Advertisement

Prospects and Obstacles of Diagnosis

  • Gabriele Halwachs-BaumannEmail author
Chapter

Abstract

Diagnosis of CMV infection is characterized by a numerousness of laboratory methods reflecting the difficulties aligned with the clinic relevant diagnosis of this infection. Generally the used methods can be divided into those detecting the virus itself or parts of it (CMV DNA or RNA assays, electron microscopy, virus culture) and those detecting the immunological reaction of the host after having been confronted with the virus (serological assays, detection of CMV-specific cellular immunity). Another classification of CMV assays would be the division in screening assays and confirmatory assays. In the context of congenital CMV infection, serological assays play an important role for screening and risk stratification. Polymerase chain reaction for the detection and quantification of CMV DNA is used for the confirmation of a CMV infection and for risk stratification. Nevertheless, since molecular biology-based methods have got easier to handle and cheaper and thus are used more generally, these methods are more and more used for screening purpose.

References

  1. 1.
    Enders G, Bader U, Lindemann L, Schalasta G, Daiminger A (2001) Prenatal diagnosis of congenital cytomegalovirus infection in 189 pregnancies with known outcome. Prenat Diagn 21(5):362–377PubMedGoogle Scholar
  2. 2.
    Zafar U, Ong S, Gray J, Martin WM, Kilby MD (2006) The limitations of cytomegalovirus screening. Prenat Diagn 26:866–877Google Scholar
  3. 3.
    Gagnon A, Wilson RD, Allen VM, Audibert F, Blight C, Brock JA, Désilets VA, Johnson JA, Langlois S, Murphy-Kaulbeck L, Wyatt P (2009) Evaluation of prenatally diagnosed structural congenital anomalies. J Obstet Gynaecol Can 31(9):875–881PubMedGoogle Scholar
  4. 4.
    Abdel-Fattah SA, Bhat A, Illanes S, Bartha JL, Carrington D (2005) TORCH test for fetal medicine indications: only CMV is necessary in the United Kingdom. Prenat Diagn 25(11):1028–1031PubMedGoogle Scholar
  5. 5.
    Wilson JMG, Junger G (1968) Principles and practice of screening for disease. World Health Organization, Public Health Papers No. 34.Google Scholar
  6. 6.
    Demmler GJ (2005) Screening for congenital cytomegalovirus infection: a tapestry of controversies. J Pediatr 146:162–164PubMedGoogle Scholar
  7. 7.
    Mahon BE, Yamada EG, Newman TB (1994) Problems with serum IgM as a screening test for congenital infection. Clin Pediatr 33(3):142–146Google Scholar
  8. 8.
    El-Mekki A, Deverajan l V, Soufi S, Strannegard O, Al-Nakib W (1988) Specific and non-specific serological markers in the screening for congenital CMV infection. Epidem Inf 101:495–501Google Scholar
  9. 9.
    Alford CA, Schaefer J, Blankenship WJ, Straumfjord j V, Cassady G (1967) A correlative immunologic, microbiologic and clinical approach to the diagnosis of acute and chronic infections in newborn infants. N Engl J Med 277(9):437–449PubMedGoogle Scholar
  10. 10.
    Landini MP, Lazzarotto T (1999) Prenatal diagnosis of congenital cytomegalovirus infection: light and shade. Herpes 6:45–49Google Scholar
  11. 11.
    Lazzarotto T, Gabrielli L, Lanari M, Guerra B, Bellucci T, Sassi M, Landini MP (2004) Congenital cytomegalovirus infection: recent advances in the diagnosis of maternal infection. Hum Immunol 65:410–415PubMedGoogle Scholar
  12. 12.
    Collinet P, Subtil D, Houfflin-Debarge V, Kacet N, Dewilde A, Puech F (2004) Routine CMV screening during pregnancy. E J Obstet Gynecol 114:3–11Google Scholar
  13. 13.
    Lazzarotto T, Varani S, Spezzacatena P, Gabrielli L, Pradelli P, Guerra B, Landini MP (2000) Maternal IgG avidity and IgM detected by blot as diagnostic tools to identify pregnant women at risk of transmitting cytomegalovirus. Viral Immunol 13(1):137–141PubMedGoogle Scholar
  14. 14.
    Lazzarotto T, Guerra B, Lanari M, Gabrielli L, Landini MP (2008) New advances in the diagnosis of congenital cytomegalovirus infection. J Clin Virol 41:192–197PubMedGoogle Scholar
  15. 15.
