Human cytomegalovirus load in various body fluids of congenitally infected newborns

Halwachs‐Baumann, Gabriele; Genser, Bernd; Pailer, Sabine; Engele, Heidi; Rosegger, H; Schalk, Andreas; Kessler, Harald H.; Truschnig-Wilders, M.

doi:10.1016/s1386-6532(02)00188-9

Cited by 58 publications

(45 citation statements)

References 17 publications

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“…Recently developed deepsequencing methods (14) have been reported to be highly sensitive because of their ability to detect genotype mixtures in low ratios, but they require a large input of approximately 280 l of whole blood (30 times more than that used in our assay) containing 50,000 to 500,000 CMV DNA copies/ml plasma (14). For comparison, the median CMV DNA whole-blood load in congenitally CMV-infected newborns (symptomatic and asymptomatic newborns) has been reported to be 2,300 copies/ml blood (17).…”

Section: Discussionmentioning

confidence: 99%

Rapid Genotyping of Cytomegalovirus in Dried Blood Spots by Multiplex Real-Time PCR Assays Targeting the Envelope Glycoprotein gB and gH Genes

et al. 2012

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Genotyping of cytomegalovirus (CMV) is useful to examine potential differences in the pathogenicity of strains and to demonstrate coinfection with multiple strains involved in CMV disease in adults and congenitally infected newborns. Studies on genotyping of CMV in dried blood spots (DBS) are rare and have been hampered by the small amount of dried blood available. In this study, two multiplex real-time PCR assays for rapid gB and gH genotyping of CMV in DBS were developed. Validation of the assays with 39 CMV-positive plasma samples of transplant recipients and 21 urine specimens of congenitally infected newborns was successful in genotyping 100% of the samples, with gB1 and gB3 being the most prevalent genotypes. Multiple gB and gH genotypes were detected in 36% and 33% of the plasma samples, respectively. One urine sample from a newborn with symptomatic congenital CMV was positive for gB1 and gB2. DBS of congenitally infected newborns (n ‫؍‬ 41) were tested using 9 l of dried blood, and genotypes were detected in 81% (gB) and 73% (gH) of the samples, with gB3 being the most prevalent genotype. No clear association of specific genotypes with clinical outcome was observed. In conclusion, the CMV gB and gH PCR assays were found to be rapid, sensitive for detecting mixed infections, and suitable for direct usage on DBS. These assays are efficient tools for genotyping of CMV in DBS of congenitally infected newborns. C ytomegalovirus (CMV) is the most common cause of congenital infection worldwide and an important viral pathogen affecting immunocompromised patients (13, 21). Both in congenitally infected newborns and in immunocompromised patients, genotyping of CMV has been used to study potential differences in pathogenicity of specific strains. However, few authors describe a correlation between specific CMV genotypes and severity of disease (29,32,34,40). More important, genotyping of CMV has enabled the discrimination of reactivation of latent virus from reinfection with new CMV strains in transplant patients, allowing a better definition of donor-to-recipient transmission patterns (24). Congenital CMV infections mainly result from recurrent infections among pregnant women (37), comprising both reactivation and reinfection. The discrimination of reactivation from reinfection may give insight into the mother-to-fetus transmission pattern and the possible associations with the outcome of congenital CMV infections.Genotyping of CMV has mainly focused on envelope glycoproteins gB (UL55) and gH (UL75), which play a role in virus entry and are major targets for neutralizing antibody response. The most frequently used methods for genotyping of CMV are nucleotide sequence analysis (27) and restriction fragment length polymorphism of PCR products (25, 28). Recently, real-time PCR-based assays have been used for rapid detection and quantification of CMV gB and gH genotypes (12,15,24,26). However, they have mainly been applied to plasma or other high-volume samples. Also, deep-sequencing-based methods, sensitive in the de...

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Section: Discussionmentioning

confidence: 99%

Rapid Genotyping of Cytomegalovirus in Dried Blood Spots by Multiplex Real-Time PCR Assays Targeting the Envelope Glycoprotein gB and gH Genes

et al. 2012

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“…When relying on a DBS test, we also have to consider that viral DNA levels are lower in peripheral neonatal blood than in urine or saliva. 98,101,102 It is possible that viremia had not yet occurred at the time of sampling. 103 Moreover, as mentioned earlier, length of storage of the DBS might decrease the apparent viral load.…”

