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Detection of Cytomegalovirus (CMV) in Cerebrospinal Fluid of Infants with Congenital CMV Infection: Is It Worth Doing the Lumbar Puncture?

Session: Poster Abstract Session: Pediatric - Viral Studies
Friday, October 10, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Background: Congenital CMV infection is a leading cause of sensorineural hearing loss (SNHL) and neurodevelopmental impairment in childhood. Information on CMV detection in cerebrospinal fluid (CSF) and its association with outcomes is limited.  The objective of this study was to determine the significance of CMV detection in CSF of infants with congenital CMV infection. 

Methods: Retrospective review of cases of congenital CMV infection diagnosed at Nationwide Children’s Hospital, Parkland Memorial Hospital/Children’s Medical Center Dallas, and the University of Oklahoma Health Sciences Center from 1996-2014. Diagnosis of congenital CMV was made by culture or PCR from urine or saliva within the first 3 weeks of age. Detection of CMV in CSF was performed by culture or PCR. Clinical, laboratory, radiographic, and audiologic data was reviewed.  Infants in whom CMV was detected in CSF were compared to those whose CSF was negative for CMV. 

Results: Twenty-two infants with congenital CMV infection who had a lumbar puncture performed and CSF tested for CMV were enrolled.  All 22 infants had clinically apparent ("symptomatic") disease. 10 (45%) infants had CMV detected in CSF (CSF+) and were compared to the 12 infants whose CSF was CMV-negative (CSF-). The CSF+ infants did not differ from those whose CSF was CMV negative (CMV-) in age at diagnosis (median/range; 1.5 [1-8] vs.1 [1-17]; p>0.05), platelet count (p=0.47), alanine aminotransferase (p=0.11), direct bilirubin concentration (p=0.08), or CSF analyses including white blood cell count (p=0.98), protein content(p=0.39), or glucose concentration (p=0.31). Of the CSF+ infants, 6 (60%) had SNHL, while 10 (83%) CSF- infants had SNHL. Abnormalities on CNS imaging studies, either ultrasound/CT/MRI, were comparable between groups.

Conclusion: CMV was frequently detected in CSF of infants with clinically apparent congenital CMV infection. However, its detection was not associated with increased rate of SNHL or neuroimaging abnormalities.  Larger studies that incorporate neurodevelopmental assessments are needed to determine the potential role of CSF evaluation in the management of infants with congenital CMV infection.

Christopher Ouellette, MD1, Andrea Ronchi, MD2, Asuncion Mejias, MD, PhD3, Susana Chavez-Bueno, MD4, Douglas Salamon, MB(ASCP)SV5, Lorenza Pugni6, Fabio Mosca6 and Pablo J. Sanchez, MD, FIDSA1, (1)Pediatrics, Division of Infectious Diseases, Nationwide Children's Hospital, Columbus, OH, (2)Pediatrics, University of Texas Southwestern, Dallas, TX, (3)Center for Vaccines and Immunity, The Research Institute at Nationwide Children's Hospital, Columbus, OH, (4)University of Oklahoma Health Sciences Center, Oklahoma City, OK, (5)Department of Laboratory Medicine, Nationwide Children's Hospital, Columbus, OH, (6)Neonatal Intensive Care Unit, Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy


C. Ouellette, None

A. Ronchi, None

A. Mejias, None

S. Chavez-Bueno, None

D. Salamon, None

L. Pugni, None

F. Mosca, None

P. J. Sanchez, None

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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