The following is a summary of “Clinical Value of Serial Quantitative Analysis of Cytomegalovirus DNA in Blood and Saliva Over the First 24 Months of Life in Congenital Infection: The French Cymepedia Cohort,” published in the FEBRUARY 2023 issue of Pediatrics by Fourgeaud, et al.

For a study, researchers sought to evaluate the cytomegalovirus (CMV) viral load dynamics in blood and saliva during the first 2 years of life in symptomatic and asymptomatic infected infants and to identify whether these dynamics could have practical clinical implications.

The study was a part of the Cymepedia cohort, which prospectively included 256 congenitally infected neonates followed for 2 years. Whole blood and saliva samples were collected at inclusion and months 4 and 12, with saliva samples also being collected at months 18 and 24. Real-time CMV polymerase chain reaction (PCR) was performed, with results expressed as log10 IU/mL in blood and in copies per milliliter in saliva.

The study found that the viral load in saliva progressively decreased from 7.5 log10 at birth to 3.3 log10 at month 24. CMV PCR in saliva was positive in 100% and 96% of infants at 6 and 12 months, respectively. Neonatal saliva viral load of less than 5 log10 was related to a late CMV transplacental passage. In the first month of life, detection in blood was positive in 92% of neonates (147/159). However, no viral load threshold values in blood or saliva were associated with a high risk of sequelae. Neonatal blood viral load of less than 3 log10 IU/mL had a 100% negative predictive value for long-term sequelae.

The study demonstrated that viral loads in blood and saliva by CMV PCR testing in congenital infection fall over the first 24 months. All salivary samples were positive in the first 6 months of life in infants affected mainly after primary maternal infection during pregnancy, and sequelae were not seen in infants with neonatal blood viral load of less than 3 log10 IU/mL. The findings suggested that viral load dynamics could have practical clinical implications in the management of congenital CMV infection.