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.
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.
Pediatric Infectious Diseases Unit, Hospital Universitario La Paz, Madrid.
Walter-Alfredo
WA
Goycochea-Valdivia
Pediatric Infectious Diseases Unit, Hospital Universitario La Paz, Madrid.
Fernando
F
Baquero-Artigao
Pediatric Infectious Diseases Unit, Hospital Universitario La Paz, Madrid.
Teresa
T
Del Rosal
Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona.
Marie-Antoinette
MA
Frick
Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid.
Pablo
P
Rojo
Neonatology Unit, Hospital Universitario de Donostia.
María-Juncal
MJ
Echeverría
Malalties infeccioses i resposta inflamatòria sistèmica en pediatria. Unitat d'Infeccions, Servei de Pediatria. Institut de Recerca Pediàtrica Hospital Sant Joan de Déu, Barcelona.|Departament de Pediatria, Universitat de Barcelona.|CIBER de Epidemiología y Salud Pública (Ciberesp, Spain) Barcelona.
Antoni
A
Noguera-Julian
Department of Pediatrics and Neonatal Unit, Hospital Universitario Arnau de Vilanova, Lleida.
Xavier
X
Bringué
Pediatric Infectious Diseases Unit, Hospital Universitario Gregorio Marañón, Madrid.
Jesús
J
Saavedra-Lozano
Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona.|Department of Pediatrics, Hospital Quirónsalud Barcelona.
Isabel
I
Vives-Oñós
Pediatric Infectious Diseases Unit, Hospital de la Santa Creu y Sant Pau, Barcelona.
Elisenda
E
Moliner
Pediatric Infectious Diseases Unit, Hospital Universitario Puerta de Hierro, Madrid.
María-José
MJ
Cilleruelo
Department of Pediatrics, Hospital de Getafe, Madrid.
Irene
I
Cuadrado
Pediatric Infectious Diseases Unit, Hospital Las Palmas de Gran Canaria.
Elena
E
Colino
Department of Pediatrics and Neonatology Unit, Hospital Universitario General de Cataluña, Barcelona.
Laura
L
Castells
Department of Pediatrics, Hospital Universitario Infanta Sofía, Universidad Europea de Madrid; and.
Alfredo
A
Tagarro
Department of Pediatric Infectious Diseases, Complejo Hospitalario de Pontevedra, Spain.
Javier
J
Vilas
Pediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d Hebrón, Vall d'Hebron Research Institute, Universitat Autònoma de Barcelona.
Pere
P
Soler-Palacin
Pediatric Infectious Diseases Unit, Hospital Universitario 12 de Octubre, Universidad Complutense, Instituto de Investigación Hospital 12 de Octubre (i+12), Madrid.
Daniel
D
Blázquez-Gamero
D058345:Asymptomatic Infections; D003587:Cytomegalovirus / Q000235:genetics / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000150:complications / Q000151:congenital* / Q000175:diagnosis*; D004279:DNA, Viral / Q000097:blood / Q000134:cerebrospinal fluid* / Q000302:isolation & purification; D005260:Female; D005315:Fetal Diseases / Q000821:virology; D005500:Follow-Up Studies; D006319:Hearing Loss, Sensorineural / Q000821:virology; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008831:Microcephaly / Q000821:virology; D059906:Neuroimaging; D016133:Polymerase Chain Reaction / Q000379:methods; D012189:Retrospective Studies; D012463:Saliva / Q000821:virology; D013129:Spinal Puncture; D019562:Viral Load
D004279:DNA, Viral
cerebrospinal fluid; congenital infection; human cytomegalovirus; pediatrics.; polymerase chain reaction