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1.
Zhonghua Er Ke Za Zhi ; 57(8): 597-602, 2019 Aug 02.
Artigo em Chinês | MEDLINE | ID: mdl-31352744

RESUMO

Objective: To study the relationship between human cytomegalovirus (HCMV) envelope glycoprotein gene H and clinical features of children with congenital cytomegalovirus infection. Methods: A cohort study was conducted. Newborns diagnosed with congenital cytomegalovirus infection, hospitalized in the Department of Neonatology and Neonatal Intensive Care Unit (NICU) of the Children's Hospital, Zhejiang University School of Medicine, were included from July 2013 to December 2015.HCMV-DNA gH typing in urine, sputum or blood was conducted. Patients then were divided into gH1 group and gH2 group according to gH genotypes. Patients' data during hospitalization in newborn and 3-5 years of follow-up were collected.The relationships between gH genotype and clinical manifestations, laboratory examinations, hearing loss and neurological prognosis were analyzed by chi-square test, t test and non-parametric test. Results: A total of 21 cases were enrolled as congenital HCMV infection and followed-up for 3-5 years. Among them, 14 (67%) were gH1 type and 7 (33%) were gH2 type. No mixed infection was found. In the two groups, there were no significant differences in the ratio of males (9/14 vs. 3/7,P=0.397), or birth weight ((2 609±686) vs. (3 021±451) g, t=-1.436, P=0.167). Gestational age of gH1 group was younger than that of gH2 group (38 (29-40) vs. 39(38-40) weeks, Z=-2.18, P=0.029). Moderate to severe hearing loss detected by neonatal auditory brainstem response were found in 40 ears (20 cases). It was higher in gH1 group than that in gH2 group (4/22 vs.0/18, χ(2)=5.145, P=0.023). In the imaging examination of the nervous system, the Alarcon score of gH1 group was lower than that of gH2 group (0.4±0.3 vs. 1.3±1.1, t=-2.459,P=0.024).No significant statistical difference was found in the probability of motor or language development lag in gH2 group and gH1 group (4/7 vs.4/14, P=0.346). Conclusions: Compared with gH2 infection, gH1 infection in children has a younger gestational age. The major type of hearing loss in neonatal period is gH1 infection. Children with gH2 congenital infections are more likely to suffer from nervous systems damage.


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/virologia , Citomegalovirus/classificação , Citomegalovirus/genética , Proteínas do Envelope Viral/genética , Criança , Estudos de Coortes , Citomegalovirus/isolamento & purificação , Infecções por Citomegalovirus/genética , Primers do DNA , Genótipo , Humanos , Recém-Nascido , Masculino
2.
J Pediatr Ophthalmol Strabismus ; 56(3): 194-202, 2019 May 22.
Artigo em Inglês | MEDLINE | ID: mdl-31116869

RESUMO

PURPOSE: To describe the presentation, evolution, and long-term outcome of cortical visual impairment (CVI) in patients with symptomatic congenital cytomegalovirus (CMV) infection, and to identify risk factors for the development of CVI in patients with symptomatic congenital CMV. METHODS: Retrospective subanalysis of a long-term prospective cohort study with data gathered from 1982 to 2013. RESULTS: Eleven of 77 (14.3%) patients with symptomatic CMV, 0 of 109 with asymptomatic CMV, and 51 control patients had CVI. Overall, patients with symptomatic CMV had worse vision than patients with asymptomatic CMV, who in turn had worse vision than control patients. Microcephaly, intracranial calcification, dilatation of ventricles, encephalomalacia, seizure at birth, optic atrophy, chorioretinitis/retinal scars, strabismus, and neonatal onset of sensorineural hearing loss were risk factors associated with CVI. CONCLUSIONS: CVI may result from symptomatic congenital CMV infection. The relationship of CVI and its risk factors in patients with CMV suggests the potential to predict the development of CVI through predictive modeling in future research. Early screening of CVI in children born with symptomatic congenital CMV can facilitate educational, social, and developmental interventions. [J Pediatr Ophthalmol Strabismus. 2019;56(3):194-202.].


