Karolina Falkenius Schmidt- Institutionen för kliniska vetenskaper, Lund

Title: Congenital cytomegalovirus infection – a long-term follow-up study

Main supervisor:

Professor Måns Magnusson,

Associate Professor Johannes Ehinger (from 2024)

Division of Otorinolaryngology, Lund University

Reviewers:

Professor Per Östberg, 

Department of Intervention and Technology, Karolinska Institute

PhD Ioannis Orfanos, 

Dept of Clinical Science, Section of Pediatrics. Lund University

Abstract

Background

Congenital Cytomegalovirus (cCMV) is the most common prenatal infection, the main infectious cause of sensorineural hearing loss in childhood and neurodevelopmental abnormalities in developed countries. Newborns who show obvious symptoms are likely to be identified early, but since most of the infants are asymptomatic at birth, the infection is often unrecognized. 

This is a long-term follow-up study of a universal newborn CMV screening study, performed in Sweden 1977-1985. All individuals with cCMV infection and uninfected controls were invited to participate. Participants, now adults between 34-43 years, form a unique study cohort to improve knowledge about the impact of long-term effects of cCMV infection. This PhD-project focus on hearing ability, vestibular function, and cognitive functions including linguistic ability.

Main research questions

1. What is the risk of late progressive hearing loss in adults with cCMV infection?
2. How common is vestibular dysfunction in adults with cCMV infection?
3. Is word fluency performance different in adults with cCMV infection compared to age-matched controls who were uninfected at birth?
4. Is there a difference in self-reported everyday executive functioning in adults with cCMV infection compared to age-matched controls who were uninfected at birth?

Preliminary results

Linguistic ability and evaluation of executive functions form the first part of this PhD-project due to data sampling during the Covid-19 pandemic.

Results so far suggest that adults with cCMV infection may have deficits in the word retrieval process, even in absence of known neurodevelopmental delay and hearing loss. Long-term effects of cCMV infection may exist even in those with asymptomatic infection at birth. Everyday executive functioning might not be affected according to self-reports in individuals with cCMV. More studies are needed to evaluate cognitive abilities in adults with cCMV infection, preferable with both subjective and objective methods. 

Significance

Long-term effects of cCMV infection are still not well understood. This is the first study in the literature that has investigated long-term outcomes in a cohort of adults who were screened at birth. The PhD-project contribute to new knowledge and better understanding of long-term effects of cCMV infection in both symptomatic and asymptomatic individuals. Preliminary results support the importance not only to perform long-term evaluations, but also endorse benefit of early identification of all individuals who are born with cCMV infection. 

Publications

Original articles

I

Long-term linguistic outcome in adults with congenital cytomegalovirus infection

Falkenius Schmidt K, Nyström A, Karltorp E, Magnusson M, Löfkvist U. Infect Dis (Lond). 2024 Jan;56(1):32-41. doi: 10.1080/23744235.2023.2263567. Epub 2023 Dec 18.PMID: 37795972

II 

Self-reported executive functioning in adults with congenital cytomegalovirus infection

Karolina Falkenius Schmidt, Anastasia Nyström, Eva Karltorp, Måns Magnusson, Ulrika Löfkvist (Manuscript)