Auditory and Visual Defects Resulting from Symptomatic and Subclinical Congenital Cytomegaloviral and Toxoplasma Infections

Sensorineural hearing loss was present in ten of 59 (17%) patients with congenital cytomegalovirus (CMV) infection (three of eight born with symptomatic and seven of 51 born with subclinical infection). The defect was bilateral in eight, moderate to profound in eight, and of progressive nature in two. Hearing loss did not occur in 21 patients with natal CMV infection nor in seven of 12 patients with congenital toxoplasmosis. Histopathologic and immunofluorescent studies of the inner ear in two of three neonates who died with severe infection revealed that viral antigens were widely distributed in cochlear structures. Eye pathology was associated only with congenital Toxoplasma (nine of 12) and CMV (seven of 43) infections. Visual impairments were more prominent and severe in those born with symptomatic infections, exclusively so with CMV. However, ocular defects, in particular chorioretinitis, developed after birth in five of eight patients born with asymptomatic congenital toxoplasmosis. These data firmly establish clinically inapparent congenital CMV infection as a major public health problem and confirm the fact that congenital toxoplasmosis may be associated with late-appearing, debilitating chorioretinitis.

Download Full-text

Progressive Hearing Loss in Infants With Asymptomatic Congenital Cytomegalovirus Infection

PEDIATRICS ◽

10.1542/peds.90.6.862 ◽

1992 ◽

Vol 90 (6) ◽

pp. 862-866 ◽

Cited By ~ 1

Author(s):

W. Daniel Williamson ◽

Gail J. Demmler ◽

Alan K. Percy ◽

Francis I. Catlin

Keyword(s):

Hearing Loss ◽

Public Health Problem ◽

The United States ◽

Major Public Health Problem ◽

Cmv Infection ◽

Congenital Cytomegalovirus ◽

Computed Tomographic ◽

Significant Difference ◽

Congenital Cmv Infection ◽

Congenital Cmv

Congenital cytomegalovirus (CMV) infection is a major public health problem because 30 000 to 40 000 neonates with the infection are born each year in the United States. Although 90% of the congenitally infected infants are asymptomatic at birth, evidence is accumulating that these infants are at risk for audiologic, neurologic, and developmental sequelae. The current study describes the audiologic outcome of 59 infants with asymptomatic congenital CMV infection compared with 26 control infants. Eight of 59 infected infants had congenital sensorineural hearing loss (SNHL) but none of the control subjects did. Longitudinal audiologic assessments revealed that 5 of the 8 infants had further deterioration of their SNHL; a ninth infant with initially normal hearing experienced a unilateral SNHL during the first year of life, with further deterioration subseguently. The frequency of SNHL was similar for infected infants born to mothers with recurrent CMV infections during pregnancy (2 of 9) and for those born to mothers who experienced primary CMV infections (5 of 26). There was a significant difference between the occurrence of hearing loss in infected infants with normal computed tomographic scans (2 of 40) compared with those with either periventricular radiolucencies (4 of 13) or calcifications (1 of 3). Children with SNHL often have no identified cause of the loss; thus, it is likely that many of these children had asymptomatic congenital CMV infection. Given the progressive nature of SNHL associated with asymptomatic congenital CMV infection, longitudinal audiologic assessments are mandatory.

Download Full-text

1143. Late-Onset Hearing Loss and Antiviral Therapy for Congenital Cytomegalovirus Infection

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.1329 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S599-S599

Author(s):

Alexandra K Medoro ◽

Cory T Hanlon ◽

Traci Pifer ◽

Maria Reyes Escamilla ◽

Masako Shimamura ◽

...