    Genser B, Truschnig-Wilders M, Stünzner D, Landini MP, Halwachs-Baumann G (2001) Evaluation of five commercial enzyme immunoassays for the detection of human cytomegalovirus-specific IgM antibodies in the absence of a commercially available gold standard. Clin Chem Lab Med 39(1):62–70PubMedGoogle Scholar
  16. 16.
    Halwachs-Baumann G (2007) Recent developments in human cytomegalovirus diagnosis. Expert Rev Anti Infect Ther 5(3):427–439PubMedGoogle Scholar
  17. 17.
    Kraat YJ, Stals FS, Landini MP, Bruggeman CA (1993) Cytomegalovirus IgM antibody detection: comparison of five asays. New Microbiol 16(4):297–307PubMedGoogle Scholar
  18. 18.
    Daiminger A, Bäder U, Eggers M, Lazzarotto T, Enders G (1999) Evaluation of two novel enzyme immunoassays using recombinant antigens to detect cytomegalovirus-specific immunoglobulin M in sera from pregnant women. J Clin Virol 13:161 b–16171Google Scholar
  19. 19.
    Gentile M, Galli C, Pagnotti P, Di Marco P, Tzantzoglou S, Bellomi F, Ferreri ML, Selvaggi C, Antonelli G (2009) Measurement of the sensitivity of different commercial assays in the diagnosis of CMV infection in pregnancy. Eur J Clin Microbiol Infect Dis 28:977–981PubMedGoogle Scholar
  20. 20.
    De Carolis S, Santucci S, Botta A, Garofalo S, Martino C, Perrelli A, Salvi S, Degennaro VA, De Belvis AG, Ferrazzani S, Scambia G (2010) False-positive IgM for CMV in pregnant women with autoimmune disease: a novel prognostic factor for poor pregnancy outcome. Lupus 19:844–849PubMedGoogle Scholar
  21. 21.
    Mendelson E, Aboudy Y, Smetana Z, Tepperberg M, Grossman Z (2006) Laboratory assessment and diagnosis of congenital viral infections: Rubella, cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), parvovirus B19 and human immunodeficiency virus (HIV). Reprod Toxicol 21:350–382PubMedGoogle Scholar
  22. 22.
    Schoppel K, Kropff B, Schmidt C, Vornhagen R, Mach M (1997) The humoral immune response against human cytomegalovirus is characterized by a delayed synthesis of glycoprotein-specific antibodies. J Infect Dis 175:533–544PubMedGoogle Scholar
  23. 23.
    Boppana SB, Britt WJ (1995) Antiviral antibody responses and intrauterine transmission after primary maternal cytomegalovirus infection. J Infect Dis 171:1115–1121PubMedGoogle Scholar
  24. 24.
    Boppana SB, Pass RF, Britt WJ (1993) Virus-specific antibody responses in mothers and their newborn infants with asymptomatic congenital cytomegalovirus infections. J Infect Dis 167:72–77PubMedGoogle Scholar
  25. 25.
    Prince HE, Leber AL (2002) Validation of an in-house assay for cytomegalovirus immunoglobulin G (CMV IgG) avidity and relationship of avidity to CMV IgM levels. Clin Diagn Lab Immunol 9(4):824–827PubMedPubMedCentralGoogle Scholar
  26. 26.
    Curdt I, Praast G, Sickinger E, Schultess J, Herold I, Braun HB, Bernhardt S, Maine GT, Smith DD, Hsu S, Christ HM, Pucci D, Hausmann M, Herzogenrath J (2009) Development of fully automated determination of marker-specific immunoglobulin G (IgG) avidity based on the avidity competition assay format: application for Abbott Architect cytomegalovirus and toxo IgG avidity assays. J Clin Microbiol 47(3):603–613PubMedPubMedCentralGoogle Scholar
  27. 27.
    Bodéus M, Goubau P (1999) Predictive value of maternal-IgG avidity for congenital human cytomegalovirus infection. J Clin Virol 12:3–8PubMedGoogle Scholar
  28. 28.
    Blackburn NK, Besselaar TG, Schoub BD, O’Connell KF (1991) Differentiation of primary cytomegalovirus infection from reactivation using the urea denaturation test for measuring antibody avidity. J Med Virol 33:6–9PubMedGoogle Scholar
  29. 29.
    Gutiérrez J, Piédrola G, del Carmen Maroto M (1998) Value of cytomegalovirus (CMV) IgG avidity index for the diagnosis of primary CMV infection. J Infect Dis 178:599–600PubMedGoogle Scholar
  30. 30.