Assuntos
Infecções por Citomegalovirus/congênito , Citomegalovirus , Transtornos da Visão/etiologia , Acuidade Visual , Córtex Visual/fisiopatologia , Adolescente , Adulto , Criança , Pré-Escolar , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/virologia , Infecções Oculares Virais/complicações , Infecções Oculares Virais/congênito , Feminino , Seguimentos , Idade Gestacional , Humanos , Imagem por Ressonância Magnética , Masculino , Estudos Prospectivos , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Transtornos da Visão/fisiopatologia , Córtex Visual/diagnóstico por imagem , Adulto Jovem
3.
Malays J Pathol ; 41(1): 75-78, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31025643

RESUMO

We report a case of congenital cytomegalovirus and Herpes simplex virus infection suspected via ultrasound indicated by the presence of fetal cerebral abnormalities. The pregnancy was electively terminated at 31 weeks of gestation. The postmortem examination of the foetus showed brain with lissencephaly. The histopathological examination revealed numerous enlarged cells containing cytomegalic inclusions and multinucleated giant cells in multiple fetal organs and placenta. Documented evidence of histopathological detection of cytomegalovirus inclusions in multiple organs are very sparse in literature. This case highlights the causal relationship of viral infections in early pregnancy and abnormalities of the central nervous system.


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/patologia , Feto/patologia , Herpes Simples/congênito , Herpes Simples/patologia , Complicações Infecciosas na Gravidez/patologia , Feminino , Feto/virologia , Humanos , Lisencefalia/patologia , Lisencefalia/virologia , Gravidez
5.
Int J Pediatr Otorhinolaryngol ; 118: 124-127, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30611098

RESUMO

OBJECTIVES: Congenital human cytomegalovirus (cCMV) is a leading cause of pediatric hearing loss. Recent literature has suggested that valganciclovir (VGCV) therapy can improve hearing outcomes. The objective of this study was to evaluate the long-term hearing outcomes among symptomatic CMV patients treated with VGCV. METHODS: A retrospective chart review of symptomatic CMV patients treated with VGCV was completed. The primary endpoint was the change in best ear hearing scores prior to treatment and after follow-up audiograms. A paired-sample t-test was used to evaluate the data. RESULTS: A total of 16 children were included in the study and participants were followed for an average of 3.2 years. There was a measurable worsening, but not a statistically significant change in the best ear hearing scores, where the mean change was 11.9 dB (p-value = 0.070). However, 14/16 patients (87.5%, p-value<0.001) were found to have clinically significant worsening of hearing. The mean change in hearing scores for the left and right ear was 14.2 dB (p-value = 0.023) and 15.5 dB (p-value = 0.032), respectively. Mean elapsed time for progressive loss was 2.6 ±â€¯0.2 years. When comparing the better or worse ear, there was no pattern for which ear deteriorated earlier or more frequently. CONCLUSIONS: Our data did show a measurable, but not a statistically significant worsening outcome in best ear hearing. There was a significant change in both left and right ear hearing. Our results suggest that VGCV may provide only a short-term improvement in hearing outcomes; however, these preliminary post-hoc findings suggest the need for a more rigorous evaluation.


Assuntos
Antivirais/uso terapêutico , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/tratamento farmacológico , Perda Auditiva Neurossensorial/virologia , Valganciclovir/uso terapêutico , Criança , Pré-Escolar , Infecções por Citomegalovirus/congênito , Progressão da Doença , Feminino , Audição , Perda Auditiva Neurossensorial/diagnóstico , Testes Auditivos , Humanos , Lactente , Recém-Nascido , Masculino , Estudos Retrospectivos , Fatores de Tempo
6.
Pediatr Radiol ; 49(5): 687-689, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30612159

RESUMO

Congenital cytomegalovirus infection is one of the most common congenital viral infections in the world. Brain magnetic resonance imaging plays a key role in evaluating brain involvement and establishing prognosis; several characteristic features have been described. We present a description of cerebellar cysts in a neonate with polymerase chain reaction-confirmed cytomegalovirus congenital infection, and discuss the differential diagnosis and potential pathophysiological mechanisms.


