Cytomegalovirus DNA Detection by Polymerase Chain Reaction in Cerebrospinal Fluid of Infants With Congenital Infection: Associations With Clinical Evaluation at Birth and Implications for Follow-up

• Published in: Clinical infectious diseases Vol. 64; no. 10; pp. 1335 - 1342
• Main Authors: Goycochea-Valdivia, Walter-Alfredo, Baquero-Artigao, Fernando, del Rosal, Teresa, Frick, Marie-Antoinette, Rojo, Pablo, Echeverría, María-Juncal, Noguera-Julian, Antoni, Bringué, Xavier, Saavedra-Lozano, Jesús, Vives-Oñós, Isabel, Moliner, Elisenda, Cilleruelo, María-José, Cuadrado, Irene, Colino, Elena, Castells, Laura, Tagarro, Alfredo, Vilas, Javier, Soler-Palacin, Pere, Blázquez-Gamero, Daniel
• Format: Journal Article
• Language: English
• Published: United States Oxford University Press 15-05-2017
• Subjects: Abnormalities; Age; ARTICLES AND COMMENTARIES; Asymptomatic Infections; Babies; Body fluids; Central nervous system; Cerebrospinal fluid; Colony-stimulating factor; Congenital diseases; Congenital infection; Cytomegalovirus; Cytomegalovirus - genetics; Cytomegalovirus - isolation & purification; Cytomegalovirus Infections - complications; Cytomegalovirus Infections - congenital; Cytomegalovirus Infections - diagnosis; Deoxyribonucleic acid; DNA; DNA, Viral - blood; DNA, Viral - cerebrospinal fluid; DNA, Viral - isolation & purification; Evaluation; Female; Fetal Diseases - virology; Follow-Up Studies; Hearing loss; Hearing Loss, Sensorineural - virology; Humans; Infant; Infant, Newborn; Infants; Male; Medical imaging; Microcephaly; Microcephaly - virology; Neonates; Nervous system; Neuroimaging; Neurological complications; Neurology; Patients; Polymerase chain reaction; Polymerase Chain Reaction - methods; Retrospective Studies; Saliva - virology; Spinal Puncture; Viral Load; congenital infection; human cytomegalovirus; polymerase chain reaction; cerebrospinal fluid; pediatrics
• ISSN: 1058-4838; 1537-6591
• DOI: 10.1093/cid/cix105

Background. DNA detection of human cytomegalovirus (hCMV) in cerebrospinal fluid (CSF) by polymerase chain reaction (PCR) is a marker of central nervous system (CNS) involvement in congenital hCMV infection (cCMV), but its prognostic value is unknown. Methods. A multicenter, retrospective study was performed using the Spanish Congenital Cytomegalovirus Infection Database (REDICCMV; http://www.cmvcongenito.es). Newborns with cCMV and a lumbar puncture performed were included and classified according to their hCMV-PCR in CSF result (positive/negative). Clinical characteristics, neuroimaging abnormalities, plasma viral load, and audiological and neurological outcomes of both groups were compared. Results. A total of 136 neonates were included in the study: 21 (15.4%) with positive CSF hCMV-PCR and 115 (84.6%) with negative results. Seventeen patients (81%) in the positive group were symptomatic at birth compared with 52.2% of infants in the negative group (odds ratio [OR], 3.86; 95% confidence interval [CI], 1.28–14.1; P = .01). Only 4 asymptomatic newborns (6.8%) had a positive CSF hCMV-PCR. There were no differences between groups regarding the rate of microcephaly, neuroimaging abnormalities, neurological sequelae at 6 months of age, or plasma viral load. Sensorineural hearing loss (SNHL) at birth was associated with a positive CSF hCMV-PCR result (OR, 3.49; 95% CI, 1.08–11.27; P = .04), although no association was found at 6 months of age. Conclusions. A positive hCMV-PCR result in CSF is associated with symptomatic cCMV and SNHL at birth. However, no differences in neuroimaging studies, plasma viral load, or outcomes at 6 months were found. These results suggest that hCMV-PCR in CSF may not be a useful prognostic marker in cCMV.