The Open Neurology Journal




ISSN: 1874-205X ― Volume 13, 2019
RESEARCH ARTICLE

Cytomegalovirus and Toxoplasma Gondii: Common Causes of Profound Sensori Neural Hearing Loss in Children with Cochlear Implant Surgery in a Highly Immune Population: Tehran; Iran



Samileh Noorbakhsh1, *, Mohammad Farhadi2, M.R. Shokrollahi2, Hesamodin E. Jomeh2, Sarvenaz Ashouri2
1 Departement of Pediatric Infectious Diseases, Iran University of Medical Sciences, Tehran, Islamic Republic of Iran
2 Iran University of Medical Sciences, Tehran, Islamic Republic of Iran

Abstract

Background:

Iranian population is highly immune from T.Gondii and CMV infection.

Objective:

To determine the immunity to T.Gondii and CMV in children with the cochlear implant surgery accompanied with the profound Idiopathic type of SNHL

Methods and Materials:

We studied 45 cases with the cochlear implant surgery (Idiopathic profound SNHL) and 30 controls with the normal OAEs in a cross-sectional study in Rasoul Akram Hospital in Tehran (2010 -2012). Blood samples (2 ml) were centrifuged and were kept frozen at -20°C. Sera searched for the specific antibodies against CMV and T.Gondii. The enzyme-linked immunosorbent assay (ELISA; BioChem Immune System) was calculated qualitatively. (P value< 0.05)

Results:

Range of age in cases with profound SNHL (<95 dB) was 6 months- to-14 years; mean=3.4+3.16 y; Idiopathic type of SNHL children diagnosed in 45 cases were younger than cases with non-Idiopathic SNHL (mean age=20 months; PV=0.05). Positive T.Gondii - IgM was found in 8 /45 (17.7%) and also one of these cases (2.2%) had positive T.Gondii –IgG test. Positive CMV- IgM & IgG were determined in 23% and 51% of cases, respectively. Positive T.Gondii –IgG was observed in 60% (18/30) of controls but none of them had positive T.Gondii – IgM. Positive CMV- IgM & IgG in controls was 3.3% and 90%, respectively.

Conclusion:

CMV infection is one of the most common infections found in profound idiopathic SNHL children especially in younger cases (< 2 years) even in highly immune Iranian populations. Probably, T.Gondii infection has a relative role in younger cases with profound SNHL but a higher role in mild to moderate SNHL in our pediatric population. Most of the T.Gondii infected SNHL cases never require cochlear implant surgery.

In future, a cohort study for prenatal diagnosis of the intrauterine infection and the role of infection in producing SNHLwould be very helpful. It has been recommended to search the specific antibodies against these two common infections in all types of SNHL in pediatric groups which are treatable especially in younger cases (<2 year).

Keywords: Sensory Neural Hearing Loss (SNHL), Cochlear implant, CMV (Cytomegalovirus), T.Gondii (Toxoplasma Gondii), ELISA (Enzyme-Linked, Immunosorbent Assay), Idiopathic.


Article Information


Identifiers and Pagination:

Year: 2019
Volume: 13
First Page: 45
Last Page: 49
Publisher Id: TONEUJ-13-45
DOI: 10.2174/1874205X01913010045

Article History:

Received Date: 12/12/2018
Revision Received Date: 21/02/2019
Acceptance Date: 21/02/2019
Electronic publication date: 28/03/2019
Collection year: 2019

Article Metrics:

CrossRef Citations:
0

Total Statistics:

Full-Text HTML Views: 382
Abstract HTML Views: 402
PDF Downloads: 141
ePub Downloads: 139
Total Views/Downloads: 1064

Unique Statistics:

Full-Text HTML Views: 260
Abstract HTML Views: 249
PDF Downloads: 95
ePub Downloads: 86
Total Views/Downloads: 690
Geographical View

© 2019 Noorbakhsh et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: (https://creativecommons.org/licenses/by/4.0/legalcode). This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


* Address correspondence to this author at the Departement Pediatric Infectious Diseases, 4th floor Hazrat Rasul Hospital, Niayesh Street, Satarkhan Avenue, Tehran, 14455 Islamic Republic of Iran; Tel: 098-21-66525328;Fax: 098-21-66516049; E mail: Samileh_noorbakhsh@yahoo.com




