103) or 1.3x105 IU/105 cell equivalents (median: 4.0x102). The viral load of screening samples with confirmed cCMV infection ranged from 7.5x102 to 8.2x109 IU/ml saliva (median: 9.3x107) or 1.5x102 to 5.6x1010 IU/105 cell equivalents (median: 3.5x106). Clinical follow-up of these newborns with confirmed cCMV infection should reveal whether the risk of late-onset cCMV disease correlates with CMV DNA load in early life saliva samples and whether a cut-off can be defined identifying cCMV infected infants with or without risk for late-onset cCMV disease.
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Affiliation(s)
- Angela Nagel
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany
- * E-mail:
| | - Emmanouela Dimitrakopoulou
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Norbert Teig
- Department of Pediatrics, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Peter Kern
- Department of Gynecology, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Thomas Lücke
- Department of Pediatrics, St. Josef-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Dariusz Michna
- Department of Pediatrics, Elisabeth-Hospital Essen, Germany
| | - Klaus Korn
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany
| | - Philipp Steininger
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany
| | - Khalid Shahada
- Audiology and Balance Center, Hamad Medical Corporation, Doha, Qatar
| | - Katrin Neumann
- Department of Otorhinolaryngology, Head and Neck Surgery, Division of Phoniatrics and Pediatric Audiology, St. Elisabeth-Hospital, Ruhr University Bochum, Bochum, Germany
| | - Klaus Überla
- Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany
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Frick MA, Barba I, Fenoy-Alejandre M, López-López P, Baquero-Artigao F, Rodríguez-Molino P, Noguera-Julian A, Nicolás-López M, de la Fuente-Juárez A, Codina-Grau MG, Esperalba Esquerra J, Linde-Sillo Á, Soler-Palacín P. 1H-NMR Urinary Metabolic Profile, A Promising Tool for the Management of Infants with Human Cytomegalovirus-Infection. Metabolites 2019; 9:metabo9120288. [PMID: 31775291 PMCID: PMC6949898 DOI: 10.3390/metabo9120288] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 11/14/2019] [Accepted: 11/23/2019] [Indexed: 02/07/2023] Open
Abstract
Congenital human cytomegalovirus (HCMV) infection is the most common mother-to-child transmitted infection in the developed world. Certain aspects of its management remain a challenge. Urinary metabolic profiling is a promising tool for use in pediatric conditions. The aim of this study was to investigate the urinary metabolic profile in HCMV-infected infants and controls during acute care hospitalization. Urine samples were collected from 53 patients at five hospitals participating in the Spanish congenital HCMV registry. Thirty-one cases of HCMV infection and 22 uninfected controls were included. Proton nuclear magnetic resonance (1H-NMR) spectra were obtained using NOESYPR1D pulse sequence. The dataset underwent orthogonal projection on latent structures discriminant analysis to identify candidate variables affecting the urinary metabolome: HCMV infection, type of infection, sex, chronological age, gestational age, type of delivery, twins, and diet. Statistically significant discriminative models were obtained only for HCMV infection (p = 0.03) and chronological age (p < 0.01). No significant differences in the metabolomic profile were found between congenital and postnatal HCMV infection. When the HCMV-infected group was analyzed according to chronological age, a statistically significant model was obtained only in the neonatal group (p = 0.01), with the differentiating metabolites being betaine, glycine, alanine, and dimethylamine. Despite the considerable variation in urinary metabolic profiles in a real-life setting, clinical application of metabolomics to the study of HCMV infection seems feasible.
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Affiliation(s)
- Marie Antoinette Frick
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Pediatrics Department, Children’s Hospital, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | | | - Marina Fenoy-Alejandre
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Pediatrics Department, Children’s Hospital, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | - Pere Soler-Palacín
- Pediatric Infectious Diseases and Primary Immunodeficiencies Unit, Pediatrics Department, Children’s Hospital, Vall d’Hebron Barcelona Hospital Campus, 08035 Barcelona, Spain
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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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