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Congenital cytomegalovirus: Association between dried blood spot viral load and hearing loss
  1. Simone Walter (simone.walter{at}ntlworld.com)
  1. Great Ormond Street Hospital, United Kingdom
    1. Claire Atkinson (claire.atkinson{at}royalfree.nhs.uk)
    1. Royal Free and University College Medical School, London, United Kingdom
      1. Mike Sharland (mike.sharland{at}stgeorges.nhs.uk)
      1. St George's Hospital, London, United Kingdom
        1. Philip Rice (price{at}sgul.ac.uk)
        1. St George's Hospital, London, United Kingdom
          1. Ewa Raglan (ewa.raglan{at}stgeorges.nhs.uk)
          1. St George's Hospital, London, United Kingdom
            1. Vincent C Emery (v.emery{at}medsch.ucl.ac.uk)
            1. Royal Free and University College Medical School, London, United Kingdom
              1. Paul D Griffiths (p.griffiths{at}medsch.ucl.ac.uk)
              1. Royal Free and University College Medical School, London, United Kingdom

                Abstract

                Aim: To investigate the relationship between cytomegalovirus (CMV) viral load on dried blood spots (DBS) from newborn biochemical screening ('Guthrie') cards, and sensorineural hearing loss (SNHL) in congenital CMV.

                Design: Cross-sectional study with retrospective case-note review.

                Setting: Seven paediatric audiology departments in the UK.

                Patients: 84 children, median age 7 years: 43 with known congenital CMV, 41 with unexplained SNHL.

                Interventions:Half a DBS was tested for CMV deoxyribonucleic acid (DNA) viral load by quantitative real-time polymerase chain reaction (PCR).

                Main outcome measures: Pure tone average hearing thresholds (0.5-4 KHz).

                Results: DBS CMV DNA viral load significantly correlated with hearing thresholds for the worst and best hearing ears (Spearman's Rank correlations: r=0.445, p=0.008 and r=0.481, p=0.004 respectively). Multivariable logistic regression showed that the effect of increasing DBS viral load on the risk of SNHL remained important, when age and central nervous system involvement had been taken into account (odds ratio (OR) 2.76, 95% confidence interval (CI) 1.14 to 6.63, p=0.024). The mean log DBS viral load was significantly higher in children with SNHL than in those with normal hearing (2.69 versus 1.64, 95% CI -1.84 to -0.27, p=0.01). 8/35 (23%) children with unexplained SNHL tested positive for CMV DNA on DBS. One false positive result was obtained.

                Conclusion: The risk of SNHL increased with DBS viral load. Further studies should investigate whether DBS CMV testing has a role in identifying asymptomatic congenitally-infected neonates at risk of SNHL and whether antiviral treatment can reduce this risk.

                • congenital infection
                • cytomegalovirus (CMV)
                • dried blood spot (DBS)
                • sensorineural hearing loss (SNHL)
                • viral load

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