    Munro SC, Hall B, Whybin LR, Leader L, Robertson P, Maine GT, Rawlinson WD (2005) Diagnosis of and screening for cytomegalovirus infection in pregnant women. J Clin Microbiol 43(9):4713–4718PubMedPubMedCentralGoogle Scholar
  31. 31.
    Lazzarotto T, Spezzacatena P, Pradelli P, Abate DA, Varani S, Landini MP (1997) Avidity of immunoglobulin G directed against human cytomegalovirus during primary and secondary infections in immunocompetent and immunocompromised subjects. Clin Diagn Lab Immunol 4(4):469–473PubMedPubMedCentralGoogle Scholar
  32. 32.
    Maine GT, Lazzarotto T, Landini MP (2001) New developments in the diagnosis of maternal and congenital CMV infection. Expert Rev Mol Diagn 1(1):19–29PubMedGoogle Scholar
  33. 33.
    Cahill AG, Odibo AO, Stamilio DM, Macones GA (2009) Screening and treating for primary cytomegalovirus infection in pregnancy: where do we stand? A decision-analytic and economic analysis. Am J Obstet Gynecol 201:466.e1–466.e7Google Scholar
  34. 34.
    Demmler-Harrison GJ (2009) Congenital cytomegalovirus: public health action towards awareness, prevention, and treatment. J clin Virol 465:S1–S5Google Scholar
  35. 35.
    Yinon Y, Farine D, Yudin MH (2010) Cytomegalovirus infection in pregnancy. J Obstet Gynecol Can 32(4):348–354Google Scholar
  36. 36.
    Stagno S, Tinker MK, Elrod C, Fuccillo DA, Cloud G, O’Beirne AJ (1985) Immunoglobulin M antibodies detected by enzyme-linked immunosorbent assay and radioimmunoassay in the diagnosis of cytomegalovirus infections in pregnant women and newborn infants. J Clin Microbiol 21(6):930–935PubMedPubMedCentralGoogle Scholar
  37. 37.
    Donner C, Liesnard C, Content J, Busine A, Aderca J, Rodesch F (1993) Prenatal diagnosis of 52 pregnancies at risk for congenital cytomegalovirus infection. Obstet Gynecol 82(4):481–486PubMedGoogle Scholar
  38. 38.
    Griffiths PD, Stagno S, Pass RF, Smith RJ, Alford CA (1982) Congenital cytomegalovirus infection: diagnostic and prognostic significance of the detection of specific immunoglobulin M antibodies in cord serum. Pediatrics 69(5):544–549PubMedGoogle Scholar
  39. 39.
    Nelson CT, Istas A, Wilkerson MK, Demmler GJ (1995) PCR detection of cytomegalovirus DNA in serum as a diagnostic test for congenital cytomegalovirus infection. J Clin Microbiol 33(12):3317–3318PubMedPubMedCentralGoogle Scholar
  40. 40.
    Halwachs-Baumann G, Genser B, Danda M, Engele H, Rosegger H, Fölsch B, Maurer U, Lackner H, Truschnig-Wilders M (2000) Screening and diagnosis of congenital cytomegalovirus infection: a 5-y study. Scand J Infect Dis 32(2):137–142PubMedGoogle Scholar
  41. 41.
    Naessens A, Casteels A, Decatte L, Foulon W (2005) A serologic strategy for detecting neonates at risk for congenital cytomegalovirus infection. J Pediatr 146:194–197PubMedGoogle Scholar
  42. 42.
    Stagno S, Pass RF, Reynolds DW, Moore MA, Nahmias AJ, Alford CA (1980) Comparative study for diagnostic procedures for congenital cytomegalovirus infection. Pediatrics 65(2):251–247PubMedGoogle Scholar
  43. 43.
    Stagno S, Reynolds DW, Tsiantos A, fuccillo DA, Long W, Alford CA (1975) Comparative serial virologic and serologic studies of symptomatic and subclinical congenitally and natally acquired cytomegalovirus infections. J Infect Dis 132(5):568–577PubMedGoogle Scholar
  44. 44.
    Coll O, BEnoist G, Ville Y, Weisman LE, Botet F (2009) Guidelines on CMV congenital infection. J Perinat Med 37:433–445PubMedGoogle Scholar
  45. 45.
