Congenital Cytomegalovirus Infection in Fraternal Twins: A Longitudinal Case Study Examining Neurocognitive and Neurobehavioral Correlates

Abstract

Cytomegalovirus (CMV) is the most ubiquitous member of the herpes virus family and is the leading cause of congenital (vertical) infection in newborns (Fowler, Stagno, & Pass, 2003; Llorente, Steigmeyer, Cooper, Rivers, & Gazley, 2011; Noyola et al., 2000; Steigmeyer & Llorente, 2010). CMV is related to the group of viruses capable of causing more pernicious infectious diseases, such as chicken pox (Santos de Barona, 1998). Although the virus generally remains dormant, individuals whose symptoms are clinically apparent often are dramatically affected. Common symptomatic characteristics of the virus include microcephaly, jaundice, liver-spleen infections, pneumonia, cardiac anomalies, chorioretinitis, vision loss, sensory-neural hearing loss, mental retardation, and mononucleosis (Demmler, 1991; Kashden, Frison, Fowler, Pass, & Boll, 1998; Noyola et al., 2000; Pass, 2005; Santos de Barona). The prognosis of individuals with CMV is highly variable, and the prognosis of individuals with congenital CMV can usually be determined based on the extent of infection at birth. The purpose of this investigation is to present longitudinal results of neuropsychological evaluation of two dizygotic twin sets (one twin of each set is asymptomatic CMV-positive and the other is uninfected) who were reared in the same environment. In addition, the present findings are discussed within the context of emerging murine and other animal analogues of CMV as well as within the extant CMV literature.

Association between Exposure to HSV1 and Cognitive Functioning in a General Population of Adolescents. The TRAILS Study

“…In a recent case study, two adolescent homozygote twin pairs were followed, in which one of the pair was seropositive for CMV and the other seronegative. In both pairs, there was no difference in neurocognitive development between the seropositive and the seronegative twin [51]. Together with our findings, this suggests that CMV is not predictive for cognitive performance in adolescents.…”

Congenital cytomegalovirus infection in monozygotic twins with twin-to-twin transfusion syndrome

“…Most previous reports of congenital CMV infection in twins discussed diamnionic-dichorionic patients whose genetic predisposition, gestational age at infection, and viral load were suggested to be definitive factors in the manifestation of infection [3][4][5][6][7]. In our patients, the former two factors were the same because of their monozygosity and continuous blood exchange.…”

Comparison of Presentation, Course, and Outcome of Congenital and Acquired Cytomegalovirus Infection in Twins

“…Even though initially he had no neurological symptoms, cranial ultrasound on day 5 of life showed heterogeneous, echogenic bilateral masses within the ventricular system indicative of bilateral germinal matrix hemorrhage; magnetic resonance imaging (MRI) at the age of 2 months revealed hyperintensity on fluid attenuated inversion recovery sequences were suggestive of white matter rarefaction and cystic degeneration. 5 6 …”