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• W3017259677 abstract "The diagnosis of congenital cytomegalovirus (CMV) infection (cCMV) depends on the result of CMV PCR testing of saliva, urine, or both within the first 21 days of life.1Rawlinson W.D. Boppana S.B. Fowler K.B. Kimberlin D.W. Lazzarotto T. Alain S. et al.Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy.Lancet Infect Dis. 2017; 17: e177-e188Abstract Full Text Full Text PDF PubMed Scopus (334) Google Scholar The nail plate is composed of keratinized epithelial cells, and CMV can infect epithelial cells.2Sinzger C. Grefte A. Plachter B. Gouw A.S. The T.H. Jahn G. Fibroblasts, epithelial cells, endothelial cells and smooth muscle cells are major targets of human cytomegalovirus infection in lung and gastrointestinal tissues.J Gen Virol. 1995; 76: 741-750Crossref PubMed Scopus (295) Google Scholar Moreover, CMV DNA is detectable in the skin.3Grimes P.E. Sevall J.S. Vojdani A. Cytomegalovirus DNA identified in skin biopsy specimens of patients with vitiligo.J Am Acad Dermatol. 1996; 35: 21-26Abstract Full Text PDF PubMed Scopus (72) Google Scholar The purpose of this study is to determine whether CMV DNA is detectable in the fingernails of our patient, who is an infant with cCMV. On day 5 of life, our patient failed the hearing screening test. The patient's urine was positive for a CMV-specific real-time PCR on day 6 of life. Moreover, whole blood (day 9) and preserved umbilical cord were also positive for a CMV-specific real-time PCR. We, therefore, diagnosed cCMV. We obtained a fingernail sample from the patient on days 55, 134, and 191 of life. We collected fingernails by using a stainless-steel clipper. To avoid contamination, nails were washed three times with 1 mL of PBS and dried before being used in assays. In addition, we evaluated whole blood (day 9) and preserved the umbilical cord by a CMV-specific real-time PCR and a sequence analysis. We performed the CMV-specific real-time PCR for the quantification of CMV DNA as described in a previous research.4Wada K. Kubota N. Ito Y. Yagasaki H. Kato K. Yoshikawa T. et al.Simultaneous quantification of Epstein-Barr virus, cytomegalovirus, and human herpesvirus 6 DNA in samples from transplant recipients by multiplex real-time PCR assay.J Clin Microbiol. 2007; 45: 1426-1432Crossref PubMed Scopus (84) Google Scholar We also performed a PCR to amplify the regions of UL55 gene encoding glycoprotein B (gB) and UL73 gene encoding glycoprotein N (gN).5Mujtaba G. Khurshid A. Sharif S. Alam M.M. Aamir U.B. Shaukat S. et al.Distribution of cytomegalovirus genotypes among neonates born to infected mothers in Islamabad, Pakistan.PloS One. 2016; 11e0156049Crossref PubMed Scopus (13) Google Scholar We detected CMV DNA by the real-time PCR in the patient's fingernail samples from days 55 and 191 of life. The nail sample obtained on day 134 was negative in the real-time PCR. The patient's whole blood and the preserved umbilical cord were positive in the real-time PCR. The PBS samples that were used for washing fingernails were negative for CMV DNA. The levels of CMV DNA are as follows: umbilical cord had 4.6 log copies/mL; whole blood (day 9) had 5.0 log copies/mL; nails (day 55) had 4.5 log copies/mL; and nails (day 191) had 4.0 log copies/mL. The phylogenetic analysis of the UL55 gene showed that the sequences of CMV DNA from the umbilical cord, whole blood, and nails (days 55 and 191) belonged to the genotype gB-1 (Fig. 1A). All the sequences of the UL55 gene were completely identical except for those in the fingernail sample obtained on day 191. In the sequence of the UL55 gene from the nail sample of day 191, there were three nucleotides that were different from the others. The phylogenetic analysis of the UL73 gene showed that the sequences of CMV DNA from the umbilical cord, whole blood, and nails (day 55) belonged to the genotype gN-4a and were completely identical. However, the sequence of CMV DNA from the patient's fingernail sample of day 191 belonged to the genotype gN-4b (Fig. 1B). This study suggests that the infectious source of CMV in the patient's nails was the same as the source in the umbilical cord and blood. However, the sequence of CMV DNA from the nail sample collected on day 191 showed a genotype that was different from the sequences in the umbilical cord and blood in the UL77 gene. Finger nails grow by about 3 mm/month. Nails have peripheral blood supply networks, which are relatively vascular. Nail clippings are considered to represent body intake or exposure for a period from a few months to a year. Thus, nails have been used for the measurement of trace elements. The mechanism of the presence of CMV DNA in the nail plate is still unknown. We considered two possibilities. The first is the permeation of amniotic fluid into the nail plates of infected fetuses in the amniotic cavity. CMV is excreted into the amniotic fluid through fetal urine. Compared to the skin, the nail plate is 1000-fold more permeable to water. The nail plates could be, therefore, contaminated with CMV in the amniotic cavity. The second possibility is that viremia might be associated with the detection of CMV DNA in nails. CMV viremia was confirmed on day 9 of the patient's life. CMV viremia might contribute to the detection of CMV DNA in nails. Fingernails could, therefore, be the diagnostic materials for cCMV when neither urine nor saliva is available for its diagnosis. However, the appropriate timing to collect nail samples is indispensable to distinguish congenital CMV from a postnatally acquired CMV infection." @default.
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• W3017259677 date "2020-08-01" @default.
• W3017259677 modified "2023-10-16" @default.
• W3017259677 title "Cytomegalovirus DNA in the nails of an infant diagnosed with a congenital cytomegalovirus infection" @default.
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• W3017259677 doi "https://doi.org/10.1016/j.pedneo.2020.04.003" @default.
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