Skip to main content
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems
  • Log in
  • My alerts
  • My Cart

Main menu

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • COVID-19 Special Collection
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About JCM
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
  • ASM
    • Antimicrobial Agents and Chemotherapy
    • Applied and Environmental Microbiology
    • Clinical Microbiology Reviews
    • Clinical and Vaccine Immunology
    • EcoSal Plus
    • Eukaryotic Cell
    • Infection and Immunity
    • Journal of Bacteriology
    • Journal of Clinical Microbiology
    • Journal of Microbiology & Biology Education
    • Journal of Virology
    • mBio
    • Microbiology and Molecular Biology Reviews
    • Microbiology Resource Announcements
    • Microbiology Spectrum
    • Molecular and Cellular Biology
    • mSphere
    • mSystems

User menu

  • Log in
  • My alerts
  • My Cart

Search

  • Advanced search
Journal of Clinical Microbiology
publisher-logosite-logo

Advanced Search

  • Home
  • Articles
    • Current Issue
    • Accepted Manuscripts
    • COVID-19 Special Collection
    • Archive
    • Minireviews
  • For Authors
    • Submit a Manuscript
    • Scope
    • Editorial Policy
    • Submission, Review, & Publication Processes
    • Organization and Format
    • Errata, Author Corrections, Retractions
    • Illustrations and Tables
    • Nomenclature
    • Abbreviations and Conventions
    • Publication Fees
    • Ethics Resources and Policies
  • About the Journal
    • About JCM
    • Editor in Chief
    • Editorial Board
    • For Reviewers
    • For the Media
    • For Librarians
    • For Advertisers
    • Alerts
    • RSS
    • FAQ
  • Subscribe
    • Members
    • Institutions
The Brief Case

Closing the Brief Case: Nystagmus in a 3-Month-Old Leading to a Diagnosis of Congenital Cytomegalovirus Infection

Priyanka Uprety, Erin H. Graf
Carey-Ann D. Burnham, Editor
Priyanka Uprety
aDepartment of Laboratory Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Erin H. Graf
bDepartment of Laboratory Medicine and Pathology, Mayo Clinic Arizona, Phoenix, Arizona, USA
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
Carey-Ann D. Burnham
Washington University School of Medicine
Roles: Editor
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
DOI: 10.1128/JCM.01471-19
  • Article
  • Info & Metrics
  • PDF
Loading

ANSWERS TO SELF-ASSESSMENT QUESTIONS

  1. Which of the following is the most sensitive and specific laboratory test to diagnose congenital CMV (cCMV) in a pregnant woman who has fetal abnormalities detected during her 20-week ultrasound?

    • a. CMV IgG enzyme immunoassay from the mother’s serum

    • b. CMV IgM enzyme immunoassay from the mother’s serum

    • c. CMV PCR of the mother’s blood

    • d. CMV PCR of amniotic fluid

Answer: d. PCR of amniotic fluid is the preferred method for highly sensitive and specific diagnosis of congenital CMV. IgG and IgM testing can reflect past infection and therefore lack specificity. Detection of CMV DNA in the mother’s blood can be supportive evidence, but since only around a third of primary infections are passed to the fetus, detection in the mother’s bloodstream does not guarantee that the virus was passed to the fetus.

  1. Which of the following is the most sensitive and specific laboratory test to diagnose cCMV in a newborn who has failed their first hearing screen at day 1 of life?

    • a. CMV PCR of urine

    • b. CMV PCR of swab-collected saliva

    • c. CMV IgG testing of the neonate’s serum

    • d. CMV IgG testing of the mother’s serum

Answer: a. Some states now recommend CMV testing for newborns who fail their first hearing screen. The preferred method is CMV PCR of urine; however, this requires brief catheterization for collection. Swab-collected saliva is also acceptable, but there is the risk of false positivity in breast-fed neonates, as CMV is frequently shed in breastmilk. Thus, a positive saliva result should be confirmed with a urine PCR. IgG testing lacks specificity, as antibodies in the mother can reflect past infection and antibodies in the neonate are likely from transplacental acquisition.

  1. Which of the following could be considered to support a diagnosis of cCMV in a 6-month-old infant who has developmental delays and abnormal MRI findings?