1. INTRODUCTION

Sensor Neural Hearing Loss (SNHL) is a type of hearing loss in which the root cause lies in the vestibulocochlear nerve (cranial nerve VIII), the inner ear or the central processing centres of the brain [1Chen YS, Emmerling O, Ilgner J, Westhofen M. Idiopathic sudden sensor neural hearing loss in childrenInt. J Pediatr Otorhinolaryngol 2005 Jun; 69(6): 817-21.]. The ethology of SNHL is unknown in near about 40% of children which may be viral in origin [1Chen YS, Emmerling O, Ilgner J, Westhofen M. Idiopathic sudden sensor neural hearing loss in childrenInt. J Pediatr Otorhinolaryngol 2005 Jun; 69(6): 817-21.]. Idiopathic (unexplained) hearing loss may be the result of an infectious disease or an injury [1Chen YS, Emmerling O, Ilgner J, Westhofen M. Idiopathic sudden sensor neural hearing loss in childrenInt. J Pediatr Otorhinolaryngol 2005 Jun; 69(6): 817-21.]. Cytomegalovirus is the most common cause of congenital infection, 40% of the unknown cause of deafness cases are due to congenital CMV [2Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 2007; 17(4): 253-76.[http://dx.doi.org/10.1002/rmv.535] [PMID: 17579921] ]. Gancyclovir treatment is recommended for diminishing the SNHL-induced congenital CMV [3Cannon MJ. Congenital cytomegalovirus (CMV) epidemiology and awareness. J Clin Virol 2009; 46(Suppl. 4): S6-S10.[http://dx.doi.org/10.1016/j.jcv.2009.09.002] [PMID: 19800841] , 4Yamamoto Aparecida Y, Mussi-Pinhata Marisa M, Isaac Myriam de L, et al. Congenital cytomegalovirus infection as a cause of sensor neural hearing loss in a highly immune population. Pediatric Infectious Disease Journal 2011 December; 30(12): 1043-6.]. Asymptomatic infected neonates might have SNHL, vision loss and mental retardation and development delay [3Cannon MJ. Congenital cytomegalovirus (CMV) epidemiology and awareness. J Clin Virol 2009; 46(Suppl. 4): S6-S10.[http://dx.doi.org/10.1016/j.jcv.2009.09.002] [PMID: 19800841] , 4Yamamoto Aparecida Y, Mussi-Pinhata Marisa M, Isaac Myriam de L, et al. Congenital cytomegalovirus infection as a cause of sensor neural hearing loss in a highly immune population. Pediatric Infectious Disease Journal 2011 December; 30(12): 1043-6.].

Many studies proved the significant role for the congenital CMV in children with SNHL [2Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 2007; 17(4): 253-76.[http://dx.doi.org/10.1002/rmv.535] [PMID: 17579921] -4Yamamoto Aparecida Y, Mussi-Pinhata Marisa M, Isaac Myriam de L, et al. Congenital cytomegalovirus infection as a cause of sensor neural hearing loss in a highly immune population. Pediatric Infectious Disease Journal 2011 December; 30(12): 1043-6.]. Yamamoto et al., confirmed the prominent role for the congenital CMV in children with SNHL even in a country with high immunity to CMV. They determined the rate, risk factors, and predictors of SNHL in CMV-infected neonates identified by newborn screening in a highly immune maternal population [4Yamamoto Aparecida Y, Mussi-Pinhata Marisa M, Isaac Myriam de L, et al. Congenital cytomegalovirus infection as a cause of sensor neural hearing loss in a highly immune population. Pediatric Infectious Disease Journal 2011 December; 30(12): 1043-6.].

First Siadati et al., reported the CMV infection in primiparous pregnant women in Tehran [5Siadati SA, Noorbakhsh S. CMV infection in primiparus pregnant women in Tehran’. Acta Med Iran 2002; 40(3): 136-9.]. Sotoodeh et al., described the CMV in South of Iran [6Sotoodeh A, Jamshidi M, Farjam MR, et al. Cytomegalovirus immunity in South of Iran. Am J Infect Dis 2010; 6: 8-12.[http://dx.doi.org/10.3844/ajidsp.2010.8.12] ]. Bagheri et al., study showed the seroprevalence of CMV infection (IgG and IgM) among 240 pregnant women in East of Iran [7Bagheri L, Mokhtarian H, Sarshar N, Ghahramani M. Seroprevalence of cytomegalovirus infection among pregnant women in Eastern Iran. Braz J Infect Dis 2012; 16(4): 402-3.[http://dx.doi.org/10.1016/j.bjid.2012.01.002] [PMID: 22846136] ] CMV was reported to be the common cause of intrauterine infection in Iran [8Noorbakhsh S, Farhadi M, Siadati A, Tabatabaei A. Study of TORCH suspected infants. Iran J Pediatr 2005; 15(Suppl. 1): 87., 9Noorbakhsh S, Farhadi M, Tabatabaei A. Cytomegalovirus a common cause of intrauterine infection:A case-control study. Iran J Clin Infect Dis 2010; 5(1): 9-13.]. Congenital CMV infection was developed in 2.6% of neonates in Tehran [9Noorbakhsh S, Farhadi M, Tabatabaei A. Cytomegalovirus a common cause of intrauterine infection:A case-control study. Iran J Clin Infect Dis 2010; 5(1): 9-13.]. CMV infection was reported as one of the most common infectious agents in SNHL children [10Noorbakhsh S, Farhadi M, Tabatabaei A. Infection in childhood. SNHL SMJ 29(10): 1470-4.-12Noorbakhsh S, Farhadi M, Daneshi A, Mohamadi Sh, Tabatabaei A. Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensor neural hearing loss. EMHJ 2011; 17(11): 868-71.]

