Skip to main content
×
×
Home

Effect on hearing of ganciclovir therapy for asymptomatic congenital cytomegalovirus infection: four to 10 year follow up

  • A Lackner (a1), A Acham (a1), T Alborno (a1), M Moser (a1), H Engele (a2), R B Raggam (a3), G Halwachs-Baumann (a4), M Kapitan (a5) and C Walch (a1)...
Abstract
Background:

Congenital cytomegalovirus infection is the leading identified nongenetic cause of congenital sensorineural hearing loss. Most of the infections are asymptomatic but may be detected from umbilical cord vein and/or newborn serum positivity for human cytomegalovirus immunoglobulin M, and from urine positivity (on polymerase chain reaction) for human cytomegalovirus deoxyribonucleic acid in the newborn period. Children infected by cytomegalovirus may later develop sensorineural hearing loss. In symptomatically infected infants, ganciclovir therapy administered in the neonatal period prevents hearing deterioration. However, preventative therapy of asymptomatic congenital cytomegalovirus disease with ganciclovir is controversial, as side effects such as severe neutropenia may occur during treatment.

Methods:

The study population consisted of 23 asymptomatic children with congenital cytomegalovirus infection. Twelve children were treated just after diagnosis of cytomegalovirus infection in the newborn period, with ganciclovir 10 mg/kg bodyweight for 21 days. The other 11 children were observed without therapy. Over a four to 10 year follow-up period, we evaluated all the children's hearing status using pure tone audiometry.

Results:

All 23 children had normal sensorineural hearing at one year follow up. Five of the 23 children (21.7 per cent) were lost to follow up over the four to 11 year follow-up period. Of the remaining 18 children, sensorineural hearing loss occurred in two (11.1 per cent). Neither child had been treated with ganciclovir in the newborn period. An eight-year-old boy showed bilateral high frequency loss and a 10-year-old girl showed severe unilateral sensorineural hearing loss. In the ganciclovir-treated group (nine children), none showed sensorineural hearing loss. During ganciclovir therapy, moderate neutropenia occurred as a side effect in two out of 12 (16.6 per cent) treated children. Speech and general development were normal in all children.

Conclusion:

Asymptomatic congenital cytomegalovirus infection is likely to be a leading cause of sensorineural hearing loss in young children. Intravenous ganciclovir therapy seems to offer a medical option to prevent subsequent sensorineural hearing loss. Further studies including a greater number of children are needed. Cytomegalovirus screening models are mandatory if medical therapy is to be implemented in time.