    Boppana SB, Ross SA, Novak Z, Shimamura M, Tolan RW, Palmer AL, Ahmed A, Michaels MG, Sánches PJ, Bernstein DI, Britt WJ, Fowler KB (2010) Dried blood spot real-time polymerase chain reaction assays to screen newborns for congenital cytomegalovirus infection. J Am Med Assoc 303(14):1375–1381Google Scholar
  46. 46.
    Halwachs-Baumann G, Genser B, Pailer S, Engele H, Rosegger H, Schlak A, Kessler HH, Truschnig-Wilders M (2002) Human cytomegalovirus load in various body fluids of congenitally infected newborns. J Clin Virol 25:S81–S87PubMedGoogle Scholar
  47. 47.
    Paixao P, Almeida S, Gouveia P, Binda S, Caroppo S, Barbi M (2005) Diagnosis of congenital cytomegalovirus infection by detection of viral DNA in urine pools. J Virol Meth 128:1–5Google Scholar
  48. 48.
    Bale JF (2010) Screening newborns for congenital cytomegalovirus infection. J Am Med Assoc 303(14):1425–1426Google Scholar
  49. 49.
    Grosse SD, Dollard S, Ross DS, Cannon M (2009) Newborn screening for congenital cytomegalovirus: options for hospital-based and public health programs. J Clin Virol 465:S32–S36Google Scholar
  50. 50.
    Barbi M, Binda S, Caroppo S, Primache V (2006) Neonatal screening for congenital cytomegalovirus infection and hearing loss. J Clin Virol 35:206–209PubMedGoogle Scholar
  51. 51.
    Barbi M, MacKay WG, Binda S, van Loon AM (2008) External quality assessment of cytomegalovirus DNA detection on dried blood spots. BMS Microbiology 8:2.  https://doi.org/10.1186/1471-2180-8-2CrossRefGoogle Scholar
  52. 52.
    Kharrazi M, Hyde T, Young S, Amin MM, Cannon MJ, Dollard SC (2010) Use of screening dried blood spots for estimation of prevalence, risk factors, and birth outcome of congenital cytomegalovirus infection. J Pediatr 157(2):191–197PubMedGoogle Scholar
  53. 53.
    Neto EC, Rubin R, Schulte J, Giugliani R (2004) Newborn screening for congenital infectious diseases. Emerg Infect Dis 10(6):1069–1073PubMedCentralGoogle Scholar
  54. 54.
    Yamagishi Y, Miyagawa H, Wada K, Matsumoto S, Arahori H, Tamura A, Taniguchi H, Kanekiyo T, Sashihara J, Yoda T, Kitagawa M, Ozono K (2006) CMV DNA detection in dried blood spots for diagnosing congenital CMV infection in Japan. J Med Virol 78:923–925PubMedGoogle Scholar
  55. 55.
    Soetens O, Vauloup-Fellous C, Foulon I, Dubreuil P, De Saeger B, Grangeot-Keros L, Naessens A (2008) Evaluation of different cytomegalovirus (CMV) DNA PCR protocols for analysis of dried blood spots from consecutive cases of neonates with congenital CMV infections. J Clin Microbiol 46(3):943–946PubMedPubMedCentralGoogle Scholar
  56. 56.
    Binda S, Caroppo S, Didò P, Primache V, Veronesi L, Calvario A, Piana A, Barbi M (2004) Modification of CMV DNA detection from dried blood spots for diagnosing congenital CMV infection. J Clin Virol 30:276–279PubMedGoogle Scholar
  57. 57.
    Barbi M, Binda S, Caroppo S (2006) Diagnosis of congenital CMV infection via dried blood spots. Rev Med Virol 16:385–392PubMedGoogle Scholar
  58. 58.
    Barbi M, Binda S, Primache V, Luraschi C, Corbetta C (1996) Diagnosis of congenital cytomegalovirus infection by detection of viral DNA in dried blood spots. Clin Diagn Virol 6:27–32PubMedGoogle Scholar
  59. 59.
    de Vries JJC, Claas ECJ, Kroes ACM, Vossen ACTM (2009) Evaluation of DNA extraction methods for dried blood spots in the diagnosis of congenital cytomegalovirus infection. J Clin Virol 465:S37–S42Google Scholar
  60. 60.
    Thorne LB, Civalier C, Booker J, Fan H, Gulley ML (2007) Analytic validation of a quantitative real-time PCR assay to measure CMV viral load in whole blood. Diagn Mol Pathol 16(2):73–80PubMedGoogle Scholar
  61. 61.