Congenital toxoplasmosis is a mild or severe neonatal disease during the first months of life, or with sequels or relapse of a previously undiagnosed infection at any time during infancy or later in life [13Lebas F, Ducrocq S, Mucignat V, et al. Congenital toxoplasmosis: A new case of infection during pregnancy in an previously immunized and immunocompetent woman. Arch Pediatr 2004; 11(8): 926-8.[http://dx.doi.org/10.1016/j.arcped.2004.04.017] [PMID: 15288083] , 14Boyer K, Mc Leod R, Karrison T, et al. Congenital toxoplasmosis study; Outcome of treatment for congenital toxoplasmosis, 1981–2004. Clin Infect Dis 2006; 42: 1383-94.[http://dx.doi.org/10.1086/501360] [PMID: 16619149] ]. 10-17% of infants with congenital toxoplasmosis developed SNHL at the age of 4 months or later [14Boyer K, Mc Leod R, Karrison T, et al. Congenital toxoplasmosis study; Outcome of treatment for congenital toxoplasmosis, 1981–2004. Clin Infect Dis 2006; 42: 1383-94.[http://dx.doi.org/10.1086/501360] [PMID: 16619149] , 15del Castillo Martin F. Congenital toxoplasmosis. A disease with too many questions. A Pediatr (Barc) 2004 Aug; 61(2): 115-7.]. Treatment of Active T.Gondii infection in pregnant women can prevent congenital toxoplasmosis from occurring in infants [16Wallon M, Kodjikian L, Binquet C, et al. Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics 2004; 113(6): 1567-72.[http://dx.doi.org/10.1542/peds.113.6.1567] [PMID: 15173475] -20Keshavarz H. Seroprevalence of toxoplasmosis in pregnant women in ilam province in iran. Iran J Parasitol 2008; 3: 34-7.].

Screening for intrauterine infections during pregnancy or in neonates is not available in Iran [21Assmar A, Yassaei A, Terhovanesian AR, Esmaeili N, Hassan Z, et al. Prenatal diagnosis of congenital toxoplasmosis: Validity of PCR using amniotic fluid against indirect fluorescent antibody assay in mothers. Iran J Public Health 2004; 33: 1-4.-23Saki J. The role of toxoplasmosis in ophthalmic disorders. Iran J Public Health 2007; 36: 1-2.]. The prevalence of antibodies to T.Gondii ranges from 24% to 57.7% in Iran [19Noorbakhsh S, Mamishi S, Rimaz S, Monavari SHR. Toxoplasmosis in primiparus pregnant women and their neonates. Iran J Public Health 2002; 31: 51-4., 20Keshavarz H. Seroprevalence of toxoplasmosis in pregnant women in ilam province in iran. Iran J Parasitol 2008; 3: 34-7.]. Acute T-Gondii was reported in 9.8% of TORCH suspected infants (< 2 y old) which had no significant difference with controls but in contrast, the previous immunity was higher in the control group [21Assmar A, Yassaei A, Terhovanesian AR, Esmaeili N, Hassan Z, et al. Prenatal diagnosis of congenital toxoplasmosis: Validity of PCR using amniotic fluid against indirect fluorescent antibody assay in mothers. Iran J Public Health 2004; 33: 1-4.].

All the above studies determined that the adult Iranian population is highly immune to CMV infection. The burden of congenital CMV associated Sensor Neural Hearing Loss (SNHL) in populations with 100% CMV seroprevalence is unknown [5Siadati SA, Noorbakhsh S. CMV infection in primiparus pregnant women in Tehran’. Acta Med Iran 2002; 40(3): 136-9.].

