Use of Quantitative Polymerase Chain Reaction in Blood and Cerebrospinal Fluid as a Predictor of Severity in Congenital Cytomegalovirus Infection

Background. There is currently no consensus (1) on the role of quantitative polymerase chain reaction (qPCR) in the management of infants with congenital cytomegalovirus (cCMV) infection or (1) on the need for routine lumbar puncture in infected infants. We describe (1) the use of qPCR in the blood and cerebrospinal fluid (CSF) as a means of guiding treatment in cCMV infection and (2) the correlates of baseline PCR values to clinical outcome. Methods. We conducted a retrospective review of all cases of cCMV infection diagnosed at CHU Sainte-Justine, Montreal, Canada, between 2005 and 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. Thirty-two cases of cCMV were included in the analysis. In 9 patients (28%), diagnosis was made due to maternal seroconversion during pregnancy, 19 (59%) were diagnosed on the basis of neonatal symptomatology, and 4 (12%) were diagnosed as part of neonatal screening for at-risk patients (failed neonatal screening or infant of human immunodeficiency virus-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 and 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, versus 75% of patients with VL >100 000 copies/mL (P =0.2), whereas 50% of patients with VL <10 000 copies/mL had sensorineural hearing loss (SNHL), versus 71% of those with VL >100 000 copies/mL (P = 0.6). In 24 of the 32 patients, lumbar puncture was performed. In 7 of 24, CSF qPCR for CMV was positive (CSF+) (mean, 410 ± 238 copies/mL). Among those CSF+, 85% (6 of 7) had abnormal neuroimaging findings, versus 64% (11 of 17) of those whose CSF was negative (CSF−). Eighty-five percent of the CSF+ infants had SNHL, versus only 52% of those who were CSF−. Conclusion. Our findings suggest (1) a possible association between baseline qPCR VL >100 000 copies/mL and positive CSF and (2) the presence of SNHL and/or abnormal neuroimaging findings. Further study is necessary among larger cohorts to confirm these findings. Disclosures. All authors: No reported disclosures.

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