    Nye MB, Leman AR, Meyer ME, Menegus MA, Rothberg PG (2005) Sequence diversity in the glycoprotein B gene complicates real-time PCR assays for detection and quantification of cytomegalovirus. J Clin Microbiol 43(10):4968–4971PubMedPubMedCentralGoogle Scholar
  62. 62.
    Schäfer P, Tenschert W, Schröter M, Gutensohn K, Laufs R (2000) False-positive results of plasma PCR for cytomegalovirus DNA due to delayed sample preparation. J Clin Microbiol 38(9):3249–3253PubMedPubMedCentralGoogle Scholar
  63. 63.
    Goegebuer T, Van Meensel B, Beuselinck K, Cossey V, Van Ranst M, Hanssens M, Lagrou K (2009) Clinical predictive value of real-time PCR quantification of human cytomegalovirus DNA in amniotic fluid samples. J Clin Microbiol 47(3):660–665PubMedGoogle Scholar
  64. 64.
    Grose C, Meehan T, Weiner C (1992) Prenatal diagnosis of congenital cytomegalovirus infection by virus isolation after amniocentesis. Pediatr Infect Dis J 11:605–607PubMedGoogle Scholar
  65. 65.
    Gabrielli L, Losi L, Varani S, Lazzarotto T, Eusebi V, Landini MP (2001) Complete replication of human cytomegalovirus in explants of first trimester human placenta. J Med Virol 64:499–504PubMedGoogle Scholar
  66. 66.
    Gouarin S, Palmer P, Cointe D, Rogez S, Vabret A, Rozenberg F, Denis F, Freymuth F, Lebon P, Grangeot-Keros L (2001) Congenital HCMV infection: a collaborative and comparative study of virus detection in amniotic fluid by culture and by PCR. J Clin Virol 21:47–55PubMedGoogle Scholar
  67. 67.
    Revello MG, Gerna G (2004) Pathogenesis and prenatal diagnosis of human cytomegalovirus infection. J Clin Virol 29:71–83PubMedGoogle Scholar
  68. 68.
    Revello MG, Lilleri D, Zavattoni M, Furione M, Middeldorp J, Gerna G (2003) Prenatal diagnosis of congenital human cytomegalovirus infection in amniotic fluid by nucleic acid sequence-based amplification assay. J Clin Microbiol 41(4):1772–1774PubMedPubMedCentralGoogle Scholar
  69. 69.
    Catanzarte V, Dankner WM (1993) Prenatal diagnosis of congenital cytomegalovirus infection: false-negative amniocentesis at 20 weeks’ gestation. Prenat Diagn 13:1021–1025Google Scholar
  70. 70.
    Revello MG, Gerna G (2002) Diagnosis and management of human cytomegalovirus infection in the mother, fetus, and newborn infant. Clin Microbiol Rev 15(4):680–715PubMedPubMedCentralGoogle Scholar
  71. 71.
    Liesnard C, Donner C, Brancart F, Gosselin F, Delforge ML, Rodesch F (2000) Prenatal diagnosis of congenital cytomegalovirus infection: prospective study of 237 pregnancies at risk. Obstet Gynecol 95(6):881–888PubMedGoogle Scholar
  72. 72.
    Grose C, Itani O, Weiner CP (1989) Prenatal diagnosis of fetal infection: advances from amniocentesis to cordocentesis – congenital toxoplasmosis, rubella, cytomegalovirus, varicella virus, parvovirus and human immunodeficiency virus. Pediatr Infect Dis J 8:459–468PubMedGoogle Scholar
  73. 73.
    Guerra B, Lazzarotto T, Quarta S, Lanari M, Bovicelli L, Nicolosi A, Landini MP (2000) Prenatal diagnosis of symptomatic congenital cytomegalovirus infection. Am J Obstet Gynecol 183:476–482PubMedGoogle Scholar
  74. 74.
    Lazzarotto T, Varani S, Guerra B, Nicolosi A, Lanari M, Landini MP (2000) Prenatal indicators of congenital cytomegalovirus infection. J Pediatr 137:90–95PubMedGoogle Scholar
  75. 75.
    Lazzarotto T, Gabrielli L, Foschini PM, Lanari M, Guerra B, Eusebi V, Landini MP (2003) Congenital cytomegalovirus infection in twin pregnancies: viral load in the amniotic fluid and pregnancy outcome. Pediatrics 12:e153–e157Google Scholar
  76. 76.