Assuntos
Doenças Cerebelares/diagnóstico por imagem , Doenças Cerebelares/virologia , Cistos/diagnóstico por imagem , Cistos/virologia , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/diagnóstico por imagem , Imagem por Ressonância Magnética/métodos , Diagnóstico Diferencial , Feminino , Humanos , Recém-Nascido , Reação em Cadeia da Polimerase
7.
Int J Pediatr Otorhinolaryngol ; 119: 10-14, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30660013

RESUMO

INTRODUCTION: Non-genetic, congenital sensorineural hearing loss (cSNHL) is commonly caused by congenital CMV infection (cCMV). Hearing loss related to cCMV is variable in degree, often progressive, and can affect one or both ears. OBJECTIVES: We sought to examine the outcomes of DBS testing in California, and the hearing outcomes of cCMV-positive children. METHODS: This is a retrospective study of patients with SNHL of unknown etiology aged 6 months to 17 years old presenting to a tertiary care pediatric center and evaluated for cCMV by DBS testing. RESULTS: 114 children (228 ears) with SNHL of unknown origin were included. 6/114 (5.3%) tested positive for cCMV versus 108/114 (94.7%), who tested negative. None of the cCMV-positive children had symmetric bilateral hearing loss, compared with 56.5% (61/108) of cCMV-negative children (p < 0.05). cCMV-positive children were more likely to have profound SNHL in the worse-hearing ear (5/6 (83%) vs 16/108 (14.9%) of cCMV-negative children, p < 0.001). 86% (5/6) exhibited progressive hearing loss, including progression or new-onset hearing loss in the previously better hearing ear. 3 of the 6 children with cCMV underwent CI. CONCLUSION: A small proportion of patients presenting with SNHL tested positive on DBS. Of cCMV-positive children, most presented with profound hearing loss in the worse-hearing ear, and 50% of cCMV-positive children developed progressive hearing loss in the initially better-hearing ear. Prognostic information afforded by etiologic confirmation of cCMV infection informed decision-making concerning cochlear implantation in these cases.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Surdez/virologia , Teste em Amostras de Sangue Seco , Perda Auditiva Neurossensorial/virologia , Adolescente , California , Criança , Pré-Escolar , Implantes Cocleares , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/congênito , Surdez/congênito , Surdez/cirurgia , Progressão da Doença , Feminino , Audição , Perda Auditiva Neurossensorial/congênito , Perda Auditiva Neurossensorial/cirurgia , Humanos , Lactente , Masculino , Estudos Retrospectivos
8.
J Obstet Gynaecol Res ; 45(3): 514-521, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30590863

RESUMO

Human cytomegalovirus (CMV) is a common cause of congenital infection that may lead to severe long-term sequelae. Because there are no established vaccines, fetal interventions or neonatal treatments, neither maternal nor neonatal screening is recommended. However, recent studies have indicated that early antiviral treatment may improve neurological outcomes in symptomatic infants with congenital infection. Therefore, prenatal detection may be important in newborns at high risk of such infection. Polymerase chain reaction for CMV DNA in the amniotic fluid is considered the gold standard for diagnosis of intrauterine infection, but its use is limited because amniocentesis is an invasive procedure. In a prospective cohort study, we have reported that the presence of CMV DNA in secretions of the maternal uterine cervix were predictive of congenital infection in groups at high risk. However, we also recently demonstrated that maternal serological screening for primary CMV infection using specific immunoglobulin G, the immunoglobulin G avidity index or specific immunoglobulin M can overlook many cases. Previous research has indicated that the combination of early detection by universal neonatal screening of urinary CMV DNA combined with early antiviral therapy can improve outcomes in infants with symptomatic congenital infection. In this article, we review the current state of maternal and neonatal screening for congenital CMV infection.


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/diagnóstico , Transmissão Vertical de Doença Infecciosa , Triagem Neonatal/métodos , Líquido Amniótico/virologia , Citomegalovirus/isolamento & purificação , Feminino , Humanos , Recém-Nascido , Estudos Prospectivos
9.
J Matern Fetal Neonatal Med ; 32(4): 617-625, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-28978246