Keyword(s):

Hearing Loss ◽

Antiviral Therapy ◽

Clinical Laboratory ◽

Late Onset ◽

Antiviral Treatment ◽

Cmv Infection ◽

Congenital Cytomegalovirus ◽

Congenital Cmv Infection ◽

Newborn Hearing ◽

Congenital Cmv

Abstract Background Congenital cytomegalovirus (CMV) is the leading non-genetic cause of sensorineural hearing loss (SNHL) in children. While SNHL is often present at birth, as many as 25% of congenital CMV-infected infants may develop late-onset hearing loss. Antiviral therapy improves hearing outcomes, but its effect on the occurrence of late-onset SNHL is not fully known. Thus, our objective was to describe the prevalence of late-onset SNHL among congenital CMV-infected children treated with antiviral therapy in the first month of age. Methods From 2013 to present, infants with congenital CMV infection referred to Nationwide Children’s Hospital’s (NCH) NEO-ID Clinic, Columbus, OH underwent complete evaluation including hearing testing. Pertinent demographic, clinical, laboratory, and radiographic data were obtained and managed using REDCap electronic data capture tools. Infants who passed the newborn hearing screen and subsequently developed late-onset SNHL were identified and compared with respect to receipt of antiviral therapy in the neonatal period. Statistical analyses were performed using GraphPad Prism for macOS version 8.3.0. Results During the 6-year study period, 99 infants had congenital CMV infection and 69 (70%) of them passed the newborn hearing screen. 46 (46%) neonates received antiviral therapy (1, ganciclovir; 38, valganciclovir; 7, both) for clinically apparent congenital CMV infection. One (2%) child developed late-onset SNHL.This infant was born at 37 weeks’ gestation (birth weight, 2525 g) with microcephaly (head circumference, 31 cm) and cerebral calcifications and was diagnosed with congenital CMV infection at 8 days of age. Treatment with valganciclovir was initiated at 9 days of age, and he developed mild unilateral SNHL at 1 month of age while on treatment and subsequently right severe-profound SNHL and left mild-moderate SNHL. In comparison, among 23 infants with clinically inapparent disease who passed the newborn hearing screen and did not receive antiviral therapy, 5 (22%) subsequently developed SNHL (p=0.014). Conclusion Infants who received antiviral therapy for clinically apparent congenital CMV infection had significantly less late-onset SNHL than untreated infants, thus supporting a hearing protective effect of antiviral treatment. Disclosures All Authors: No reported disclosures

Download Full-text

Modern diagnostic and treatment approaches of congenital cytomegalovirus infection: a clinical case

Ukrainian journal of Perinatology and Pediatrics ◽

10.15574/pp.2020.84.48 ◽

2020 ◽

pp. 48-54

Author(s):

O.H. Shadrin ◽

◽

A.P. Volokha ◽

N.H. Chumachenko ◽

V.M. Fysun ◽

...

Keyword(s):

Cytomegalovirus Infection ◽

Clinical Case ◽

Clinical Manifestations ◽

Severe Infection ◽

Organ Damage ◽

Antiviral Drugs ◽

Cmv Infection ◽

Congenital Cytomegalovirus Infection ◽

Congenital Cytomegalovirus ◽

Congenital Cmv Infection

Cytomegalovirus infection (CMV) is one of the most common causes of fetal infection. Recently fetal infections cause from 11% to 45% of perinatal losses, according to various authors, and are considered to be one of the most likely causes of congenital malformations, which lead to infants disability and reduce quality of life. CMV-infection clinical picture is very diverse, disguised as other diseases. There may be clinical manifestations of both generalized infection and single organ damage, because the virus has tropism to various organs and tissues. Timely diagnosis and treatment are the key to successful therapy of even severe manifestations of congenital CMV-infection in infants. Antiviral drugs usage can be sufficiently justified in patients with severe infection and can prevent complications. A clinical case of a manifest form of cytomegalovirus infection with severe hepatitis in an infant is presented and the therapeutic efficacy and safety of the ganciclovir and valganciclovir antiviral drugs are shown. The study is performed in accordance with principles of the Declaration of Helsinki. The research protocol was approved by the Local Ethics Committee of the institution mentioned in the article. Informed consent of parents was obtained for the research. The authors declare no conflict of interest. Key words: infants, congenital cytomegalovirus infection, ganciclovir, valganciclovir, clinical case.

