Journal of Clinical Virology - Volume 82 - Supplement 1 - September 2016

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Abstracts / Journal of Clinical Virology 82S (2016) S1–S142 S3
the age of six years in the Netherlands. cCMV was diagnosed using
polymerase chain reaction on 31,484 stored dried blood spots,
collected for neonatal screening purposes. Medical data on 133
cCMV-positive children and 274 cCMV-negative controls (matched
for age, gender and region), were obtained from general physi-
cians and other health care providers. Symptoms in the neonatal
period and moderate to severe long-term impairments, in hearing,
visual, neurological, motor, cognitive and speech-language, were
analyzed.
Results: In the cCMV-positive group 26 (19.6%) children were
classified symptomatic at birth, whereas in the cCMV negative
group 34 (12.4%) children had similar symptoms. Overall 33 (24.8%)
cCMV-positive and 33 (12.0%) cCMV-negative children had one
or more long term impairments (risk difference: 12.8%, 95% CI:
4.5–21.1). Long-term impairment was more common in children
with cCMV who were symptomatic at birth (53.9%) compared to
cCMV-positive children without symptoms at birth (17.8%).
Sensorineural hearing loss was only seen in children with
cCMV (3.8%). Impairments in cognitive, motor and speech-language
development were respectively 5.5, 7.2 and 2.2 times more fre-
quent in children with cCMV compared to the control group
without cCMV. Impairment in multiple domains was also more
common in children with cCMV (10.5%), especially in children with
symptoms at birth (19.2%), compared to children without cCMV
(1.8%).
Conclusion: Long term impairments were more common in
the cCMV positive than the cCMV negative children. Especially
hearing loss, cognitive, motor and speech-language impairment is
more common in childrenwith cCMV. Childrenwith cCMVwho are
symptomatic at birth have an even higher risk of one or multiple
impairments compared to asymptomatic cCMV-positive children
and children without cCMV.
These findings demonstrate the need to reinterpret the role that
congenital CMV infectionplays in causing symptoms at birth aswell
as long term sequelae.
Abstract no: 32
Presentation at ESCV 2016: Oral 5
Severe fetopathy caused by cytomegalovirus
recurrence with isolated intra-abdominal
complication in an immune woman
M. Pichon ∗, A. Gaymard , P.A. Bolze ,
V. Verneau , A. Buenerd , P. Gaucherand ,
B. Lina , Y. Mekki
1 Virology Department, University Hospital of Lyon,
France
2 Virpath, Inserm U1111 – CNRS UMR 5308, Lyon,
France
3 Department of Gynecological Surgery and
Oncology, Obstetrics, University Hospital of Lyon,
France
4 Laboratoire BioRhone, France
5 Pathology Department, University Hospital of Lyon,
France
Introduction: Cytomegalovirus (CMV) is the main cause of
foetal infection: 1% of neonates are CMV-infected and among these,
10% are symptomatic at birth. Despite this prevalence, only anec-
dotal cases of severe congenital CMV disease have been reported.
We report here the case of a pregnant womanwith CMV recurrence
linked to an atypical clinical presentation, leading to the abortion
of her first pregnancy.
Case report: A healthy 23 years-old woman (gravida 1, para 0)
became pregnant without any clinical or biological problem dur-
ing the first trimester. A systematic foetal ultrasound, at 22 weeks
of gestation, showed a large intra-abdominal hyper echogenic
and heterogenic cystic mass. These results were confirmed by
foetal MRI and meconial peritonitis was suspected. Extra- and
intra-abdominal complications were explored and a cardio- and
a splenomegaly were diagnosed without any evolution during all
the pregnancy. There was no neurological signs, no variation of the
amniotic fluid volume and no cardiologic dysfunction. The mater-
nal serological assay done before and during pregnancy showed
constant low levels of IgM anti-CMV (between 0.5 and 0.7 IU/ml)
and high level of IgG anti-CMV (between 245 and 402 IU/ml)
(Beckman-Coulter, USA; Abbott, USA). Inflammatory markers (CRP,
fibrinogen, neutrophils cells) were all up-regulated but there
was no thrombocytemia in foetal and maternal blood. Foetal
amniocentesis showed a high CMV viral load in amniotic fluid
(7.5 log copies/ml) and foetal blood (6.1 log copies/ml) (bioMérieux,
France). At the same time, CMV viral load was slightly positive in
the mother‘s blood (198 copies/ml) (Vela diagnostics, Germany).
Sequencing of CMV strains is currently ongoing in order to explore
possible viral severity markers. All the other fetopathy causes
were negatives (genetic: trisomy 21, cystic fibrosis/metabolic dis-
eases/immunologic: Kleihauer test/infectious: Parvovirus B19). The
pregnancy was interrupted at 34 weeks, because of the major
risk of intestinal sequelae, leading to foetal death. There was no
post-mortem examination of the corpse due to the parents’ oppo-
sition. However, pathological examination of the placenta revealed
hydrophic chorionic villi with cytomegalic inclusion bodies and
positive anti-CMV nuclear staining (Ventana, Argene, clone E13).
Discussion: We showed here a case of CMV recurrence leading
to severe complications of the foetal development, in a pregnant
woman considered to be immune. The absence of neurological
(microcephaly and periventricular calcifications) or hematologic
(thrombocytemic purpura) signs caused a delayed diagnosis. The
isolated intra-abdominal abnormalities were an atypical but severe
presentation of CMV’s infection of the foetus. In conclusion, our
case-report highlighted the need for an optimized partnership
between hospital clinicians and private biologist. A systematic
viral screening of foetal infections (Parvoviridae or Herpesviridae)
should be proposed in front of any abnormalities during the foetal
ultrasound examination. The use of symptom multiplex screening
assays on amniotic fluid may help in these difficult situations to
optimizemanagement of patients in order to detect or prevent fatal
outcomes.
Abstract no: 349
Presentation at ESCV 2016: Oral 6
Current trends in molecular epidemiology of
Varicella-Zoster Virus clinical isolates in Czech
republic
Vanda Bostikova∗, Radek Sleha, Pavel Bostik
FMHS, Hradec Kralove, Department of Epidemiology,
Faculty of Military Health Sciences, Hradec Kralove,
Czech Republic
Infections with Varicella-Zoster Virus (VZV) in humans mani-
fest by two different sets of symptoms – chickenpox and shingles.
These infections exhibit annual peaks, as well as geographical dis-
tributions of different virus genotypes and predilection of each of
the 2 manifestations in defined age groups.