scholarly journals Congenital Cytomegalovirus Infection: Update on Diagnosis and Treatment

2020 ◽  
Vol 8 (10) ◽  
pp. 1516
Author(s):  
Giulia Chiopris ◽  
Piero Veronese ◽  
Francesca Cusenza ◽  
Michela Procaccianti ◽  
Serafina Perrone ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Gestational Age ◽  
Late Onset ◽  
Sensorineural Hearing ◽  
Diagnosis And Treatment ◽  
Congenital Cytomegalovirus ◽  
Symptomatic Disease ◽  
Neonates And Infants

Congenital cytomegalovirus (cCMV) infection is the most common congenital viral infection and is the leading non-genetic cause of sensorineural hearing loss (SNLH) and an important cause of neurodevelopmental disabilities. The risk of intrauterine transmission is highest when primary infection occurs during pregnancy, with a higher rate of vertical transmission in mothers with older gestational age at infection, while the risk of adverse fetal effects significantly increases if fetal infection occurs during the first half of pregnancy. Despite its prevalence and morbidity among the neonatal population, there is not yet a standardized diagnostic test and therapeutic approach for cCMV infection. This narrative review aims to explore the latest developments in the diagnosis and treatment of cCMV infection. Literature analysis shows that preventive interventions other than behavioral measures during pregnancy are still lacking, although many clinical trials are currently ongoing to formulate a vaccination for women before pregnancy. Currently, we recommend using a PCR assay in blood, urine, and saliva in neonates with suspected cCMV infection. At present, there is no evidence of the benefit of antiviral therapy in asymptomatic infants. In the case of symptomatic cCMV, we actually recommend treatment with oral valganciclovir for a duration of 12 months. The effectiveness and tolerability of this therapy option have proven effective for hearing and neurodevelopmental long-term outcomes. Valganciclovir is reserved for congenitally-infected neonates with the symptomatic disease at birth, such as microcephaly, intracranial calcifications, abnormal cerebrospinal fluid index, chorioretinitis, or sensorineural hearing loss. Treatment with antiviral drugs is not routinely recommended for neonates with the mildly symptomatic disease at birth, for neonates under 32 weeks of gestational age, or for infants more than 30 days old because of insufficient evidence from studies. However, since these populations represent the vast majority of neonates and infants with cCMV infection and they are at risk of developing late-onset sequelae, a biomarker able to predict long-term sequelae should also be found to justify starting treatment and reducing the burden of CMV-related complications.

scholarly journals 1146. Thrombocytosis in Infants with Congenital Cytomegalovirus Infection Being Treated with Valganciclovir

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S600-S600
Author(s):  
Kathleen Murtagh ◽  
Jacquie Toia ◽  
Tonya Scardina ◽  
Anne H Rowley ◽  
Leena B Mithal
Keyword(s):  
Hearing Loss ◽  
Platelet Count ◽  
Sensorineural Hearing Loss ◽  
Complete Blood Count ◽  
Sensorineural Hearing ◽  
Congenital Cytomegalovirus ◽  
Symptomatic Disease ◽  
Number Of Patients ◽  
Oral Valganciclovir ◽  
Bone Marrow Function

Abstract Background Congenital CMV (cCMV) is associated with sensorineural hearing loss and neurodevelopmental disabilities. Infants with symptomatic cCMV infection benefit from 6 months of oral valganciclovir (vGCV) therapy. Neutropenia, thrombocytopenia, and hepatotoxicity are adverse effects vGCV, for which we monitor. We observed a pattern that cCMV infants treated with vGCV developed an uptrend in platelets and/or thrombocytosis (platelet count >450,000/uL) while on therapy. This observation has not previously been reported. Methods Medical records and laboratory results from our multi-disciplinary cCMV clinic led by Infectious Diseases at Lurie Children’s Hospital were reviewed (2017-2020). Data included cCMV signs/symptoms, cCMV treatment prescribed, indication for ganciclovir/vGCV treatment, and complete blood count prior to, during, and post- vGCV therapy. Results Of 21 cCMV infants referred to clinic, 14 received >1 month of vGCV for symptomatic disease, 1 discontinued vGCV < 1 month due to perceived fussiness, and 1 was part of a clinical trial. Four infants were initially treated with ganciclovir for ≤1 month and transitioned to vGCV. Of the 14 patients treated with vGCV, 10 (71%) had sensorineural hearing loss (50% unilateral), 12 (86%) had central nervous system abnormalities (including cystic lesions on head ultrasound), 5 (36%) had thrombocytopenia, and 7 (50%) were intrauterine growth restricted [Table 1]. Eleven infants (79%) developed thrombocytosis. Thirteen infants (93%) had an uptrend in platelet count [not including normalization of initial thrombocytopenia (platelets < 150,000/uL)]. Figure 1 shows platelet counts by time with respect to vGCV treatment. Neutropenia (absolute neutrophil count < 500/uL) occurred in 1 patient that required temporary discontinuation of vGCV. Table 1 Figure 1 Conclusion We observed an interesting trend of rising platelet count and the development of thrombocytosis in the majority of our cCMV patients on vGCV. Platelet elevation associated with vGCV has not previously been described. This observation is limited by small number of patients and thrombocytosis is not a definitive association/adverse effect. With increasing use of vGCV and interest in its effect on bone marrow function, this observation is notable and warrants further study. Disclosures All Authors: No reported disclosures

scholarly journals Congenital cytomegalovirus infection and its impact on the auditory function

