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Updated: Aug 1, 2026
Use of In vivo Imaging to Monitor the Progression of Experimental Mouse Cytomegalovirus Infection in Neonates
Published on: July 6, 2013
Characterization of a universal screening approach for congenital CMV infection based on a highly-sensitive,
Angela Nagel1, Emmanouela Dimitrakopoulou2, Norbert Teig3
1Institute of Clinical and Molecular Virology, University Hospital Erlangen, Erlangen, Germany.
Insights
Universal screening for congenital cytomegalovirus (cCMV) at birth is crucial. A new real-time PCR assay in saliva can identify infants at risk for late-onset cCMV disease, enabling timely interventions.
Area of Science:
- Virology
- Neonatal Medicine
- Molecular Diagnostics
Background:
- Congenital cytomegalovirus (cCMV) infections are often asymptomatic at birth, leading to delayed diagnosis.
- A significant percentage of infants with cCMV develop late-onset hearing loss and developmental disorders.
- Early detection and intervention are critical for managing cCMV-related complications.
Purpose of the Study:
- To develop and validate a universal screening algorithm for cCMV using real-time PCR on saliva samples.
- To stratify CMV-infected infants based on viral load to predict the risk of late-onset disease.
- To reduce parental anxiety and follow-up costs associated with cCMV screening.
Main Methods:
- Development of a sensitive, quantitative real-time PCR assay for CMV DNA detection in saliva.
- Compatibility of the assay with centralized testing for large-scale universal screening.
- Determination of CMV DNA load in International Units (IU)/ml saliva and IU/105 cell equivalents.
Main Results:
- The screening algorithm identified 18 of 34 infants with confirmed cCMV infection via blood/urine analysis.
- Unconfirmed positive screening samples showed significantly lower viral loads compared to confirmed cases.
- Confirmed cCMV infections exhibited a wide range of viral loads in saliva, necessitating further correlation with disease risk.
Conclusions:
- A quantitative real-time PCR assay for saliva is a feasible method for universal cCMV screening.
- The viral DNA load in early-life saliva may correlate with the risk of late-onset cCMV disease.
- Further clinical follow-up is needed to establish a definitive cut-off for risk stratification in cCMV-infected infants.
Abstract:
The majority of congenital cytomegalovirus (cCMV) infections are asymptomatic at birth and therefore not diagnosed. Approximately 10-15% of these infants develop late-onset hearing loss and other developmental disorders. Implementation of a universal screening approach at birth may allow early initiation of symptomatic interventions due to a closer follow-up of infants at risk and offers the opportunity to consider treatment of late-onset disease. Real-time PCR assays for the detection of CMV DNA in buccal swab samples demonstrated feasibility and good clinical sensitivity in comparison to a rapid culture screening assay. Because most cCMV infections remain asymptomatic, a universal screening assay that stratifies CMV infected infants according to low and high risk of late-onset cCMV disease could limit the parental anxiety and reduce follow-up costs. We therefore developed and characterized a screening algorithm based on a highly-sensitive quantitative real-time PCR assay that is compatible with centralized testing of samples from universal screening and allows to determine CMV DNA load of saliva samples either as International Units (IU)/ml saliva or IU/105 cell equivalents. 18 of 34 saliva samples of newborns that tested positively by the screening algorithm were confirmed by detection of CMV DNA in blood and/or urine samples obtained during the first weeks of life. All screening samples that could not be confirmed had viral loads of <2.3x105 IU/ml saliva (median: 6.8x103) or 1.3x105 IU/105 cell equivalents (median: 4.0x102). The viral load of screening samples with confirmed cCMV infection ranged from 7.5x102 to 8.2x109 IU/ml saliva (median: 9.3x107) or 1.5x102 to 5.6x1010 IU/105 cell equivalents (median: 3.5x106). Clinical follow-up of these newborns with confirmed cCMV infection should reveal whether the risk of late-onset cCMV disease correlates with CMV DNA load in early life saliva samples and whether a cut-off can be defined identifying cCMV infected infants with or without risk for late-onset cCMV disease.
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