RESUMO

INTRODUCTION: Cytomegalovirus (CMV) is the leading cause of congenital infection worldwide. Data about the management of CMV infection in pregnant women are scarce, and treatment options are very limited. The aim of the study is to investigate the effectiveness of cytomegalovirus hyperimmune globulin (CMV-HIG) for the prevention and treatment of congenital CMV (cCMV) infection. MATERIALS AND METHODS: A retrospective observational study was conducted in three tertiary hospitals in Madrid. In the period 2009-2015, CMV-HIG (Cytotect® CP Biotest, Biotest) treatment was offered to all pregnant women with primary CMV infection and/or detection of CMV-DNA in amniotic fluid in participating centers. Women were divided into prevention and treatment groups (PG and TG, respectively). Those with primary CMV infection who had not undergone amniocentesis comprised the PG and received monthly CMV-HIG (100 UI/kg). If CMV-DNA was subsequently detected in amniotic fluid, one extra dose of CMV-HIG (200 UI/kg) was given 4 weeks after the last dose. Those women were considered to be part of the PG group despite detection of CMV-DNA in amniotic fluid. In the case of a negative result in CMV-DNA detection in amniotic fluid or if amniocentesis was not performed, monthly HIG was given up to the end of the pregnancy. RESULTS: Thirty-six pregnant women were included. Median gestational age at birth was 39 weeks (interquartile range: 38-40) and two children (5.5%) were premature (born at 28 and 34 weeks' gestation). Amniocentesis was performed in 30/36 (83.4%) pregnancies and CMV PCR was positive in 21 of them (70%). One fetus with a positive PCR in amniotic fluid that received one dose of HIG after amniocentesis presented a negative CMV-PCR in urine at birth, and was asymptomatic at 12 months of age. Twenty-four children were infected at birth, and 16/21 (76.2%) presented no sequelae at 12 months, while two (9.5%) had a mild unilateral hearing loss and three (14.3%) severe hearing loss or neurological sequelae. Seventeen women were included in the PG and 19 in the TG. In the PG 7/17 (41%) fetuses were infected, one pregnancy was terminated due to abnormalities in cordocentesis and one showed a mild hearing loss at 12 months of age. In the TG, 18/19 children (95%) were diagnosed with cCMV, while the remaining neonate had negative urine CMV at birth. Eight out of the 19 fetuses (42.1%) showed CMV related abnormalities in the fetal US before HIG treatment. Complete clinical assessment in the neonatal period and at 12 months of age was available in 16 and 15 children, respectively. At birth 50% were symptomatic and at 12 months of age, 4/15 (26.7%) showed a hearing loss and 3/15 (20%) neurologic impairment. Fetuses with abnormalities in ultrasonography before HIG presented a high risk of sequelae (odds ratios: 60; 95%CI: 3-1185; p = .007). DISCUSSION: Prophylactic HIG administration in pregnant women after CMV primary infection seems not to reduce significantly the rate of congenital infection, but is safe and it could have a favorable effect on the symptoms and sequelae of infected fetuses. The risk of long-term sequelae in fetuses without US abnormalities before HIG is low, so it could be an option in infected fetuses with normal imaging. On the other hand, the risk of sequelae among infected fetuses with abnormalities in fetal ultrasonography before HIG despite treatment is high.


Assuntos
Infecções por Citomegalovirus/terapia , Doenças Fetais/prevenção & controle , Imunoglobulinas Intravenosas/administração & dosagem , Complicações Infecciosas na Gravidez/terapia , Adulto , Amniocentese , Líquido Amniótico/virologia , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/prevenção & controle , Feminino , Doenças Fetais/virologia , Humanos , Lactente , Recém-Nascido , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Gravidez , Complicações Infecciosas na Gravidez/virologia , Estudos Retrospectivos , Espanha , Centros de Atenção Terciária , Ultrassonografia Pré-Natal
10.
PLoS Pathog ; 14(12): e1007487, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30571759

RESUMO

Cytomegaloviruses (CMVs) encode cellular homologs to evade host immune functions. In this study, we analyzed the roles of GP33, a guinea pig CMV (GPCMV)-encoded G protein-coupled receptor (GPCR) homolog, in cellular signaling, viral growth and pathogenesis. The cDNA structure of GP33 was determined by RACE. The effects of GP33 on some signaling pathways were analyzed in transient transfection assays. The redET two-step recombination system for a BAC containing the GPCMV genome was used to construct a mutant GPCMV containing an early stop codon in the GP33 gene (Δ33) and a rescued GPCMV (r33). We found the following: 1) GP33 activated the CRE- and NFAT-, but not the NFκB-mediated signaling pathway. 2) GP33 was dispensable for infection in tissue cultures and in normal animals. 3) In pregnant animals, viral loads of r33 in the livers, lungs, spleens, and placentas at 6 days post-infection were higher than those of Δ33, although the viruses were cleared by 3 weeks post-infection. 4) The presence of GP33 was associated with frequent lesions, including alveolar hemorrhage in the lungs, and inflammation in the lungs, livers, and spleens of the dams. Our findings suggest that GP33 has critical roles in the pathogenesis of GPCMV during pregnancy. We hypothesize that GP33-mediated signaling activates cytokine secretion from the infected cells, which results in inflammation in some of the maternal organs and the placentas. Alternatively, GP33 may facilitate transient inflammation that is induced by the chemokine network specific to the pregnancy.