Section: Discussionmentioning

confidence: 99%

Hearing Loss and Congenital CMV Infection: A Systematic Review

Goderis¹,

Leenheer²,

et al. 2014

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BACKGROUND AND OBJECTIVE: Hearing loss caused by congenital cytomegalovirus (cCMV) infection was first observed in 1964. Today cCMV is the most common cause of nonhereditary sensorineural hearing loss in childhood. Our objective was to provide an overview of the prevalence of cCMV-related hearing loss, to better define the nature of cCMV-associated hearing loss, and to investigate the importance of cCMV infection in hearing-impaired children. METHODS:Two reviewers independently used Medline and manual searches of references from eligible studies and review articles to select cohort studies on children with cCMV infection with audiological follow-up and extracted data on population characteristics and hearing outcomes. RESULTS:Thirty-seven studies were included: 10 population-based natural history studies, 14 longitudinal cohort studies, and 13 retrospective studies. The prevalence of cCMV in developed countries is 0.58% (95% confidence interval, 0.41-0.79). Among these newborns 12.6% (95% confidence interval, 10.2-16.5) will experience hearing loss: 1 out of 3 symptomatic children and 1 out of 10 asymptomatic children. Among symptomatic children, the majority have bilateral loss; among asymptomatic children, unilateral loss predominates. In both groups the hearing loss is mainly severe to profound. Hearing loss can have a delayed onset, and it is unstable, with fluctuations and progression. Among hearing-impaired children, cCMV is the causative agent in 10% to 20%. Despite strict selection criteria, some heterogeneity was found between selected studies.CONCLUSIONS: This systematic review underscores the importance of cCMV as a cause of sensorineural hearing loss in childhood. Pediatrics 2014;134:972-982

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“…Another possible explanation for the variability in sensitivity between the different methods could be the low viral load in congenitally infected neonates (5,8), necessitating the use of the most sensitive methods. Indeed, testing of DBSs with viral loads at the detection limits of the methods may result in discrepant results.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Different Cytomegalovirus (CMV) DNA PCR Protocols for Analysis of Dried Blood Spots from Consecutive Cases of Neonates with Congenital CMV Infections

et al. 2008

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Two protocols for the extraction of cytomegalovirus (CMV) DNA and two methods for the amplification of CMV DNA in dried blood spots were evaluated for the retrospective diagnosis of congenital CMV infection. During the period from 1996 to 2006, a urine screening program detected 76 congenitally infected neonates. Stored Guthrie cards with blood from 55 cases and 12 controls were tested. Two spots of dried blood were cut from each card and evaluated in two centers. CMV DNA was extracted from a whole single spot. Center 1 used phenol-chloroform extraction and ethanol precipitation followed by a conventional PCR. Center 2 used the NucliSens easyMAG automated DNA/RNA extraction platform (bioMérieux) followed by a real-time PCR. For evaluation of the extraction method, DNA extracted from each blood spot was evaluated by the amplification method used by the collaborating center. The sensitivities were 66% for center 1 and 73% for center 2. None of the controls were positive. A sensitivity as high as 82% could be obtained by combining the most sensitive extraction method (the phenol-chloroform procedure) with the most sensitive PCR method (real-time PCR). The detection rate was not influenced by the duration of storage of the spots. The sensitivity was higher with blood from congenitally infected cases due to a primary maternal CMV infection, regardless of the protocol used. However, the difference reached significance only for the least-sensitive protocol (P ‫؍‬ 0.036).Cytomegalovirus (CMV) infection during pregnancy can be transmitted to the fetus, resulting in a congenital infection. Congenital CMV infection (cCMV) occurs in 0.2 to 2.2% of live-born infants. An incidence of 0.62% is found in the Brussels, Belgium, region (11).The standard diagnosis of cCMV relies on the isolation of the virus from urine or saliva collected in the first 2 weeks of life. The diagnosis of cCMV infection in children older than 2 weeks cannot be made or excluded on the basis of viral isolation. Blood is routinely collected from neonates in the first 2 weeks of life and is stored as dried blood spots (DBSs) on Guthrie cards. The detection of CMV DNA on these stored DBSs could be an opportunity to diagnose cCMV during later life, when symptoms suggestive of cCMV develop (3).The aim of this study was to test the clinical sensitivity of CMV DNA PCR with DBSs from consecutive cases of neonates with cCMV infections. We evaluated two methods for the extraction of CMV DNA and two methods for the amplification of CMV DNA from DBSs on Guthrie cards for the retrospective diagnosis of cCMV. MATERIALS AND METHODSThe study protocol was approved by the Committee of Medical Ethics of the UZ Brussel. cCMV infections. From 1996 to 2006 a neonatal screening program (11) detected cCMV in 76 newborns at the Universitair Ziekenhuis Brussels. The diagnosis of cCMV infection was made by isolation of the virus from urine within 7 days of birth. Blood from the first consecutive 57 cases and from the last 4 cases was retrieved and placed on Guthrie cards (no. 903 ...

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Human cytomegalovirus load in various body fluids of congenitally infected newborns

Cited by 58 publications

References 17 publications

Rapid Genotyping of Cytomegalovirus in Dried Blood Spots by Multiplex Real-Time PCR Assays Targeting the Envelope Glycoprotein gB and gH Genes

Rapid Genotyping of Cytomegalovirus in Dried Blood Spots by Multiplex Real-Time PCR Assays Targeting the Envelope Glycoprotein gB and gH Genes

Hearing Loss and Congenital CMV Infection: A Systematic Review

Evaluation of Different Cytomegalovirus (CMV) DNA PCR Protocols for Analysis of Dried Blood Spots from Consecutive Cases of Neonates with Congenital CMV Infections

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