Download Full-text

CMV AND INFANTILE SPASMS

PEDIATRICS ◽

10.1542/peds.63.2.285 ◽

1979 ◽

Vol 63 (2) ◽

pp. 285-285

Author(s):

R. Riikonen

Keyword(s):

Neonatal Period ◽

Clinical Symptoms ◽

Congenital Toxoplasmosis ◽

Infantile Spasms ◽

Early Years ◽

Cmv Infection ◽

Slow Virus ◽

Congenital Cmv Infection ◽

The Central Nervous System ◽

Slow Virus Infection

At the Children's Hospital, University of Helsinki, 205 children with infantile spasms who were born between 1960 and 1976 were studied in a search for the factors responsible. In 11 children (5%) the infantile spasms were possibly associated with cytomegalovirus (CMV) infection. The number may actually have been considerably higher, as no systematic search was made for CMV, especially in the early years. In four of the 11 children, the infection was probably congenital, and was the most likely cause of the spasms. One of the remaining seven children had congenital toxoplasmosis and the simultaneous CMV infection was probably also congenital. The children with congenital CMV infection exhibited severe clinical symptoms in the neonatal period or in early infancy. Two frequent symptoms were persistent tremor and meningoencephalitis. Later, all five children were severely mentally retarded and had spastic tetraplegia and small heads; three of them had optic atrophy and were blind. In the other six children, the CMV infection was probably acquired, the clinical symptoms being less severe, and the spasms may have been caused by another factor. In two of the 11 cases, immunosuppressive therapy (ACTH treatment generally given for infantile spasms) seems to have caused a fulminant CMV infection. Two children with CMV infection still show signs of a slow virus infection in the central nervous system many years later.

Download Full-text

Should You Follow the Better-Hearing Ear for Congenital Cytomegalovirus Infection and Isolated Sensorineural Hearing Loss?

Otolaryngology ◽

10.1177/0194599819880348 ◽

2019 ◽

Vol 162 (1) ◽

pp. 114-120 ◽

Cited By ~ 1

Author(s):

Vanessa Torrecillas ◽

Chelsea M. Allen ◽

Tom Greene ◽

Albert Park ◽

Winnie Chung ◽

...

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Early Onset ◽

Medical Center ◽

Antiviral Treatment ◽

Sensorineural Hearing ◽

Cmv Infection ◽

Congenital Cytomegalovirus ◽

Delayed Onset ◽

Hearing Thresholds

Objective To describe the progression of sensorineural hearing loss (SNHL) in the better- and poorer-hearing ears in children with asymptomatic congenital cytomegalovirus (CMV) infection with isolated SNHL. Study Design Longitudinal prospective cohort study. Setting Tertiary medical center. Subjects and Methods We analyzed hearing thresholds of the better- and poorer-hearing ears of 16 CMV-infected patients with isolated congenital/early-onset or delayed-onset SNHL identified through hospital-based CMV screening of >30,000 newborns from 1982 to 1992. Results By 12 months of age, 4 of 7 patients with congenital/early-onset SNHL developed worsening thresholds in the poorer-hearing ear, and 1 had an improvement in the better-hearing ear. By 18 years of age, all 7 patients had worsening thresholds in the poorer-hearing ear and 3 patients had worsening thresholds in the better-hearing ear. Hearing loss first worsened at a mean age of 2 and 6 years in the poorer- and better-hearing ears, respectively. Nine patients were diagnosed with delayed-onset SNHL (mean age of 9 years vs 12 years for the poorer- and better-hearing ears), 6 of whom had worsening thresholds in the poorer-hearing ear and 1 in both ears. Conclusion In most children with congenital CMV infection and isolated SNHL, the poorer-hearing ear worsened earlier and more precipitously than the better-hearing ear. This study suggests that monitoring individual hearing thresholds in both ears is important for appropriate interventions and future evaluation of efficacy of antiviral treatment.