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/imunologia , Efeitos Tardios da Exposição Pré-Natal/virologia , Receptores Acoplados a Proteínas-G/fisiologia , Animais , Feminino , Cobaias , Inflamação/imunologia , Inflamação/virologia , Gravidez , Transdução de Sinais/fisiologia
11.
APMIS ; 126(12): 899-906, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30378168

RESUMO

CMV is the most common cause of congenital infection. During the past few decades, there has been a change in behaviour that possibly has affected the CMV infection rate of mother and child. We investigated 1350 randomly selected pregnant women from the Norwegian Mother and Child Cohort Study using an algorithm for detection of maternal and congenital CMV (cCMV) infection including both serology and nucleic acid amplification assay. The CMV IgG seroprevalence was 54% and 23 (3.7%) mothers seroconverted. Three (0.22%) children had a positive CMV PCR in the umbilical cord blood. The transmission rate was lower than reported in previous studies, probably due to lower sensitivity in plasma compared to saliva and urine. The prevalence of cCMV in the present study was compared with the number registered with the ICD-10 code P.35.1-congenital CMV infection in the Norwegian Patient Register. The number registered was lower than the number of estimated infections. Factors like lower level of education and parity were associated with higher CMV IgG seroprevalence, but no significant difference could be linked to age. In conclusion, in this cohort of pregnant women, a high CMV IgG seroconversion rate was found, while the vertical transmission rate was low.


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/epidemiologia , Citomegalovirus/isolamento & purificação , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/virologia , Adulto , Anticorpos Antivirais/sangue , Criança , Pré-Escolar , Estudos de Coortes , Citomegalovirus/genética , Citomegalovirus/imunologia , DNA Viral/sangue , Ensaio de Imunoadsorção Enzimática , Feminino , Humanos , Imunoglobulina G/sangue , Lactente , Recém-Nascido , Masculino , Noruega/epidemiologia , Reação em Cadeia da Polimerase , Gravidez , Prevalência , Estudos Soroepidemiológicos , Inquéritos e Questionários , Adulto Jovem
14.
Semin Pediatr Neurol ; 26: 88-91, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29961530

RESUMO

Cytomegalovirus (CMV) is the most common congenital virus passed from mother to fetus in the United States, and the most common acquired cause of sensorineural hearing loss. Neuroimaging in patients with symptomatic congenital CMV demonstrates abnormalities frequently, but many providers are unaware of the extent of these findings. We present a case of a 15-month-old girl with progressive sensorineural hearing loss and developmental delays. Magnetic resonance imaging of her brain was done by her otolaryngologist as part of a routine cochlear implant evaluation where it was found to be drastically abnormal and reported as a likely leukodystrophy. It was subsequently found to be related to congenital CMV on further evaluation. Congenital CMV should be considered in the differential of white matter hyperintensities, especially in the setting of sensorineural hearing loss, developmental delays, or both, and given how common CMV is around the world.


Assuntos
Infecções por Citomegalovirus/congênito , Deficiências do Desenvolvimento/etiologia , Perda Auditiva Neurossensorial/etiologia , Encéfalo/diagnóstico por imagem , Infecções por Citomegalovirus/diagnóstico por imagem , Deficiências do Desenvolvimento/diagnóstico por imagem , Deficiências do Desenvolvimento/virologia , Diagnóstico Diferencial , Feminino , Perda Auditiva Neurossensorial/diagnóstico por imagem , Perda Auditiva Neurossensorial/reabilitação , Perda Auditiva Neurossensorial/virologia , Humanos , Lactente
15.
J Pediatric Infect Dis Soc ; 7(3): e160-e162, 2018 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-29860410

RESUMO

Among newborns with congenital cytomegalovirus (CMV) infection from China, there was no difference in CMV viral load in saliva specimens dried and stored at room temperature compared with those kept wet and stored cold, even after longer storage time for the former than the later (74 vs 58 days, P = .02).