2019 ◽  
Vol 11 (3) ◽  
pp. 83-89
Author(s):  
R. A. Ivanova ◽  
M. Yu. Boboshko ◽  
E. S. Garbaruk ◽  
S. M. Vikhnina ◽  
V. V. Vasiliev ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Cytomegalovirus Infection ◽  
Comparison Group ◽  
Late Onset ◽  
Main Group ◽  
Sensorineural Hearing ◽  
Congenital Cytomegalovirus Infection ◽  
Congenital Cytomegalovirus

Congenital cytomegalovirus infection contributes substantially to the incidence of sensorineural hearing loss, which may be late-onset, progressive or fluctuating. It leads to delayed diagnostics of hearing impairments in children. The aim is to assess the frequency and time of hearing loss occurrence in children with congenital cytomegalovirus infection and to develop the audiological follow-up algorithm adapted for those children. Materials and methods: 60 children with verified congenital cytomegalovirus infection have been involved into research as the main group. 61 children, with other sensorineural hearing loss risk factors, but excluding congenital cytomegalovirus, were included into the comparison group. The age of children ranged from 2 months to 7 years old. The follow-up duration was up to 4 years. Audiological assessment included: auditory brainstem response, auditory steady state response, otoacoustic emissions, impedancometry, pure tone audiometry (its type depended on the children’s age and development level) and speech tests. Results: Hearing loss was revealed in 17% of the main group, it varied from mild to severe degree. Among these children 30% developed late-onset hearing loss. 5% of children of the comparison group were identified with congenital hearing loss. Assessment of central auditory pathways function has been performed in children elder than 4 years old: 70% of children of the main group and 10% of children of the comparison one were identified with auditory processing disorders. The received data may be used by otolaryngologists, audiologists, pediatricians and infectious diseases physicians. The developed follow-up admits timely diagnostics of sensorineural hearing loss in children with congenital cytomegalovirus.

scholarly journals Fluctuating Sensorineural Hearing Loss

2019 ◽  
Vol 24 (3) ◽  
pp. 109-116 ◽  
Author(s):  
Hui Liu ◽  
Kunpeng Zhou ◽  
Xuemei Zhang ◽  
Kevin A. Peng
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Current Treatment ◽  
Sensorineural Hearing ◽  
Initial Presentation ◽  
Vestibular Aqueduct ◽  
Long Term Follow Up ◽  
Inner Ear Disease ◽  
Fluctuating Hearing Loss

Background: Several otologic conditions can present with fluctuating sensorineural hearing loss, including Ménière’s disease, autoimmune inner ear disease, and enlarged vestibular aqueduct. Although these 3 etiologies vary greatly, distinguishing between these conditions at initial presentation can be challenging. Furthermore, initial treatment of these conditions is often similar. In this review, we discuss historical and current perspectives on diagnosis and treatment of these conditions. Summary: A literature search was performed regarding fluctuating hearing loss, and current treatment of these etiologies of fluctuating hearing loss was summarized. Immediate measures at the onset of acute hearing loss include corticosteroid therapy, while preventative and chronic therapies, which can limit disease severity and frequency, vary based on the specific condition treated. Key Messages: Fluctuating hearing loss can represent a range of pathologies, but the precise etiology may not be clear at initial presentation. Timely treatment and long-term follow-up, along with appropriate diagnostics, are necessary to optimize long-term hearing.

scholarly journals Third-generation bisphosphonates for cochlear otosclerosis stabilizes sensorineural hearing loss in long-term follow-up

2017 ◽  
Vol 2 (5) ◽  
pp. 262-268 ◽  
Author(s):  
Taha A. Jan ◽  
Aaron K. Remenschneider ◽  
Christopher Halpin ◽  
Margaret Seton ◽  
Michael J. McKenna ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Third Generation ◽  
Long Term Follow Up

scholarly journals Toward the Future of Early Intervention for Adult Hearing Loss

2018 ◽  
Vol 39 (02) ◽  
pp. 221-226 ◽  
Author(s):  
Christi Barbee ◽  
Jeffrey Danhauer ◽  
Anna Jilla ◽  
Suzanne Kimball ◽  
Katie Seever ◽  
...  
Keyword(s):  
Hearing Loss ◽  
Early Intervention ◽  
Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Diagnosis And Treatment ◽  
The Future

AbstractThis issue of Seminars in Hearing has focused on the early intervention of adult sensorineural hearing loss (SNHL). Contributions to this monograph have taken a contemporary issues approach to the prevention, diagnosis, and treatment of mild SNHL. This article looks toward the future and discusses clinical and research implications for the early intervention of adult SNHL.

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