    • a. CMV PCR of urine

    • b. CMV PCR of swab-collected saliva

    • c. CMV PCR of the 6-month-old infant’s dried blood spot collected 24 hours after birth

    • d. CMV IgG testing of the 6-month-old infant’s serum

Answer: c. Detection of CMV DNA in urine or saliva or of anti-CMV IgG antibodies at this age could reflect postpartum acquisition. The most specific approach would be to test the blood spot collected around 24 h after birth, although current testing methods are not 100% sensitive and thus could miss cases. Unfortunately, many states discard the newborn screening card before symptoms are realized.

TAKE-HOME POINTS

  • Diagnosis of congenital cytomegalovirus infection can be challenging and requires different approaches based upon the stage at which symptoms are observed.

  • cCMV is the most common congenital infection, and there is consideration of including detection of CMV DNA from the dried blood spot card as part of newborn screening.

  • CMV PCR from saliva and/or urine in newborns that fail their first hearing screen is required in some states and is recommended in many others to diagnose cCMV.

  • Avidity testing for CMV IgG antibodies can be considered in pregnant women with concern for transplacental transmission but should not be used as a standalone test.

  • Diagnosis of cCMV can allow therapeutic interventions and/or frequent hearing and vision screening.

See https://doi.org/10.1128/JCM.01470-19 in this issue for case presentation and discussion.

  • Copyright © 2020 American Society for Microbiology.

All Rights Reserved.

PreviousNext
Back to top
Download PDF
Citation Tools
Closing the Brief Case: Nystagmus in a 3-Month-Old Leading to a Diagnosis of Congenital Cytomegalovirus Infection
Priyanka Uprety, Erin H. Graf
Journal of Clinical Microbiology Jun 2020, 58 (7) e01471-19; DOI: 10.1128/JCM.01471-19

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Print

Alerts
Sign In to Email Alerts with your Email Address
Email

Thank you for sharing this Journal of Clinical Microbiology article.

NOTE: We request your email address only to inform the recipient that it was you who recommended this article, and that it is not junk mail. We do not retain these email addresses.

Enter multiple addresses on separate lines or separate them with commas.
Closing the Brief Case: Nystagmus in a 3-Month-Old Leading to a Diagnosis of Congenital Cytomegalovirus Infection
(Your Name) has forwarded a page to you from Journal of Clinical Microbiology
(Your Name) thought you would be interested in this article in Journal of Clinical Microbiology.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Share
Closing the Brief Case: Nystagmus in a 3-Month-Old Leading to a Diagnosis of Congenital Cytomegalovirus Infection
Priyanka Uprety, Erin H. Graf
Journal of Clinical Microbiology Jun 2020, 58 (7) e01471-19; DOI: 10.1128/JCM.01471-19
del.icio.us logo Digg logo Reddit logo Twitter logo CiteULike logo Facebook logo Google logo Mendeley logo
  • Top
  • Article
    • ANSWERS TO SELF-ASSESSMENT QUESTIONS
  • Info & Metrics
  • PDF

KEYWORDS

congenital infections
cytomegalovirus
pediatric infectious disease

Related Articles

Cited By...

About

  • About JCM
  • Editor in Chief
  • Board of Editors
  • Editor Conflicts of Interest
  • For Reviewers
  • For the Media
  • For Librarians
  • For Advertisers
  • Alerts
  • RSS
  • FAQ
  • Permissions
  • Journal Announcements

Authors

  • ASM Author Center
  • Submit a Manuscript
  • Article Types
  • Resources for Clinical Microbiologists
  • Ethics
  • Contact Us

Follow #JClinMicro

@ASMicrobiology

       

ASM Journals

ASM journals are the most prominent publications in the field, delivering up-to-date and authoritative coverage of both basic and clinical microbiology.

About ASM | Contact Us | Press Room

 

ASM is a member of

Scientific Society Publisher Alliance

 

American Society for Microbiology
1752 N St. NW
Washington, DC 20036
Phone: (202) 737-3600

 

Copyright © 2021 American Society for Microbiology | Privacy Policy | Website feedback

Print ISSN: 0095-1137; Online ISSN: 1098-660X