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/virologia , Saliva/virologia , Manejo de Espécimes/métodos , Carga Viral , China/epidemiologia , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/imunologia , Teste em Amostras de Sangue Seco , Humanos , Recém-Nascido , Estudos Soroepidemiológicos , Fatores de Tempo
16.
Swiss Med Wkly ; 148: w14627, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29894555

RESUMO

BACKGROUND: Congenital cytomegalovirus (cCMV) infections are the leading nongenetic cause of congenital sensorineural hearing loss (SNHL); however the true impact of cCMV infections remains unknown. AIMS OF THE STUDY: (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. METHODS: This was a single-centre, observational, exploratory, retrospective study of newborns diagnosed with cCMV infection at the Lausanne University Hospital between 1999 and 2014. RESULTS: 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. CONCLUSIONS: 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.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Infecções por Citomegalovirus/epidemiologia , Perda Auditiva Neurossensorial/diagnóstico , Triagem Neonatal , Infecções por Citomegalovirus/congênito , Feminino , Perda Auditiva Neurossensorial/congênito , Testes Auditivos/métodos , Humanos , Lactente , Recém-Nascido , Masculino , Exposição Materna , Mães , Triagem Neonatal/métodos , Estudos Retrospectivos , Suíça/epidemiologia
17.
Jpn J Infect Dis ; 71(4): 309-311, 2018 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-29709989

RESUMO

Cytomegalovirus (CMV) is the most common cause of congenital infection. Pneumonitis is considered to be a rare manifestation although congenital CMV infection presents with various non-specific findings. Ganciclovir and valganciclovir are beneficial for improving neurodevelopmental sequelae and hearing outcomes of congenital CMV infection; however, treatment response evaluation is not well reported. We report a female case of congenital CMV infection presenting with pneumonitis, meningoencephalitis, and chorioretinitis. She was treated with intravenous ganciclovir for 6 weeks, and clinical features improved. Measurement of the CMV genome load by real-time polymerase chain reaction assay was performed during treatment. After the administration of ganciclovir, the CMV genome was not detected in the blood and levels decreased gradually in the urine. Physicians should consider the possibility of congenital CMV infection in neonates who present with respiratory distress. Furthermore, measurement of the CMV genome load in blood and urine may be useful for evaluating treatment response.


Assuntos
Antivirais/administração & dosagem , Infecções por Citomegalovirus/tratamento farmacológico , Citomegalovirus/isolamento & purificação , Monitoramento de Medicamentos/métodos , Ganciclovir/administração & dosagem , Pneumonia/tratamento farmacológico , Carga Viral , Administração Intravenosa , Adulto , Sangue/virologia , Coriorretinite/congênito , Coriorretinite/tratamento farmacológico , Coriorretinite/patologia , Coriorretinite/virologia , Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/patologia , Infecções por Citomegalovirus/virologia , DNA Viral/sangue , DNA Viral/urina , Feminino , Humanos , Recém-Nascido , Meningoencefalite/congênito , Meningoencefalite/tratamento farmacológico , Meningoencefalite/patologia , Meningoencefalite/virologia , Pneumonia/congênito , Pneumonia/patologia , Pneumonia/virologia , Reação em Cadeia da Polimerase em Tempo Real , Urina/virologia
18.
Rinsho Shinkeigaku ; 58(5): 320-323, 2018 May 25.
Artigo em Japonês | MEDLINE | ID: mdl-29710020

RESUMO

A 15-year-old girl presented with non-progressive sensorineural hearing impairment in her right ear since her early childhood. She had normal intellectual development. When she was 15 years old, small deep white matter lesions around the lateral ventricles were incidentally detected in brain MRI studies through further investigation of auditory organs. Laboratory data including cerebrospinal fluid analysis and antibodies to aquaporin-4 or myelin-oligodendrocyte glycoprotein were normal. She was diagnosed as a congenital cytomegalovirus (CMV) infection based on the detection of CMV DNA from preserved umbilical cord tissue by real-time polymerase chain reaction. It should be kept in mind that a case of congenital CMV infection with normal intelligence may be underdiagnosed and that sensorineural hearing impairment from early childhood and deep white matter abnormalities can be key features giving rise to suspicion on congenital CMV infection.


