Diagnóstico retrospectivo de infecção congénita por citomegalovírus numa coorte de crianças com hipoacusia neurossensorial
DOI:
https://doi.org/10.34631/sporl.437Palavras-chave:
Surdez infantil, infecção por citomegalovírus, cartões de GuthrieResumo
Objectivos: Determinar a prevalência da infecção congénita por Citomegalovírus (CMV) como causa de hipoacusia infantil.
Métodos: Realizou-se um estudo de coorte retrospectivo através da revisão de dados nos processos clínicos. Seleccionaram-se as crianças com hipoacusia neuro-sensorial bilateral moderada ou mais grave e que não tinham diagnóstico estabelecido. Os cartões de Guthrie armazenados num laboratório de referência nacional foram analisados com uma técnica baseada em extracção de ácido desoxirribonucleico (ADN) induzida por calor, seguida de pesquisa de ADN do CMV através de amplificação por polymerase chain reaction.
Resultados: Dos 83 cartões de Guthrie testados, 8 (9,6%) foram positivos. Na nossa coorte, 11 doentes têm infecção congénita por CMV confirmada, correspondendo a 8,1% dos casos com diagnóstico confirmado mas apenas 3,4% dos casos no global.
Conclusão: A infecção congénita por CMV é uma causa significativa de hipoacusia infantil na nossa população. O diagnóstico retrospectivo é possível com recurso aos cartões de Guthrie.
Referências
Vaz R, Spratley J, Silva JS, Falcão A, et al. Rastreio auditivo neonatal universal no Hospital de S. João: resultados dos primeiros 12 meses. Rev Portuguesa ORL. 2010;48(4):207-10.
De S, Archbold S, Clarke R. Investigation and Management of the Deaf Child. In: Gleeson M, Clarke R, editors. Scott Brown’s
Otorhinolaryngology, Head and Neck Surgery. London, UK: Edward Arnold Ltd; 2008.
Matsunaga T. Value of genetic testing in the otological approach for sensorineural hearing loss. Keio J Med. 2009;58(4):216-22. Epub 2009/12/29.
Nassetta L, Kimberlin D, Whitley R. Treatment of congenital cytomegalovirus infection: implications for future therapeutic
strategies. J Antimicrob Chemother. 2009;63(5):862-7. Epub 2009/03/17.
Foulon I, Naessens A, Faron G, Foulon W, et al. Hearing thresholds in children with a congenital CMV infection: A prospective study. Int J Pediatr Otorhinolaryngol. 2012. Epub 2012/03/06.
Cheeran MC, Lokensgard JR, Schleiss MR. Neuropathogenesis of congenital cytomegalovirus infection: disease mechanisms and
prospects for intervention. Clin Microbiol Rev. 2009;22(1):99-126, Table of Contents. Epub 2009/01/13.
Yamamoto AY, Mussi-Pinhata MM, Isaac MdeL, Amaral FR, et al. Congenital cytomegalovirus infection as a cause of sensorineural
hearing loss in a highly immune population. Pediatr Infect Dis J. 2011;30(12):1043-6. Epub 2011/08/05.
Fowler KB, Boppana SB. Congenital cytomegalovirus (CMV) infection and hearing deficit. J Clin Virol. 2006;35(2):226-31. Epub 2006/01/03.
Lazzarotto T, Lanari M. Why is cytomegalovirus the most frequent cause of congenital infection? Expert Rev Anti Infect Ther.
;9(10):841-3. Epub 2011/10/07.
Vohr B, Topol D, Girard N, St Pierre L, et al. Language outcomes and service provision of preschool children with congenital hearing loss. Early Hum Dev. 2012. Epub 2012/01/24.
Paradiz KR, Seme K, Puklavec E, Paro-Panjan D, et al. Prevalence of congenital cytomegalovirus infection in Slovenia: a study on 2,841 newborns. J Med Virol. 2012;84(1):109-15. Epub 2011/10/27.
Paixao P, Almeida S, Gouveia P, Vilarinho L, et al. Prevalence of human cytomegalovirus congenital infection in Portuguese newborns. Euro Surveill. 2009;14(9):13-5. Epub 2009/03/26.
Noyola DE, Matienzo-Serment L, Rodriguez-Vidal SO, Ochoa-Perez UR, et al. [Congenital cytomegalovirus infection in newborn
infants from the state of San Luis Potosi, Mexico]. Salud Publica Mex. 2011;53(6):513-5. Epub 2012/01/28. Infeccion congenita por citomegalovirus en recien nacidos del estado de San Luis Potosi, Mexico.
Barbi M, Binda S, Primache V, Caroppo S, et al. Cytomegalovirus DNA detection in Guthrie cards: a powerful tool for diagnosing
congenital infection. J Clin Virol. 2000;17(3):159-65. Epub 2000/09/21.
Kadambari S, Williams EJ, Luck S, Griffiths PD, et al. Evidence based management guidelines for the detection and treatment of congenital CMV. Early Hum Dev. 2011;87(11):723-8. Epub 2011/10/04.
Milewska-Bobula B, Zebrowska J, Olszaniecka M, Pijanowska S, et al. Evaluation of intellectual development of children following congenital, mildly symptomatic cytomegalovirus (CMV) infection. A prospective study. Med Wieku Rozwoj. 2010;14(4):370-3. Epub 2011/04/05.
Oliver SE, Cloud GA, Sanchez PJ, Demmler GJ, et al. Neurodevelopmental outcomes following ganciclovir therapy in
symptomatic congenital cytomegalovirus infections involving the central nervous system. J Clin Virol. 2009;46 Suppl 4:S22-6. Epub 2009/09/22.
Shin JJ, Keamy DG, Jr., Steinberg EA. Medical and surgical interventions for hearing loss associated with congenital cytomegalovirus: a systematic review. Otolaryngol Head Neck Surg. 2011;144(5):662-75. Epub 2011/04/16.
Royackers L, Christian D, Frans D, Ermelinde R. Hearing status in children with congenital cytomegalovirus: up-to-6-years audiological follow-up. Int J Pediatr Otorhinolaryngol. 2011;75(3):376-82. Epub 2011/01/18.
Lackner A, Acham A, Alborno T, Moser M, et al. Effect on hearing of ganciclovir therapy for asymptomatic congenital cytomegalovirus infection: four to 10 year follow up. J Laryngol Otol. 2009;123(4):391-6. Epub 2008/07/01.
Bernstein DI. Vaccines for Cytomegalovirus. Infect Disord Drug Targets. 2011. Epub 2011/08/11.
Snijdewind IJ, van Kampen JJ, Fraaij PL, van der Ende ME, et al. Current and future applications of dried blood spots in viral disease management. Antiviral Res. 2012;93(3):309-21. Epub 2012/01/17.
Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev
Med Virol. 2007;17(4):253-76. Epub 2007/06/21.
Boppana SB, Ross SA, Novak Z, Shimamura M, et al. Dried blood spot real-time polymerase chain reaction assays to screen newborns for congenital cytomegalovirus infection. JAMA. 2010;303(14):1375-82. Epub 2010/04/15.
