Congenital Cytomegalovirus Infection in High‐Risk Canadian Infants: Report of a Pilot Screening Study

Vaudry, Wendy; Rosychuk, Rhonda J.; Lee, Bonita E.; Cheung, Po Yin; Pang, X.L.; Preiksaitis, Jutta K.

doi:10.1155/2010/942874

Cited by 35 publications

(28 citation statements)

References 49 publications

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“…Duration of previous hospitalizations did not prove to be a risk factor in this study in spite of the literary data. 9 Prematurity is a risk factor according to some authors 9,15 , but this fi nding is refuted by others 5,10,11 , as do the authors of the present study. Low family income, rearing in an orphanage and infusion of bioproducts, which showed no correlation with CMV infection in the present study, are risk factors according to some authors 1,9 but not to others 11,15 .…”

Section: Discussioncontrasting

confidence: 52%

“…[1][2][3] The population rate of congenital CMV infection ranges from 0.04% to 2.2% depending on geographical and socio-economic factors. 2,4,5 Studies conducted in Bulgaria between 1992 and 1997 showed the congenital CMV infection to have a relatively high incidence rate (2.4%) in newborns. 6 However, most of the infections occurring in the fi rst year of life are postnatal or perinatal as a result of which more than one-third of children are CMV seropositive at about 12 months of age.…”

Section: Introductionmentioning

confidence: 99%

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Prevalence of Cytomegalovirus Infection in Hospitalized Infants

Ivanov

Popov²,

Moshe³

et al. 2012

Folia Medica

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Data on cytomegalovirus infection (CMV) prevalence and course in hospitalized infants are rather scarce, obsolete and considerably inconsistent. AIM: to determine the prevalence, rate of clinical manifestations, risk factors and predictive capacity of clinical manifestations of CMV infection in hospitalized infants during their fi rst year of life. PATIENTS AND METHODS: All 163 infants hospitalized in the Pediatric Ward for Nonrespiratory Pathology in a tertiary hospital were serologically screened for cytomegalovirus infection for 10 months. In infants up to 6 months old that were CMV IgG (+) and CMV IgM (-) we followed up the CMV IgG concentration or compared it with that of their mothers. RESULTS: The CMV prevalence for the entire study sample was 33.1 ± 3.7% (54 seropositive out of 163 examined infants); in newborns it was 19.4 ± 6.7% (7 of 36), in infants aged 1-3 months -23.8 ± 5.4% (15 of 63), in 4-6-month olds -28.1 ± 8.1% (9 of 32), and in 7-12-month old -71.9 ± 8.1% (23 of 32). The rates of clinically apparent infections in the respective groups was 33.3 ± 6.5%, 57.01 ± 20.2%, 53.3 ± 13.3%, 33.3 ± 16.6%, and 13.0 ± 7.17%. The overall rate of clinically apparent CMV infection in all 163 children was between 11.0 ± 2.5% and 17.2 ± 2.9%. The probability of CMV infection increased with age and duration of breastfeeding. Hepatitis, cerebral vasculopathy and pneumonia (alone or combined) turned out to be predictors of CMV infection, but none of these symptoms had a frequency greater than 22%. CONCLUSIONS: We found a high rate of cytomegalovirus infections in hospitalized infants less than one year of age. This infection is the reason why at least 10% of the newborns and 12% of the children aged 1 to 3 months were hospitalised. The course was clinically apparent in over half of the infected children of up to 3 months of age.

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Section: Discussioncontrasting

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Prevalence of Cytomegalovirus Infection in Hospitalized Infants

Ivanov

Popov²,

Moshe³

et al. 2012

Folia Medica

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“…The suboptimal sensitivity of the DBS PCR approach was also observed in the present study, in which only half of the newborns with confirmed congenital CMV infection had positive PCR in their DBS samples (Table I). The main factors influencing the low sensitivity of the DBS PCR approach are a lower viral load present in the blood (also observed in this study), the size of DBS used for PCR testing, the choice of method used for DNA extraction and the PCR assay's analytical characteristics [Vaudry et al, 2010;Leruez-Ville et al, 2011]. Body fluids with a higher viral load, such as urine are presumably less affected when using one of the listed less efficient variables.…”

Section: Discussionmentioning

confidence: 54%

“…Molecular methods, such as PCR, are considered currently to be the most appropriate methods for CMV screening of newborns but the question of which clinical sample is best suited for large-scale neonatal CMV screening is still unresolved [Boppana et al, 2010[Boppana et al, , 2011Vaudry et al, 2010;Cannon et al, 2011]. Although three clinical samples, urine, plasma, and DBS, were collected from each neonate for the present study, only urine was screened for CMV DNA due to financial constraints.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of congenital cytomegalovirus infection in Slovenia: A study on 2,841 newborns