Assuntos
Infecções por Citomegalovirus/congênito , Infecções por Citomegalovirus/diagnóstico , Citomegalovirus/isolamento & purificação , Perda Auditiva Neurossensorial/etiologia , Cordão Umbilical/virologia , Substância Branca/diagnóstico por imagem , Substância Branca/patologia , Adolescente , Citomegalovirus/genética , Infecções por Citomegalovirus/patologia , DNA Viral/isolamento & purificação , Diagnóstico Diferencial , Feminino , Perda Auditiva Neurossensorial/diagnóstico por imagem , Humanos , Inteligência , Testes de Inteligência , Imagem por Ressonância Magnética , Reação em Cadeia da Polimerase em Tempo Real , Valores de Referência
19.
Ital J Pediatr ; 44(1): 31, 2018 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-29490704

RESUMO

BACKGROUND: Since there is no effective treatment or vaccine against the congenital cytomegalovirus (cCMV) infection, knowledge and awareness of medical doctor's (MDs) especially family doctors are essential for preventive strategies and it also seems to be usually ignored by healthcare providers. Aim of this study was to investigate awareness of MDs about cCMV infection in Iran. METHODS: A single page questionnaire was randomly distributed among 450 MDs including general practitioners, pediatricians, gynecologists, internal and other medical specialists concerning of their knowledge in clinical presentation, diagnosis, prevention, prognosis, epidemiology, transmission, and management of cCMV infection. All statistical analyses were performed using SPSS version 16. RESULTS: More than half of questionnaire recipients refused to take part in any of the questionnaire items. The most of the respondents were agreed for newborn CMV screening tests and mandatory CMV test for women trying to get pregnant, which, are not routinely tested. The knowledge of general practitioners about cCMV was less than usual. The field of expertise had a profound effect in this survey, but age and gender did not. CONCLUSIONS: Our results indicated that the knowledge of cCMV infection, especially among family doctors contains several gaps. Urgent action is required to improve family doctor's knowledge of CMV infection. Surveys to evaluate CMV awareness among MDs, healthcare professionals and women of childbearing age are proposed.


Assuntos
Competência Clínica , Infecções por Citomegalovirus/congênito , Vacinas contra Citomegalovirus/farmacologia , Citomegalovirus/imunologia , Médicos de Família/normas , Inquéritos e Questionários , Adulto , Estudos Transversais , Infecções por Citomegalovirus/epidemiologia , Infecções por Citomegalovirus/prevenção & controle , Feminino , Humanos , Incidência , Irã (Geográfico)/epidemiologia , Masculino
20.
Acta Otolaryngol ; 138(8): 708-712, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29513124

RESUMO

OBJECTIVE: Congenital cytomegalovirus (cCMV) infection is the most common congenital infection, with the majority of infected newborns having no detectable signs. The aim of this study was to examine the accuracy of our newly developed DBS-based assay as an appropriate mass screening method for cCMV infection. METHODS: Between May 2011 and October 2016, newborns delivered at six hospitals in Nagano Prefecture, Japan were enrolled prospectively. We employed dried blood spot (DBS)-based assays with real-time quantitative PCR (qPCR). RESULTS: Prior to the clinical study, confirmation analysis was carried out using positive and negative controls. The sensitivity and specificity of this DBS-based qPCR assay for the detection of CMV DNA were 83 and 97%, respectively. During the study period, 9675 newborns were enrolled. The total recovery rate of DBS was 99.92% (9,667/9,675). From our analysis of the 9,667 samples, 47 DBS samples were found positive by the qPCR test (0.48%), and 9620 (99.5%) DBS samples were CMV-negative. CONCLUSIONS: The risk of neural disorders associated with cCMV infection is thought likely to increase with CMV viral load in the blood. DBS screening for cCMV may be sufficient in a clinical setting, and offers a realistic and feasible option for universal mass screening.


Assuntos
Infecções por Citomegalovirus/diagnóstico , Teste em Amostras de Sangue Seco/estatística & dados numéricos , Perda Auditiva/virologia , Triagem Neonatal/métodos , Infecções por Citomegalovirus/complicações , Infecções por Citomegalovirus/congênito , Humanos , Recém-Nascido , Estudos Prospectivos , Sensibilidade e Especificidade
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