Copyright
Corresponding author
Address for correspondence: Dr Andreas Lackner, Dept of Neurotology, Medical University Graz, Auenbruggerplatz 26-28, A-8036 Graz, Austria. Fax: +43 316 385 7643 E-mail: andreas.lackner@meduni-graz.at
References
Hide All
1 Dahle, AJ, Fowler, KB, Wright, JD, Boppana, SB, Britt, WJ, Pass, RF et al. Longitudinal investigation of hearing disorders in children with congenital cytomegalovirus. J Am Acad Audiol 2000;11:283–90
2 Fowler, KB, Dahle, AJ, Boppana, SB, Pass, RF. Newborn hearing screening: will children with hearing loss caused by congenital cytomegalovirus infection be missed? J Pediatr 1999;135:60–4
3 Halwachs-Baumann, G, Genser, B, Danda, M, Engele, H, Rosegger, H, Fölsch, B et al. Screening and diagnosis of congenital cytomegalovirus infection: a 5-y study. Scand J Infect Dis 2000;32:137–42
4 Halwachs-Baumann, G. The congenital cytomegalovirus infection: virus-host interaction for defence and transmission. Curr Pharm Biotechnol 2006;7:303–12
5 Andersen, HK, Brostrom, K, Hansen, KB, Leerhoy, J, Pedersen, M, Osterballe, O et al. A prospective study on the incidence and significance of congenital cytomegalovirus infection. Acta Paediatr Scand 1979;68:329–36
6 Stagno, S, Pass, RF, Reynolds, DW, Moore, MA, Nahmias, AJ, Alford, CA. Comparative study of diagnostic procedures for congenital cytomegalovirus infection. Pediatr 1980;65:251–7
7 Demmler, GJ. Infectious Diseases Society of America and Centers for Disease Control: summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev Infect Dis 1991;13:315–29
8 Williamson, WD, Desmond, MM, LaFevers, N, Taber, LH, Catlin, FI, Weaver, TG. Symptomatic congenital cytomegalovirus: disorders of language, learning and hearing. Am J Dis Child 1982;136:902–5
9 Fowler, KB, McCollister, , Dahle, AJ, Boppana, S, Britt, WJ, Pass, RF et al. Progressive and fluctuating sensorineural hearing loss in children with asymptomatic congenital cytomegalovirus infection. J Pediatr 1997;130:624–30
10 Barbi, M, Binda, S, Caroppo, S, Ambrosetti, U, Corbetta, C, Sergi, P. A wider role for congenital cytomegalovirus infection in sensorineural hearing loss. Pediatr Infect Dis J 2003;22:3942
11 Bauer, P, Parizi-Robinson, M, Roland, P, Yegappan, S. Cytomegalovirus in the perilymphatic fluid. Laryngoscope 2005;115:223–5
12 Boppana, SB, Fowler, KB, Pass, RF, Rivera, LB, Bradford, RD, Lakeman, FD et al. Congenital cytomegalovirus infection: association between virus burden in infancy and hearing loss. J Pediatr 2005;145:817–23
13 Kimberlin, DW, Chin-Yu, Lin, Sanchez, PJ, Demmler, GJ, Dankner, W, Shelton, M et al. Effect of ganciclovir therapy on hearing in symptomatic congenital cytomegalovirus disease involving the central nervous system: a randomized, controlled trial. J Pediatr 2003;143:1625
14 Whitely, RJ, Cloud, G, Gruber, W, Storch, GA, Demmler, GJ, Jacobs, RF et al. Ganciclovir treatment of symptomatic congenital cytomegalovirus infection: results of a phase II study. J Infect Dis 1997;175:1080–6
15 Nigro, G, Scholz, H, Bartmann, U. Ganciclovir therapy for symptomatic congenital cytomegalovirus infection in infants: a two regimen experience. J Pediatr 1994;124:318–22
16 Österreichische Apotheker Verlagsgesellschaft m.b.H., Wien 2004. Cymevene “Roche” Trockensubstanz zur Infusionsbehandlung, Austrian Codex Fachinformation, 2004/2005;1:1538-1541 ISBN:3852001633
17 Schleiss, MR, Heineman, TC. Progress toward an elusive goal: current status of cytomegalovirus vaccines. Expert Rev Vaccines 2005;4:381406
18 Roberton, AG. Textbook of Neonatology, 4th edn. London: Elsevier, 2004
19 Michaels, MG, Greenberg, DP, Sabo, DL, Wald, ER. Treatment of children with congenital cytomegalovirus infection with ganciclovir. Pediatr Inf Dis J 2003;22:504–8
20 Bradford, R, Cloud, G, Lakeman, A, Boppana, S, Kimberlin, DW, Jacobs, R et al. 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 2005;191:227–33
21 Lazzarotto, T, Guerra, B, Lanari, M, Gabrielli, L, Landini, MP. New advances in the diagnosis of congenital cytomegalovirus infection. J Clin Virol 2008; 41(3): 192–97
22 Jacquemard, F, Yamamoto, M, Costa, JM, Romand, S, Jaqz-Aigrin, E, Dejean, A et al. Maternal administration of valaciclovir in symptomatic intrauterine cytomegalovirus infection. BJOG 2007;114:1113–21
23 Nigro, G, Adler, SP, La Torre, R, Best, AM. (Congenital Cytomegalovirus Collaboration Group). Passive immunization during pregnancy for congenital cytomegalovirus infection. N Engl J Med 2005;353:1350–62
24 Sato, A, Hirano, H, Miura, H, Hosoya, N, Ogawa, M, Tanaka, T. Intrauterine therapy with cytomegalovirus hyperimmunoglobulin for a fetus congenitally infected with cytomegalovirus. J Obstet Gynaecol Res 2007;33:718–21
Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

The Journal of Laryngology & Otology
  • ISSN: 0022-2151
  • EISSN: 1748-5460
  • URL: /core/journals/journal-of-laryngology-and-otology
Please enter your name
Please enter a valid email address
Who would you like to send this to? *
×

Keywords

Metrics

Full text views

Total number of HTML views: 11
Total number of PDF views: 101 *
Loading metrics...

Abstract views

Total abstract views: 639 *
Loading metrics...

* Views captured on Cambridge Core between September 2016 - 19th August 2018. This data will be updated every 24 hours.