Paradiž

Seme

Puklavec

et al. 2011

Journal of Medical Virology

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Human cytomegalovirus (CMV) is the most frequent cause of congenital infection in humans. In the first prevalence study of congenital CMV infection in Eastern and Central Europe, all neonates born in a 22-month period in two Slovenian maternity units (total of 2,841 newborns) were screened prospectively for congenital CMV infection by a real-time polymerase chain reaction (PCR) in urine. In all newborns with positive screening results, plasma and dried blood spots (DBS) collected at birth were tested additionally for CMV DNA. Congenital CMV infection was confirmed by virus isolation from a urine sample collected within the first 2 weeks of life. Congenital CMV infection was identified in four out of 2,841 newborns tested (incidence 0.14%; 95% CI, 0.05-0.39%). In four newborns with confirmed congenital infection, the concentration of CMV DNA in urine ranged from 4.68 to 8.18 log(10) copies/ml, all four newborns had detectable CMV DNA in plasma taken at birth (1.26-3.34 log(10) copies/ml) and two out of four had detectable CMV DNA in DBS collected during newborn metabolic screening. None of the four newborns with confirmed congenital CMV infection was symptomatic. The study showed that the prevalence of congenital CMV infection at birth in Slovenia is among the lowest in the world and that CMV DNA PCR testing of urine is a suitable and affordable real-time screening strategy for congenital CMV infection. If it is performed in 24 mini-pools, the cost of screening is 1.4 €/newborn and the cost of detecting a single newborn with congenital CMV infection 1,000 €.

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“…In Canada, the reported prevalence rate is 0.4 to 1.7% (2). The fetus is infected by viral transmission via the placenta following an episode of viremia in the mother (1).…”

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confidence: 99%

Intraventricular Hemorrhage and Multiple Intracranial Cysts Associated with Congenital Cytomegalovirus Infection

et al. 2013

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c Intraventricular hemorrhage with congenital cytomegalovirus (CMV) infection is rare and has been reported only in extremely premature infants or in association with thrombocytopenia. We report the first case of a full-term male infant with congenital CMV infection and intraventricular hemorrhage with a normal platelet count and coagulation profile. The infant also had a left subependymal cyst and bilateral occipital cysts without any other manifestations of CMV infection. CASE REPORTT he mother of our patient was a 31-year-old woman (gravida 2, para 1) who was rubella and varicella immune, and all of her other serologic findings were negative. The parents were nonconsanguineous, and there was no family history of any bleeding disorder. Ultrasound examinations done at 12, 19, and 30 weeks of gestation showed normal fetal anatomy with a fetus appropriate for its gestational age.The pregnancy was uneventful until 38 weeks of gestation, when the mother felt that fetal movement had decreased. An ultrasound examination revealed asymmetric intracranial ventriculomegaly with the left lateral ventricle larger than the right and strands visible across both ventricles. The occipital horn of the right ventricle was also dilated, and there was echogenicity of the left choroid plexus suggestive of a blood clot (Fig. 1A). Fetal biometry was appropriate for the gestational age, the amniotic fluid index was normal, and the biophysical profile was 8/8.As an intraventricular hemorrhage was suspected, delivery was by cesarean section at 39 weeks of gestation with Apgar scores of 9 and 9 at 1 and 5 min, respectively. His birth weight was 2,790 g, his head circumference was 34 cm, and his length was 48 cm, all of which were appropriate for his gestational age. Except for mild hypotonia, the infant was normal upon examination.Magnetic resonance imaging (MRI) done on day 2 of life showed a moderately dilated left lateral ventricle with a subependymal cyst at the left foramen of Munro extending along the caudothalamic notch, consistent with a previous intraventricular hemorrhage. There were bilateral occipital cysts compressing the occipital horns with a thin intervening septation (Fig. 1B). A small-volume intraventricular hemorrhage was visible in the dependent portion of the left lateral ventricle (Fig. 1C). Myelination was appropriate for a term infant, and magnetic resonance spectroscopy was noncontributory.Given his history and neuroimaging findings, the infant was investigated for a bleeding disorder and bacterial and viral infections. Complete blood counts showed a platelet count of 190 ϫ 10 9 /liter (normal range, 150 ϫ 10 9 to 400 ϫ 10 9 /liter) with normal hemoglobin and white cell counts. The partial thromboplastin time was 46.6 s, and the international normalized ratio was 1.4, both of which were within the normal range for a term infant. Bacterial cultures and tests for parvovirus B19-specific IgM and IgG and toxoplasma-specific IgM and IgG were negative. Both the rapid plasma reagin assay and a line immunoassay (Innogene...

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Congenital Cytomegalovirus Infection in High‐Risk Canadian Infants: Report of a Pilot Screening Study

Abstract: A cCMV screening program should be universal and routine to successfully screen all newborns. Maternal CMV seropositivity varies widely within the Canadian population. In the present pilot study, DBS PCR was not a sensitive screening tool and throat swab was the best screening specimen.

Cited by 35 publications

References 49 publications

Prevalence of Cytomegalovirus Infection in Hospitalized Infants

Prevalence of Cytomegalovirus Infection in Hospitalized Infants

Prevalence of congenital cytomegalovirus infection in Slovenia: A study on 2,841 newborns

Intraventricular Hemorrhage and Multiple Intracranial Cysts Associated with Congenital Cytomegalovirus Infection

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