Detection Of Congenital Cytomegalovirus Infection Research Articles

Analysis of Dried Blood Spot and Saliva PCR Screening for Detection of Congenital Cytomegalovirus Infection Informs Implementation of a Novel Universal Newborn Screening Program

Analysis of Dried Blood Spot and Saliva PCR Screening for Detection of Congenital Cytomegalovirus Infection Informs Implementation of a Novel Universal Newborn Screening Program

EP498: Detection of congenital cytomegalovirus infection on high-risk newborn population

Congenital cytomegalovirus (cCMV) infections in infants, causes more children to have permanent disabilities than Down syndrome, fetal alcohol syndrome, and pediatric HIV/AIDS combined. Up to 0.5% of babies in the US are born with congenital Cytomegalovirus infection, and 10% of these babies can have symptoms such as hearing loss. This makes congenital CMV infection the leading environmental cause of hearing loss. Upon early detection, babies with congenital CMV infection can be treated with antiviral medicines, which may reduce the risk of hearing loss caused by this infection.

Sensitivity of Dried Blood Spot Testing for Detection of Congenital Cytomegalovirus Infection

The sensitivity of dried blood spots (DBS) to identify newborns with congenital cytomegalovirus (cCMV) infection has not been evaluated in screening studies using the current, higher-sensitivity methods for DBS processing. To assess the sensitivity of DBS polymerase chain reaction (PCR) for newborn screening for cCMV infection using saliva as the reference standard for screening, followed by collection of a urine sample for confirmation of congenital infection. This population-based cohort study took place at 5 newborn nurseries and 3 neonatal intensive care units in the Minneapolis/Saint Paul area in Minnesota from April 2016 to June 2019. Newborns enrolled with parental consent were screened for cCMV using DBS obtained for routine newborn screening and saliva collected 1 to 2 days after birth. Dried blood spots were tested for CMV DNA by PCR at both the University of Minnesota (UMN) and the US Centers for Disease Control and Prevention (CDC). Saliva swabs were tested by CMV DNA PCR at the UMN laboratory only. Newborns who screened positive by saliva or DBS had a diagnostic urine sample obtained by primary care professionals, tested by PCR within 3 weeks of birth. Analysis began July 2019. Detection of CMV from a saliva swab using a PCR assay. Number of children with urine-confirmed cCMV and the proportion of them who were CMV positive through DBS screening. Of 12 554 individuals enrolled through June 2019 (of 25 000 projected enrollment), 56 newborns were confirmed to have cCMV (4.5 per 1000 [95% CI, 3.3-5.7]). Combined DBS results from either UMN or CDC had a sensitivity of 85.7% (48 of 56; 95% CI, 74.3%-92.6%), specificity of 100.0% (95% CI, 100.0%-100.0%), positive predictive value (PPV) of 98.0% (95% CI, 89.3%-99.6%), and negative predictive value (NPV) of 99.9% (95% CI, 99.9%-100.0%). Dried blood spot results from UMN had a sensitivity of 73.2% (95% CI, 60.4%-83.0%), specificity of 100.0% (100.0%-100.0%), PPV of 100.0% (95% CI, 91.4%-100.0%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Dried blood spot results from CDC had a sensitivity of 76.8% (95% CI, 64.2%-85.9%), specificity of 100.0% (95% CI, 100.0%-100.0%), PPV of 97.7% (95% CI, 88.2%-99.6%), and NPV of 99.9% (95% CI, 99.8%-99.9%). Saliva swab results had a sensitivity of 92.9% (52 of 56; 95% CI, 83.0%-97.2%), specificity of 99.9% (95% CI, 99.9%-100.0%), PPV of 86.7% (95% CI, 75.8%-93.1%), and NPV of 100.0% (95% CI, 99.9%-100.0%). This study demonstrates relatively high analytical sensitivity for DBS compared with previous studies that performed population-based screening. As more sensitive DNA extraction and PCR methods continue to emerge, DBS-based testing should remain under investigation as a potential low-cost, high-throughput option for cCMV screening.

Detection of congenital cytomegalovirus infection by real-time polymerase chain reaction analysis of saliva or urine specimens.

Viral culture of urine or saliva has been the gold standard technique for the diagnosis of congenital cytomegalovirus (CMV) infection. Results of rapid culture and polymerase chain reaction (PCR) analysis of urine and saliva specimens from 80 children were compared to determine the clinical utility of a real-time PCR assay for diagnosis of congenital CMV infection. Results of urine PCR were positive in 98.8% of specimens. Three PCR-positive urine samples were culture negative. Results of saliva PCR and culture were concordant in 78 specimens (97.5%). Two PCR-positive saliva samples were culture negative. These findings demonstrate that PCR performs as well as rapid culture of urine or saliva specimens for diagnosing congenital CMV infection and saliva specimens are easier to collect. Because PCR also offers more rapid turnaround, is unlikely to be affected by storage and transport conditions, has lower cost, and may be adapted to high-throughput situations, it is well suited for targeted testing and large-scale screening for CMV.

