Progressive, Long-Term Hearing Loss in Congenital CMV Disease After Ganciclovir Therapy

Authors

Tatiana M Lanzieri
Alison Chantal Caviness
Peggy Blum
Gail Demmler-Harrison

Publication Date

1-27-2022

Journal

Journal of the Pediatric Infectious Diseases Society

DOI

10.1093/jpids/piab095

PMID

34718680

PMCID

PMC9590555

PubMedCentral® Posted Date

10-28-2021

PubMedCentral® Full Text Version

Post-print

Published Open-Access

yes

Keywords

Antiviral Agents, Child, Cytomegalovirus Infections, Ganciclovir, Hearing Loss, Humans, Infant, Longitudinal Studies, congenital cytomegalovirus, ganciclovir, sensorineural hearing loss

Abstract

BACKGROUND: Long-term hearing outcomes among children with symptomatic congenital cytomegalovirus (CMV) disease who received 6-week ganciclovir therapy early in life are unknown.

METHODS: Longitudinal study of 76 children with symptomatic congenital CMV disease, born 1983-2005, who were categorized into three groups: group A treated with ganciclovir; group B untreated who had microcephaly, chorioretinitis, or sensorineural hearing loss (SNHL; ≥25 dB) diagnosed in the first month of life (congenital); and group C untreated who did not meet criteria for group B.

RESULTS: Patients in groups A (n = 17), B (n = 27), and C (n = 32) were followed to median age of 13, 11, and 13 years, respectively. In group A, patients received ganciclovir for median of 40 (range, 11-63) days; 7 (41%) had grade 3 or 4 neutropenia. Congenital SNHL was diagnosed in 11 (65%) patients in group A, 15 (56%) in group B, and none in group C. Early-onset SNHL was diagnosed between ages ≥1-12 months in an additional 4 (24%), 6 (22%), and 8 (25%) patients in groups A, B, and C, respectively. By the end of follow-up, 12 (71%), 16 (59%), and 7 (22%) of patients in groups A, B, and C, respectively, had severe (>70 dB) SNHL in the better-hearing ear.

CONCLUSIONS: In this study, most patients with symptomatic congenital CMV disease and congenital or early-onset SNHL eventually developed hearing loss severe enough to have been potential candidates for cochlear implantation, with or without 6-week ganciclovir therapy. Understanding long-term hearing outcomes of patients treated with 6-month oral valganciclovir (current standard of care) is needed.