Download Full-text

Neonatal screening for congenital cytomegalovirus infection in Tehran, Iran, using Guthrie cards

Iranian Journal of Microbiology ◽

10.18502/ijm.v12i3.3236 ◽

2020 ◽

Author(s):

Samileh Noorbakhsh ◽

Mohammad Farhadi ◽

Faezeh Haghighi ◽

Sara Minaeian ◽

Morteza Haghighi Hasanabad

Keyword(s):

Early Stage ◽

Limited Data ◽

Cmv Infection ◽

Congenital Cytomegalovirus ◽

Congenital Cmv Infection ◽

Effective Counseling ◽

Total Dna ◽

Guthrie Cards ◽

Congenital Cmv

Background and Objectives: Cytomegalovirus (CMV) constitutes the most common viral cause of congenital infections in newborns worldwide. There are a significant number of asymptomatic newborns with congenital CMV infection in Iran, which may develop long-term sequelae of infection. Unfortunately, limited data exsists from Iran on the rate of congenital CMV infection among neonates. The current study was aimed to investigate the prevalence of congenital CMV infection among Iranian neonates by testing Guthrie cards. Materials and Methods: Guthrie cards were collected from infants within 2 weeks of life, and total DNA was extracted from samples by thermal shock and evaluated for CMV DNA using nested-PCR assay. CMV infection in newborns was confirmed through a commercial CMV PCR kit. Infected infants underwent further evaluation at the hospital. Results: CMV infection was identified in four of 1174 infants (0.34%) which is approximately 3 cases per 1000 live births. Infected infants were asymptomatic at birth and had a normal hearing status similar to other children. There were no factors in relation with CMV infection among newborns. Conclusion: According to the results of this study, infected infants with congenital CMV infection could identify at early stage by testing Guthrie cards (within 21 days of life). Furthermore, since there is a lack of CMV knowledge in our popula- tion, educating and effective counseling by obstetricians/ gynecologists to the pregnant women are recommended.

Download Full-text

Early high CMV seroprevalence in pregnant women from a population with a high rate of congenital infection

Epidemiology and Infection ◽

10.1017/s0950268812002695 ◽

2012 ◽

Vol 141 (10) ◽

pp. 2187-2191 ◽

Cited By ~ 17

Author(s):

A. Y. YAMAMOTO ◽

R. A. C. CASTELLUCCI ◽

D. C. ARAGON ◽

M. M. MUSSI-PINHATA

Keyword(s):

Pregnant Women ◽

Primary Infection ◽

Congenital Infection ◽

High Rate ◽

Cmv Infection ◽

Congenital Cytomegalovirus ◽

Younger Age ◽

Congenital Cmv Infection ◽

Stratified Sample ◽

Congenital Cmv

SUMMARYCongenital cytomegalovirus (CMV) infection rates increase with maternal seroprevalence due to transmission from maternal non-primary infection. CMV seroprevalence estimates of pregnant women are needed for planning strategies against congenital CMV transmission. We aimed to determine the age-specific prevalence of serum antibodies for CMV in a representative age-stratified sample of unselected pregnant women from a Brazilian population. A total of 985 pregnant women, aged 12–46 years (median 24 years), were enrolled. Overall CMV seroprevalence was 97% (95% confidence interval 95·8–98·0), with age-specific (years) prevalence as follows: 12–19 (96·3%), 20–24 (97·7%), 25–29 (97·1%), and 30–46 (96·7%). CMV seroprevalence is almost universal (97%) and is found at similar levels in pregnant women of ages ranging from 12 to 46 years. Because high CMV seroprevalence is found even in women of a younger age in this population, this finding suggests that the majority of primary CMV infections occur early, in infancy or childhood. As a consequence, vaccines currently under development to prevent primary infection may not be a solution for the prevention of congenital CMV infection in this population.

