Urine polymerase chain reaction as a screening tool for the detection of congenital cytomegalovirus infection

Schlesinger, Yechiel; Halle, David; Eidelman, Arthur I.; Reich, Dan; Dayan, Danit; Rudensky, B; Raveh, David; Branski, David; Kaplan, Martin M.; Shefer, V; Miron, Dan

doi:10.1136/fn.88.5.f371

Cited by 40 publications

(34 citation statements)

References 18 publications

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“…CMV PCR of a urine sample obtained on DOL 12 almost certainly excluded the possibility of congenital infection, given the known sensitivity and specificity of urine PCR for the diagnosis of congenital CMV. 21,27 Despite an initial absence of symptoms, this infant' s systemic viral load continued to rise to 4.8 log 10 genomes/mL on DOL 21 (the last day that DBS samples were available through the immunoreactive trypsinogen study protocol). Although no samples were available to test for CMV DNA between DOL 21 and DOL 33, the viral load on DOL 33 when the patient demonstrated a CMV sepsis syndrome and required surgical intervention for NEC was ∼6 log 10 genomes/mL.…”

Section: Figurementioning

confidence: 99%

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

et al. 2013

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Human cytomegalovirus (CMV) infection may be acquired in very low birth weight and extremely low birth weight (ELBW) infants from breast milk. The clinical relevance of such infections is uncertain. There is no consensus on whether screening breast milk for CMV, freezing/pasteurizing milk before feeding, or performing virological monitoring on at-risk infants is warranted. We describe an ELBW infant who acquired CMV postnatally from breast milk and developed CMV sepsis syndrome and clinical evidence of necrotizing enterocolitis (NEC) at ∼5 weeks of age. The availability of serial dried blood spots from day of life (DOL) 4 to 21, coincidentally obtained for a metabolic study, provided the novel opportunity to retrospectively test for and quantify the magnitude of CMV DNAemia. DNAemia was present for several weeks before the onset of severe CMV disease, first being noted on DOL 18 and increasing in magnitude daily to 4.8 log10 genomes/mL on DOL 21, approximately 8 days before the onset of abdominal distension and 15 days before the onset of CMV sepsis syndrome and NEC. After surgical resection, supportive care, and ganciclovir therapy, the infant recovered. This case underscores the importance of including CMV infection in the differential diagnosis of sepsis and NEC in premature infants. This case also suggests the value of prospective virological monitoring in at-risk low birth weight and ELBW infants. Future studies should examine the potential utility of preemptive monitoring for, and possibly treatment of, CMV DNAemia in premature infants, which may herald the onset of serious disease.

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Section: Figurementioning

confidence: 99%

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

et al. 2013

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“…This might be due to the undetectable amount of CMV-IgM antibodies in cord blood by the method used, the insensitivity of CMVIgM measurement in detecting congenital CMV infection [10], and/or delayed development of CMVIgM in infected fetuses [2].…”

Section: Discussionmentioning

confidence: 99%

Is low birth weight a risk indicator for congenital cytomegalovirus infection?

Al-Hareth

Monem

Megiud

2009

J Infect Dev Ctries

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Background: Congenital cytomegalovirus infection is currently the leading cause of congenital infection in 0.2-2.2% of live births worldwide leading to variable serious sequalae. The aim of the study was to determine if low birth weight is an indicator of CMV congenital infection evidenced by detecting CMV-DNA in umbilical cord blood at the time of delivery. Methodology: CMV-IgG and IgM antibodies and CMV-DNAemia were assessed in umbilical cord blood of two hundreds newborns, one hundred of whom had birth weight ≤ 2700 gram and/or head circumference ≤ 32 cm. Results: CMV-IgM was not detected, while CMV-IgG was positive in 80-90% of the two hundreds tested newborns. CMV-DNA was detected in four out of the 200 newborns. One of them was over the adopted weight limit (> 2700 gram). Conclusions: CMV-IgM and IgG antibodies assessment was not a potential discriminative test to identify congenitally infected newborns. In addition, low birth weight and small head circumference at birth failed to predict congenital CMV infection. CMV-DNA detection in umbilical cord blood at the time of delivery using real-time PCR of all newborns is recommended as decisive, rapid and non-invasive test.

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“…All the urine specimens were processed and used for CMV PCR reaction as recently described by our group in details. 13 In that study we have shown the high sensitivity and specificity of the PCR assay. In a prestudy sensitivity assay, the PCR reaction was positive in 99 of 100 urine specimens (99% sensitivity) spiked with as low as 20 to 30 viral copies/reaction.…”

Section: Methodsmentioning

confidence: 99%

Incidence and Clinical Manifestations of Breast Milk-Acquired Cytomegalovirus Infection in Low Birth Weight Infants

et al. 2005

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OBJECTIVES:To determine the incidence and clinical manifestations of human breast milk (HMB)-associated acquired cytomegalovirus (CMV) infection in small premature infants. STUDY DESIGN:A prospective study of premature infants born at or prior to 32 weeks gestation, and or infants weighing 1500 g or less at birth. The babies were divided into two groups: Group 1 included babies of CMV seropositive mothers who received HBM throughout the study period. Group 2 included babies of seronegative mothers or babies that did not receive HBM at all. Urine sample were obtained once weekly from birth until the age of 8 weeks or until discharge and were tested for the presence of CMV-DNA by PCR. RESULTS:Four of 70 infants from group 1 (5.7%, 95% CI, 0 to 11%) acquired CMV infection between the ages of 3 and 7 weeks as compared to none of 26 babies in group 2. Only one infected baby had severe CMV disease with complete recovery. CONCLUSION:The relative incidence of HBM-associated CMV infection and the severity of HBM-associated CMV disease in premature infants are low.

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Urine polymerase chain reaction as a screening tool for the detection of congenital cytomegalovirus infection

Cited by 40 publications

References 18 publications

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

Asymptomatic DNAemia Heralds CMV-Associated NEC: Case Report, Review, and Rationale for Preemption

Is low birth weight a risk indicator for congenital cytomegalovirus infection?

Incidence and Clinical Manifestations of Breast Milk-Acquired Cytomegalovirus Infection in Low Birth Weight Infants

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