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Genotypic Diversity and Mixed Infection in Newborn Disease and Hearing Loss in Congenital Cytomegalovirus Infection

Pati, Sunil K. PhD*; Pinninti, Swetha MD*; Novak, Zdenek MD, PhD, MSHI*; Chowdhury, Nazma MBBS, PhD*; Patro, Raj K. PhD*; Fowler, Karen DrPH*†‡; Ross, Shannon MD, MSPH; Boppana, Suresh MDfor the NIDCD CHIMES Study Investigators

The Pediatric Infectious Disease Journal: October 2013 - Volume 32 - Issue 10 - p 1050–1054
doi: 10.1097/INF.0b013e31829bb0b9
Original Studies

Background: Congenital cytomegalovirus (cCMV) is a common congenital infection and a leading nongenetic cause of sensorineural hearing loss (SNHL). CMV exhibits extensive genetic variability, and infection with multiple CMV strains (mixed infection) was shown to be common in congenital CMV. The role of mixed infections in disease and outcome remains to be defined.

Methods: Genotyping of envelope glycoproteins, UL55 (gB), UL73 (gN) and UL75 (gH), was performed on saliva specimens of 79 infants from the ongoing CMV and Hearing Multicenter Screening (CHIMES) Study and on blood and urine specimens of 52 infants who participated in natural history studies at the University of Alabama at Birmingham. Genotyping of UL144 and US28 was also performed in the CHIMES cohort. The association of individual genotypes and mixed infection with clinical findings at birth and SNHL was examined.

Results: Thirty-seven of 131 infants (28%) were symptomatic at birth and 26 (20%) had SNHL at birth. All known genotypes of UL55, UL75, UL73 and US28 were represented, and no particular genotype was associated with symptomatic infection or SNHL. UL144 subtype C was more common in symptomatic infants but not associated with SNHL. Mixed infection was observed in 59 infants (45%) and not associated with symptoms (P = 0.43) or SNHL at birth (P = 0.82). In the cohort of 52 infants with long-term hearing outcome, mixed infection at birth was not predictive of SNHL.

Conclusions: Mixed infection is common in infants with congenital CMV but is neither associated with symptomatic infection nor associated with SNHL.

Supplemental Digital Content is available in the text.

From the *Department of Pediatrics, †Department of Epidemiology, International Health, and §Department of Microbiology, The University of Alabama at Birmingham, Birmingham, AL

Accepted for publication May 13, 2013.

Supported by the National Institute on Deafness and Other Communication Disorders (N01 DC50008 and K23 DC008539). The authors have no other funding or conflict of interest to disclose.

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Address for correspondence: Sunil K. Pati, PhD, Department of Pediatrics, The University of Alabama at Birmingham, Children’s Hospital, CHB 150, 1600 6th Ave. S., Birmingham, AL 35233. E-mail:

© 2013 by Lippincott Williams & Wilkins, Inc.