Asymptomatic cCMV Research Articles

Clinical characteristics, audiological and neurodevelopmental outcomes of newborns with congenital cytomegalovirus infection.

Congenital cytomegalovirus (cCMV) infections are the leading nongenetic cause of congenital sensorineural hearing loss (SNHL); however the true impact of cCMV infections remains unknown. (1) To identify the number of asymptomatic and symptomatic cCMV infections diagnosed between 1999 and 2014 at the Lausanne University Hospital; (2) to describe the audiological and neurodevelopmental outcomes of infants with cCMV infection; and (3) to compare clinical outcomes between infants born to mothers with primary versus nonprimary infection. This was a single-centre, observational, exploratory, retrospective study of newborns diagnosed with cCMV infection at the Lausanne University Hospital between 1999 and 2014. Fifty newborns with cCMV infection were identified; 39 (78%) were symptomatic at birth, of whom 29 (74%) were neurologically symptomatic. Twelve children (24%) presented with subsequent abnormal audiological and/or neurodevelopmental outcomes. Newborns born to mothers with a nonprimary infection were more often symptomatic at birth than those born to mothers with a primary infection. All infants with subsequent SNHL or abnormal neurodevelopment were symptomatic at birth. Similar long-term neurodevelopmental and audiological outcomes were observed in infants born to mothers with a primary and nonprimary infection.

Hearing in Children with Congenital Cytomegalovirus Infection: Results of a Longitudinal Study

To evaluate hearing outcome, to characterize the nature of symptomatic and asymptomatic congenital cytomegalovirus (cCMV) infection and associated hearing loss, and to compare results with data from previous studies. A prospective multicenter registry was set up in 2007. Six centers participated in the development of a standardized protocol for diagnosis, treatment, and follow-up. Data were gathered in an online registry. Children (n=379) with a documented cCMV infection and at least 2 separate audiologic evaluations were included. Audiometric results from a multicenter cohort study of children with cCMV infection with longitudinal observation were examined. Results from 123 children with a symptomatic and 256 children with an asymptomatic cCMV infection were analyzed. In the group with symptomatic cCMV, 63% had hearing loss, compared with 8% in the group with asymptomatic cCMV. Delayed-onset hearing loss occurred in 10.6% of symptomatic cCMV and in 7.8% of asymptomatic cCMV. In the group with symptomatic cCMV, 29.3% of children used some kind of hearing amplification; 1.6% in the group with asymptomatic cCMV used hearing amplification. Symptomatic and asymptomatic cCMV infections are a major cause of hearing loss in childhood. Reliable estimates of the long-term outcome of cCMV infection are mandatory to increase vigilance, especially among pregnant women and to draw attention to preventive measures, vaccine development, and prenatal and postnatal therapy. Universal screening of newborns for cCMV infection should be initiated and combined with longitudinal audiometric follow-up.

Early motor development of children with a congenital cytomegalovirus infection

BackgroundCongenital cytomegalovirus (cCMV) infection is the most important etiology of non-hereditary childhood hearing loss and an important cause of neurodevelopmental delay. The current study aimed to investigate the early motor development of symptomatic and asymptomatic cCMV infected children with and without sensorineural hearing loss (SNHL). MethodsSixty-four children with a cCMV infection, without cerebral palsy, were compared to a control group of 107 normal hearing children. They were assessed around the ages of 6, 12, and 24 months with the Peabody Developmental Motor Scales-2 (PDMS-2), Alberta Infant Motor Scales (AIMS), and Ghent Developmental Balance Test (GDBT). The cCMV infected children were subdivided into a symptomatic (n=26) and asymptomatic cCMV group (n=38) but also into a cCMV group with SNHL (n=19) and without SNHL (n=45). ResultsSymptomatic cCMV infected children and cCMV infected children with SNHL performed significantly weaker for all gross motor outcome measures. ConclusionA congenital CMV infection is a risk factor for a delay in the early motor development. Follow-up will be necessary to gain insight into the exact cause of this motor delay and to define the predictive value of early motor assessment of cCMV infected children.

