Urine viral load and correlation with disease severity in infants with congenital or postnatal cytomegalovirus infection
Section snippets
Background
Cytomegalovirus (CMV) is the most common cause of congenital infection in newborns with a reported incidence of 0.2–2%.1, 2 These infants may be at risk of developing neurodevelopmental sequelae, including sensorineural hearing loss (SNHL). Previous studies have shown that high CMV load in blood and urine correlate with symptomatic CMV disease3, 4, 5, 6 and development of adverse sequelae.7 In contrast to congenital CMV infection, acquisition of CMV in the postnatal period, mostly through
Objectives
We aimed to study the relationship between urine viral load in preterm infants with postnatal CMV infection and severity of disease, based on clinical symptoms of CMV disease and cerebral involvement determined by cranial ultrasonography (cUS) and magnetic resonance imaging (MRI). Furthermore, we aimed to compare the CMV urine load of these infants with the CMV urine load of congenitally infected infants.
Congenital CMV infection
From July 2000 until February 2010 all infants diagnosed with congenital CMV infection and admitted to the level 3 neonatal intensive care unit (NICU) of the University Medical Center Utrecht, The Netherlands, were included. Congenital CMV infection was confirmed by positive CMV PCR of urine collected within 2 weeks after birth. Symptomatic congenital CMV infection was diagnosed using CMV PCR of urine when signs and symptoms of CMV infection were present at birth (microcephaly, growth
Congenital CMV infection
Seventeen (eleven term and six preterm) infants were diagnosed with congenital CMV infection (Table 1). Urine was collected shortly after birth in all infants (median age 1 day, range 0–12 days). Thirteen of 17 (76%) infants were symptomatic: growth retardation (2/17), microcephaly (1/17), hepatitis (2/17), hepatosplenomegaly (4/17), petechia (4/17), thrombocytopenia (8/17), neutropenia (1/17), seizures (1/17) and abnormal hearing test at birth (4/17). Eleven of 17 infants (65%) had cerebral
Discussion
Our data are the first showing that CMV load in urine of infants with postnatally acquired CMV infection is significantly lower than CMV load in urine of infants with congenital CMV infection.
Postnatally acquired CMV infection is common among preterm infants who receive breast milk from CMV seropositive mothers.10, 15 Short-term consequences of postnatal CMV infection in these preterm infants have been described previously.9, 10, 11 Long-term consequences of this infection with regard to
Funding
None.
Competing interests
None.
Ethical approval
The Medical Ethics Committee of the hospital approved this study.
Acknowledgements
None.
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