    Gouarin S, Gault E, Vabret A, Cointe D, Rozenberg F, Grangeot-Keros L, Barjot P, Garbarg-Chenon a, Lebon P, Freymuth F (2002) Real-time PCR quantification of human cytomegalovirus DNA in amniotic fluid samples from mothers with primary infection. J Clin Microbiol 40(5):1767–1772PubMedPubMedCentralGoogle Scholar
  77. 77.
    Lanari M, Lazzarotto T, Venturi V, Papa I, Gabrielli L, Guerra B, Landini MP, Faldella G Neonatal cytomegalovirus blood load and risk of sequelae in symptomatic and asymptomatic congenitally infected newborns. Pediatrics 206, 117(1):e76–e83Google Scholar
  78. 78.
    Vauloup-Fellous C, Ducroux A, Couloigner V, Marlin S, Picone O, Galimand J, Loundon N, Denoyelle F, Grangeot-Keros L, Leruez-Ville M (2007) Evaluation of cytomegalovirus (CMV) DNA quantification in dried blood spots: retrospective study of CMV congenital infection. J Clin Microbiol 45(11):3804–3806PubMedPubMedCentralGoogle Scholar
  79. 79.
    Boppana SB, Fowler KB, Pass RF, Rivera LB, Bradford RD, Lakeman FD, Britt WJ (2005) Congenital cytomegalovirus infection: association between virus burden in infancy and hearing loss. J Pediatr 146:817–823Google Scholar
  80. 80.
    Bradford RD, Cloud G, Lakeman AD, Boppana S, Kimberlin DW, Jacobs R, Demmler G, Sanchez P, Britt W, Soong SJ, Whitley RJ (2005) Detection of cytomegalovirus (CMV) DNA by polymerase chain reaction is associated with hearing loss in newborns with symptomatic congenital CMV infection involving the central nervous system. J Infect Dis 191:227–233PubMedGoogle Scholar
  81. 81.
    Walter S, Atkinson C, Sharland M, Rice P, Raglan E, Emery VC, Griffiths PD (2008) Congenital cytomegalovirus: association between dried blood spot viral load and hearing loss. Arch Dis Child Fetal Neonatal Ed 93:F280–F285PubMedGoogle Scholar
  82. 82.
    de Castro Romanelli RM, Magny JF, Jacquemard F (2008) Prognostic markers of symptomatic congenital cytomegalovirus infection. Braz J Infect Dis 12(1):38–43Google Scholar
  83. 83.
    Kapusta M, dzierzanowska D, Dunin-Wasowicz D, Milewska-Bobula B, Dobrzansky A, Wojda U, Swiatkowska E, Blaszczyk G (2001) Detection of cytomegalovirus in infant cerebrospinal fluid by conventional PCR, nested PCR and PCR-digene. Acta Microbiol Polonica 50(3):263–274Google Scholar
  84. 84.
    Troendle Atkins J, Demmler GJ, Williamson WD, McDonald JM, Istas AS, Buffone GJ (1994) Polymerase chain reaction to detect cytomegalovirus DNA in the cerebrospinal fluid of neonates with congenital infection. J Infect Dis 169(6):1334–1337PubMedGoogle Scholar
  85. 85.
    Jones CA, Isaacs D (1995) Predicting the outcome of symptomatic congenital cytomegalovirus infection. J Paediatr Child Health 31(2):70–71PubMedGoogle Scholar
  86. 86.
    Ross SA, Ahmed A, Palmer AL et al (2017) Newborn dried blood spot polymerase chain reaction to identify infants with congenital cytomegalovirus-associated sensorineural hearing loss. J Pediatr 184:57–61PubMedPubMedCentralGoogle Scholar
  87. 87.
    Meyer L, Sharon B, Huang TC et al (2017) Analysis of archived newborn dried blood spots (DBS) identifies congenital cytomegalovirus as a major cause of unexplained pediatric sensorineural hearing loss. Am J Otolaryngol 38(5):565–570PubMedGoogle Scholar
  88. 88.
    Halwachs-Baumann G (2016) Congenital cytomegalovirus infection and hearing impairment. Clin Res Infect Dis 3(2):1029Google Scholar
  89. 89.
    Lackner A, Acham A, Alborno T et al (2009) Effect on hearing of ganciclovir therapy for asymptomatic congenital cytomegalovirus infection: four to 10 year follow up. J Lanryngol Otol 123(4):391–396Google Scholar
  90. 90.
    James SH, Kimberlin DW (2016) Advances in the prevention and treatment of congenital cytomegalovirus infection. Curr Opin Pediatr 28(1):81–85PubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Laboratory MedicineRegional Hospital SteyrSteyrAustria

Personalised recommendations