Blood viral load in the diagnostic workup of congenital cytomegalovirus infection

Smiljkovic, Mina; Meur, Jean-Baptiste Le; Malette, Brigitte; Boucoiran, Isabelle; Minsart, Anne-Frédérique; Lamarre, Valérie; Tapiéro, Bruce; Renaud, Christian; Kakkar, Fatima

doi:10.1016/j.jcv.2019.104231

Cited by 21 publications

(28 citation statements)

References 29 publications

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“…Moreover, the study found a relevant association between higher VL at birth and CNS involvement. This was consistent with a notable study that found statistically relevant differences in quantitative PCR at birth among newborns with moderate-to-severe symptoms and among those with the proven neurological disease [ 76 ]. Smilkovic et al [ 76 ] concluded that although there is no VL cut-off to distinguish symptomatic and asymptomatic infants, patients whose baseline viremia was above 100,000 copies/mL had a probability of having moderate-to-severe symptoms that reached 100%.…”

Section: Neonatal Screening and Diagnosissupporting

confidence: 92%

“…This was consistent with a notable study that found statistically relevant differences in quantitative PCR at birth among newborns with moderate-to-severe symptoms and among those with the proven neurological disease [ 76 ]. Smilkovic et al [ 76 ] concluded that although there is no VL cut-off to distinguish symptomatic and asymptomatic infants, patients whose baseline viremia was above 100,000 copies/mL had a probability of having moderate-to-severe symptoms that reached 100%. Some other studies suggested that VL might predict late-onset SNHL, although the results came from small population studies with short-term follow-up [ 77 , 78 ].…”

Section: Neonatal Screening and Diagnosissupporting

confidence: 92%

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Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment

et al. 2020

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Congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection and is the leading non-genetic cause of sensorineural hearing loss (SNLH) and an important cause of neurodevelopmental disabilities. The risk of intrauterine transmission is highest when primary infection occurs during pregnancy, with a higher rate of vertical transmission in mothers with older gestational age at infection, while the risk of adverse fetal effects significantly increases if fetal infection occurs during the first half of pregnancy. Despite its prevalence and morbidity among the neonatal population, there is not yet a standardized diagnostic test and therapeutic approach for cCMV infection. This narrative review aims to explore the latest developments in the diagnosis and treatment of cCMV infection. Literature analysis shows that preventive interventions other than behavioral measures during pregnancy are still lacking, although many clinical trials are currently ongoing to formulate a vaccination for women before pregnancy. Currently, we recommend using a PCR assay in blood, urine, and saliva in neonates with suspected cCMV infection. At present, there is no evidence of the benefit of antiviral therapy in asymptomatic infants. In the case of symptomatic cCMV, we actually recommend treatment with oral valganciclovir for a duration of 12 months. The effectiveness and tolerability of this therapy option have proven effective for hearing and neurodevelopmental long-term outcomes. Valganciclovir is reserved for congenitally-infected neonates with the symptomatic disease at birth, such as microcephaly, intracranial calcifications, abnormal cerebrospinal fluid index, chorioretinitis, or sensorineural hearing loss. Treatment with antiviral drugs is not routinely recommended for neonates with the mildly symptomatic disease at birth, for neonates under 32 weeks of gestational age, or for infants more than 30 days old because of insufficient evidence from studies. However, since these populations represent the vast majority of neonates and infants with cCMV infection and they are at risk of developing late-onset sequelae, a biomarker able to predict long-term sequelae should also be found to justify starting treatment and reducing the burden of CMV-related complications.

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Section: Neonatal Screening and Diagnosissupporting

confidence: 92%

Section: Neonatal Screening and Diagnosissupporting

confidence: 92%

Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment

et al. 2020

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“…It should be underlined that a higher viral load might be connected with an increased risk of unfavorable sequelae of cCMV infection [ 52 , 53 ]. The neonatal viral load (>100,000 copies/mL) has been reported as a very good predictor of symptomatic cCMV infection [ 54 ]. Moreover, an association between viral load and the number of symptoms has also been reported.…”

Section: Discussionmentioning

confidence: 99%

Single Nucleotide Polymorphisms of Interleukins and Toll-like Receptors and Neuroimaging Results in Newborns with Congenital HCMV Infection

