137. Use of qPCR in Blood and CSF as a Predictor of Severity in Congenital CMV Infection
Session: Poster Abstract Session: Big Viruses in Little People (Pediatric Viral Diseases)
Thursday, October 27, 2016
Room: Poster Hall
Posters
  • Poster.IDSA.GM.pdf (2.1 MB)
  • Background:

    There is currently no consensus on the role quantitative PCR in the management of infants with congenital CMV (cCMV) infection, or on the need for routine lumbar puncture in infected infants. We describe the use of qPCR in the blood and cerebrospinal fluid (CSF) as a means of guiding treatment in cCMV infection, and the correlates of baseline PCR values to clinical outcome.

    Methods:

    Retrospective review of all cases of cCMV infection diagnosed at CHU Sainte-Justine, Montreal, Canada, between 2005-2015. Infants were included in the analysis if blood qPCR was done at time of diagnosis (baseline), and they had neuroimaging and audiology assessments. Patients were considered symptomatic if they had any abnormal hearing or neuroimaging findings.

    Results:

    32 cases of cCMV were included in the analysis. In 9 patients (28%), diagnosis was made due to maternal sero-conversion during pregnancy, 19 (59%) were diagnosed on the basis of neonatal symptomatology, and 4 (12%) as part of neonatal screening for at-risk patients (failed neonatal screening or infant of HIV infected mother). Baseline blood qPCR was positive in all 32 patients (mean: 136 671 copies/ml, range 513-1 077 461 copies/ml), with 11 (34%) who had a viral load (VL) <10 000 copies/ml, 13 (41%) between 10 000-100 000 copies/ml, and 8 (25%) greater than 100 000 copies/ml at baseline. Thirty-six percent of patients with VL<10 000 copies/ml had abnormal neuroimaging findings, vs. 75% of patients with VL>100 000 copies/ml (p=0.2), while 50% of patients with VL<10 000 copies/ml had sensorineural hearing loss (SNHL), vs 71% of those with VL>100 000 copies/ml (p=0.6). In 24 of the 32 patients, lumbar puncture was performed. In 7/24, CSF qPCR for CMV was positive (CSF+) (mean 410±238 copies/ml). Among those CSF+, 85% (6/7) had abnormal neuroimaging findings, vs 64% (11/17) of those whose CSF was negative (CSF-). Eighty-five percent of the CSF+ infants had SNHL, vs only 52% of those who were CSF-.

    Conclusion:

    Our findings suggest a possible association between baseline qPCR viral load VL>100 000 copies/ml and positive CSF, and the presence of SNHL and/or abnormal neuroimaging findings. Further study is necessary among larger cohorts to confirm these findings.

    Mina Smiljkovic, MD, Pediatrics, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada, Christian Renaud, MD, MSc, FRCPC, Microbiology and Infectious Diseases, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada, Dorothée Leduc, MD, FRCPC, CSSS Gatineau, Gatineau, QC, Canada, Isabelle Boucoiran, MD, MSc, Obstetrics and Gynecology, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada, Valerie Lamarre, M.D., FRCPC, Infectious Diseases, CHU Sainte-Justine, Université de Montréal, Montreal, QC, Canada and Fatima Kakkar, MD, MPH, Infectious Diseases, CHU Sainte-Justine, Université de Montréal, Montréal, QC, Canada

    Disclosures:

    M. Smiljkovic, None

    C. Renaud, None

    D. Leduc, None

    I. Boucoiran, None

    V. Lamarre, None

    F. Kakkar, None

    Findings in the abstracts are embargoed until 12:01 a.m. CDT, Wednesday Oct. 26th with the exception of research findings presented at the IDWeek press conferences.