Detection of congenital cytomegalovirus infection using umbilical cord blood samples in a screening survey

Easy screening and accurate diagnosis of congenital cytomegalovirus (CMV) infection are needed to predict and treat complications. We report the clinical course of two neonates with congenital CMV infection confirmed by real-time polymerase chain reaction (PCR) for CMV DNA in umbilical cord blood. A total of 1,010 neonates born at Yonaha Clinic from July 2005 to March 2007 were investigated. Umbilical cord blood was collected at birth, and DNA was extracted to screen for CMV DNA by real-time PCR. Head MRI and a developmental test were conducted for two cases (0.2%) in which CMV DNA was detected. Neither case showed clear abnormalities at birth, and head CT conducted at 1 month after birth revealed no abnormalities. Auditory brainstem responses were normal at both 1 and 12 months after birth in both cases. Head MRI at 12 months showed abnormalities in both cases. For both cases, development tests conducted at 12 months revealed mild developmental delays, particularly in posture and movement areas, which might have been caused by congenital CMV infection.

Newborn Hearing Screening and Detection of Congenital Cytomegalovirus Infection

The objectives were to determine the frequency of congenital cytomegalovirus infection among newborns who did not pass hearing screening tests or had confirmed hearing loss and to determine how often abnormal hearing screening results were the only manifestation of congenital cytomegalovirus infection. Retrospective chart review was performed for newborns who had abnormal hearing screening results and positive urine cytomegalovirus culture results at Parkland Memorial Hospital between September 1, 1999, and August 31, 2004. During the 5-year study period, 572 of 79047 newborns (7 of 1000 live births) did not pass hearing screening tests. Cytomegalovirus infection was identified in 24 (5%) of 483 tested infants and 16 (6%) of the 256 infants with subsequently confirmed hearing impairment. Of those 16 infants, 12 (75%) were identified as having congenital cytomegalovirus infection only because of failure to pass newborn hearing screening tests. Congenital cytomegalovirus infection was present for 6% of newborns with confirmed hearing impairment, and the majority of those infants were identified on the basis of abnormal newborn hearing screening results.

168 Asymptomatic Congenital Cytomegalovirus Infection

Background: Cytomegalovirus (CMV) is the most common congenital infection in developed countries with reported incidences varying from 0.15% to 2.0%. Congenital CMV infection may be a cause of a congenital syndrome or run without symptoms. Approximately 90% of congenitally infected infants are asymptomatic at birth but may still present handicaps at a later age. Aims: The objectives of the present study were to evaluate the importance of this agent as cause of morbidity and long term sequelae, and to assess the utility of the different methods of congenital CMV infection screening Methods: Between May and August 2002, 757 consecutive newborns were screened for CMV infection by Polymerase Chain Reaction (PCR) in cord blood and through the isolation of CMV by shell-vial from urine on the first two days of life. Epidemiological characteristics of the mothers and newborn were analysed from medical records. Follow-up was done at 3, 6, 9, 12, 15 and 18 months with neurologic, audiologic, ophthalmologic and development assessments. Results: Asymptomatic congenital CMV infection was diagnosed in 5 out of 757 (0.7%) by means of a virus culture in urine. PCR in cord blood was negative in all cases. In three newborns, within the first 3 weeks of life, the clinical findings included: pneumonia (1); bone marrow failure (1); hepatitis (2); basal ganglia vasculitis (2). At 18 months, follow-up of two infants showed short stature (1), minor abnormal neurodevelopment (1) and partial hearing loss (1). Conclusion: The incidence of congenital CMV infection was similar to that reported in other studies on highly immune populations. Urinary CMV culture is a reliable and convenient method, and may be a screening tool for the detection of congenital CMV infection. Infants with asymptomatic congenital CMV infection may have severe diseases that are not clinically evident at birth. In our series of studies, sequelae were found in 3 out of 5 (60%) children. Funded by Science and Technology Foundation

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

Objectives: To define the incidence of congenital cytomegalovirus (CMV) infection in a defined population in Israel as diagnosed by urine polymerase chain reaction (PCR), and to assess the utility of...

Detection of congenital cytomegalovirus infection in Chinese newborn infants using polymerase chain reaction

Polymerase chain reaction (PCR) amplification was used to detect cytomegalovirus (CMV) in 1000 urine specimens from Chinese newborns for defining the incidence of congenital CMV infection in the Chinese population. The major immediate-early and the late antigen genes of CMV were amplified and detected by gel electrophoresis. There were 18 congenitally infected infants found when tests were performed with one or both primer pairs. Comparing with tissue culture, PCR of both primer sets provided a sensitivity of 94%, a specificity of 100% and a predictive value of positive result of 100%.

Detection of congenital cytomegalovirus infection by using chorionic villi of the early pregnancy and polymerase chain reaction

OBJECTIVE: To detect congenital cytomegalovirus (CMV) infection of chorionic villi in early pregnancy. METHODS: Extraction of DNA of chorionic villi and amplification of the gene of major immediate-early (MIE) antigen of CM V using a polymerase chain reaction (PCR). RESULTS: Sixty-eight specimens of chorionic villi and 16 specimens were positive for CMV infection by PCR. The incidence of congenital CMV infection in the first trimester of pregnancy was 23.5%. CONCLUSIONS: The risk of transmission of CMV from mother to fetus in early pregnancy is very high and potential CMV carriers may transmit CMV to their fetus in early pregnancy.