Czech‐Kowalska

Jedlińska-Pijanowska

Pleskaczyńska

et al. 2021

Viruses

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Congenital cytomegalovirus infection (cCMV) is the most common intrauterine infection with central nervous system (CNS) involvement. There is limited data on the associations between Single Nucleotide Polymorphisms (SNPs) in genes involving the first-line defense mechanism and the risk of CNS damage during cCMV. We investigated the associations between neuroimaging findings and SNPs in genes encoding the following cytokines and cytokine receptors in 92 infants with cCMV: interleukins (IL1B rs16944, IL12B rs3212227, IL28B rs12979860), C-C motif chemokine ligand 2 (CCL2 rs1024611), dendritic cell-specific intercellular adhesion grabbing non-integrin (DC-SIGN rs735240), Toll-like receptors (TLR2 rs5743708, TLR4 rs4986791, TLR9 rs352140). The SNP of IL1B rs16944 (G/A) was associated with a reduced risk of ventriculomegaly on MRI (OR = 0.46, 95% CI, 0.22–0.95; p = 0.03) and cUS (OR = 0.38, 95% CI, 0.0–0.93; p = 0.034). Infants carrying heterozygous (T/C) genotype at IL28B rs12979860 had an increased risk of cystic lesions on cUS (OR = 3.31, 95% CI, 1.37–8.01; p = 0.0064) and MRI (OR = 4.97, 95% CI, 1.84–13.43; p = 0.001), and an increased risk of ventriculomegaly on MRI (OR = 2.46, 95% CI, 1.03–5.90; p = 0.04). No other associations between genotyped SNPs and neuroimaging results were found. This is the first study demonstrating new associations between SNPs of IL1B and IL28B and abnormal neuroimaging in infants with cCMV.

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“…Un estudio multicéntrico, realizado en 73 RN con CMVc sintomático, señala que la mayor carga viral al diagnóstico se correlaciona con la presencia de trombocitopenia, aumento de transaminasas y compromiso del SNC, sin existir aún un punto de corte determinado y con escaso valor predictor en relación al pronóstico neurológico y auditivo a largo plazo 138 . Si bien aún no existe un valor de corte de carga viral que permita diferenciar entre RN sintomáticos y asintomáticos, se ha observado que un RN con viremia > 10.000 copias/ml (log 4) al diagnóstico tiene una probabilidad de presentar una enfermedad moderada-grave cercana al 75%, y por ende requiere tratamiento antiviral 139 . Por otra parte, hay que recordar que una carga viral en sangre negativa no descarta el diagnóstico de CMVc 135 , ya que entre el 10% y el 20% de los RN no tienen viremia detectable al momento de la evaluación 134,135 .…”

Section: Evaluación De Laboratoriounclassified

“…El seguimiento de la carga viral para la evaluación de la respuesta durante el tratamiento es aún discutido. Su detección al inicio del tratamiento se ha correlacionado con la presencia de síntomas en el RN, pero el valor de corte aún no está claramente establecido 139 . Marsico et al 138 publicaron un análisis de la medición de la carga viral en los pacientes incluidos en los dos estudios clínicos prospectivos que evaluaron el uso de VGCV en lactantes con CMVc sintomático 134 .…”

Section: Mediante La Carga Viralunclassified

Recomendaciones para el diagnóstico y el manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido

Izquierdo¹,

Sandoval²,

Abarzúa-Camus³

et al. 2024

RECHOG

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infección por citomegalovirus (CMV) en la mujer embarazada y el recién nacido. Esta guía aborda el manejo de la infección en el binomio, su enfrentamiento diagnóstico y terapéutico, orientado al equipo de salud que atiende a mujeres embarazadas y recién nacidos con infección por CMV en Chile. Considera la situación epidemiológica global y latinoamericana, con recomendaciones para la evaluación clínica y de laboratorio; establece criterios de diagnóstico, propone enfoques terapéuticos de acuerdo a la situación clínica, analiza las medidas de prevención y establece una propuesta nacional para el seguimiento de esta enfermedad. Se ha puesto especial énfasis en entregar, de forma práctica, y con la mayor evidencia posible, las recomendaciones para el manejo del binomio con infección por CMV.

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Blood viral load in the diagnostic workup of congenital cytomegalovirus infection

Cited by 21 publications

References 29 publications

Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment

Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment

Single Nucleotide Polymorphisms of Interleukins and Toll-like Receptors and Neuroimaging Results in Newborns with Congenital HCMV Infection

Recomendaciones para el diagnóstico y el manejo de la infección por citomegalovirus en la mujer embarazada y el recién nacido

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