Lenticulostriated vasculopathy is a high-risk marker for hearing loss in congenital cytomegalovirus infections.

This study investigated the relationship between lenticulostriated vasculopathy (LSV) and hearing loss in 141 infants with congenital cytomegalovirus (cCMV) infection. We included all infants with cCMV infection who were followed in our clinic for more than a year with only LSV signs of brain involvement on initial brain ultrasound. Group one comprised 13 infants with no hearing impairment at birth who were not treated with gan/valganciclovir during 2006-2009. Group two was 51 infants with LSV and no hearing impairment who had been treated since mid-2009. Group three was 25 infants born with LSV and hearing loss, who had been treated from birth. Group four was 52 control infants born during the same period with asymptomatic cCMV. Hearing tests were performed during the neonatal period and every four to six months until four years of age. Hearing deterioration was more extensive in group one (85%) than in group two (0%, p<0.001) and the asymptomatic group (10%, p<0.001) and occurred more often in group four (10%) than in group two (0%, p=0.008). Lenticulostriated vasculopathy was common in infants with cCMV infection and may serve as a sign of central nervous system involvement and further hearing deterioration. Antiviral treatment may be prudent in such infants.

Outcome of cochlear implantation in asymptomatic congenital cytomegalovirus deafened children

Congenital cytomegalovirus (cCMV) infection is a common cause of sensorineural hearing loss (SNHL). The incidence of SNHL is higher in symptomatic cCMV infants and is usually identified early. By contrast, the incidence of SNHL is lower in children with asymptomatic cCMV, and the hearing loss can be delayed in onset and progressive. The objective was to compare the outcome of cochlear implantation in children deafened by cCMV with a control group of children with implants who do not have the condition. Retrospective review of case notes and data base. Retrospective review of 14 children with asymptomatic cCMV who underwent cochlear implantation. Their outcome measures were compared with those of a matched population by using standard assessment tools. In the study group, the Modified Categories of Auditory Performance (M-CAP) score (range, 1-7) ranged from 2 to 7 (mean, 4.2). In the control group, the M-CAP ranged from 5 to 7 (mean, 6.0). In the study group, the Manchester Spoken Language Development Scale (MSLDS) score (range, 1-10) ranged from 1 to 9 (mean, 5.4). In the control group, the MSLDS ranged from 3 to 10 (mean, 8.1). Children with asymptomatic deafness caused by cCMV benefit from cochlear implantation but perform less well than a comparable group of children with implants who do not have cCMV. There is a range of performance in the cCMV group that may relate to the degree of motor or cognitive disabilities.

Cochlear Implantation in Infants Deafened by Congenital Cytomegalovirus

Congenital cytomegalovirus (cCMV) is the most common intra-uterine viral infection in most developed countries. In Flanders (Belgium), Foulon and colleagues (2008) found a prevalence of approximately 0.53 per cent. Moreover, cCMV has been identified as the leading cause of non-genetic congenital sensorineural hearing loss (SNHL) in infants. The vast majority of infected newborns are asymptomatic at birth (90%), although 7–21 per cent of patients are at risk for developing SNHL, neurologic deficits, and behavioural problems later on in life (Dahle et al., 2000; Foulon et al., 2008). Research has shown that progression, fluctuation, improvement, and late onset SNHL are commonly seen within asymptomatic cCMV children (Fowler et al., 1997). Approximately 10 per cent of the infected infants (symptomatic cCMV children) are born with clinically apparent sequelae, including SNHL, mental retardation, microcephaly, and severe neurologic deficits. Cochlear implantation is of value in the setting of cCMV-associated severe SNHL, although the outcome is less predictive. Case series indicate benefit with good speech and language development (Ramirez-Inscoe et al., 2004; Lee et al., 2005).