Download Full-text

Sensorineural Hearing Loss After Congenital CMV Infection

AAP Grand Rounds ◽

10.1542/gr.20-1-5-a ◽

2008 ◽

Vol 20 (1) ◽

pp. 5-6

Author(s):

M. H. Rathore

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Sensorineural Hearing ◽

Cmv Infection ◽

Congenital Cmv Infection ◽

Congenital Cmv

Download Full-text

Cytomegalovirus congenital infection – cause of neurosensorial hearing loss

Romanian Journal of Infectious Diseases ◽

10.37897/rjid.2016.2.1 ◽

2016 ◽

Vol 19 (2) ◽

pp. 50-53

Author(s):

Dana-Teodora Anton-Păduraru ◽

◽

Ana Simona Drochioi ◽

Delia Bizim ◽

Angelica-Cristina Marin ◽

...

Keyword(s):

Hearing Loss ◽

Cytomegalovirus Infection ◽

Strong Predictor ◽

Public Health Problem ◽

Congenital Infection ◽

Major Public Health Problem ◽

Seroprevalence Rate ◽

Specific Symptoms ◽

The Relationship

Cytomegalovirus infection is a major public health problem, because annually there are born increasingly more children with this infection. Numerous studies have shown that cytomegalovirus infection is an important cause of hearing loss. Cytomegalovirus infection specific symptoms present at birth are a strong predictor for hearing loss, even in populations with low maternal seroprevalence rate. The severity of deafness due to cytomegalovirus infection is variable. Pathophysiology of deafness caused by cytomegalovirus infection is not well known, the mechanisms possible involved being impaired endolymphatic structures, cytopathic effect of the virus and the host response to the inner ear structures. The relationship between viral load and increased likelihood of deafness in infants supports the role of antiviral therapy in decreasing the incidence and the severity of deafness caused by cytomegalovirus. We consider that monitoring children with congenital cytomegalovirus infection should include also hearing monitoring.

Download Full-text

Sensorineural hearing loss in chronic otitis media: analysis of an overlooked entity!

International Journal of Otorhinolaryngology and Head and Neck Surgery ◽

10.18203/issn.2454-5929.ijohns20193883 ◽

2019 ◽

Vol 5 (5) ◽

pp. 1355

Author(s):

Kishore C. Shetty ◽

Samatha K. Jayaramaiah ◽

Biniyam Kolathingal ◽

Shravan Alva

Keyword(s):

Hearing Loss ◽

Sensorineural Hearing Loss ◽

Otitis Media ◽

Bone Conduction ◽

Chronic Otitis Media ◽

Public Health Problem ◽

Media Analysis ◽

Sensorineural Hearing ◽

Major Public Health Problem ◽

Cross Sectional

Background: In developing countries, hearing loss continues to be the major public health problem. Among the various causes of hearing loss, chronic otitis media (COM) is one of the commonest. In COM, the presence of sensorineural hearing loss is well established. Our study intends to determine the prevalence of sensorineural hearing loss in chronic otitis media.Methods: This was a cross sectional descriptive study of 151 subjects between the age group of 10 and 60 years. Patients having unilateral chronic otitis media of both mucosal and squamosal types were selected. All patients were evaluated clinically and audiologically. The type, duration of disease and type of perforation is correlated with degree of sensorineural hearing loss. Interaural differences in bone conduction thresholds at 500 Hz, 1 kHz, 2 kHz and 4 kHz were also noted. Results: A statistically significant correlation was noted between type of disease and perforation with hearing loss. A significant interaural difference was noted across the speech frequencies. Sensorineural hearing loss of 19.1% was seen.Conclusions: Significant sensorineural hearing loss is seen in chronic otitis media which was greater in squamosal disease. Statistically significant correlation was noted between type of disease and type of perforation with hearing loss.

Download Full-text