Previous immunity from T.Gondii in adult Iranian population is varied between 24%- 57.7% [19Noorbakhsh S, Mamishi S, Rimaz S, Monavari SHR. Toxoplasmosis in primiparus pregnant women and their neonates. Iran J Public Health 2002; 31: 51-4., 20Keshavarz H. Seroprevalence of toxoplasmosis in pregnant women in ilam province in iran. Iran J Parasitol 2008; 3: 34-7.] which causes congenital infection in about 10% of all intrauterine infection in our country. (21) CMV and T.Gondii infection may play a major role in children with congenital or acquired forms of SNHL in our country [10Noorbakhsh S, Farhadi M, Tabatabaei A. Infection in childhood. SNHL SMJ 29(10): 1470-4.-12Noorbakhsh S, Farhadi M, Daneshi A, Mohamadi Sh, Tabatabaei A. Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensor neural hearing loss. EMHJ 2011; 17(11): 868-71., 24Noorbakhsh S, Memari F, Farhadi M, Tabatabaei A. Sensory hearing loss due to Toxoplasma Gondii in children: A case-control study. Clin otolary 2008; 33: 265-84., 25Noorbakhsh S, Farhadi M, Daneshi A, Tabatabaei A, jomeh H Emam, Ghavami Y. Associations between antibodies against the endothelial cell and T. Gondii; Cytomegalovirus in serum of children with cochlear implant surgery. J AIDS Clin Res 2013; 4: 3.].

The main goal of study was to determine the immunity to T.Gondii and CMV in children with cochlear implant surgery (Idiopathic SNHL; < 95 db) in comparison with normal children.

2. METHODS & MATERIALS

We studied that 117 children were diagnosed as profound SNHL; < 95 dB (according to AAO; American Academy of Otolaryngology) criteria in cochlear implant center at Rasoul Akram Hospital Tehran in the duration of 2 years (2015 – 2017). This cross-sectional study was approved by the Ethical Committee in Research Center of Pediatric Infectious Diseases affiliated with Iran University of Medical Sciences. The consent letter was obtained from all persons (or parents).

2.1. Data Collection

All children with profound SNHL were referred to the selected cochlear implant surgery department. From 117 cases who were the candidates for cochlear implant surgery, 58.1% were male and 49.1%were female. The range of age was: 6 months to 14 years; mean age =3.4+3.16. The Non-idiopathic type of SNHL (Infection, familial, kernicterus, hypoxia, prematurity, convulsion, mental retardation, malformation etc.) was diagnosed in 39.5% of cases; Idiopathic type of SNHL was determined in 28.8% (47/117) of cases. Children with idiopathic type were younger than those in the cases with non-Idiopathic (mean age=20 months; PV=0.05). The controls (n= 30) had normal OAEs in screening test at birth, and were healthy in pediatrician visit before elective surgeries. The controls (n = 30) aged between 2-106 months, mean age = 38.7 - 27.3 months.

2.2. Lab Test

We used the extra blood of routine tests in cases and controls. Sera was kept frozen in our research laboratory. In frozen sera, specific antibodies (IgG, IgM) against CMV, T. Gondii were determined by Enzyme-linked immunosorbent assay (Bio Chem Immune Systems). Antibodies were calculated qualitatively by cut-off controls according to the manufacturer’s instructions

2.3. Statistical Analysis

SPSS version 13 was used. All continuous variables evaluated by Student t -test. Chi-square values (CI: 95%; P<0.05) were calculated. P value < 0.05 was significant.

3. RESULTS

Positive T.Gondii - IgM was found in 60% (18/30) of cases and none of the controls (0/30). Positive T.Gondii –IgG was detected in 2.2% (1/45) of cases and 60% (18/30) of controls. Comparison of the serologic results between cases and controls is showed in Table 1. The correlation between age and serologic results in cases showed in Table 2

4. DISCUSSION

Here, we studied 45 children with implant surgery due to the Idiopathic type of SNHL. Cases with the Idiopathic SNHL include younger children than non-Idiopathic type (mean age=20 months). We observed recent CMV infection (positive IgM) in 23% of cases (vs 3.3% controls); and previous immunity (positive IgG) in 51% of cases (vs. 90% controls).

Present findings are very close to other studies upon SNHL children (and normal controls) in our center (11, 25); positive CMV-IgM & IgG was observed in 23% of cases vs. 34.7% of controls; and 51% of cases vs. 72.6% controls, respectively. Recent CMV infection was higher in the SNHL cases (P-value = 0.000) but previously, there was higher immunity (CMV-IgG) in controls (P value = 0.001). Mean age of cases with recent infection (positive IgM) was 40 months; and 35 months for cases with previous immunity (positive IgG) probably due to the transplacentel immunity which waned after 4 months [11Samileh N, Ahmad S, Mohammad F, Framarz M, Azardokht T, Jomeht E. Role of cytomegalovirus in sensorineural hearing loss of children: A case-control study Tehran, Iran. Int J Pediatr Otorhinolaryngol 2008; 72(2): 203-8.[http://dx.doi.org/10.1016/j.ijporl.2007.10.009] [PMID: 18054797] ]. These results differ from the previous (2006-2008) serological study in 11 idiopathic type of SNHL (mean age; 32 +28 months) [12Noorbakhsh S, Farhadi M, Daneshi A, Mohamadi Sh, Tabatabaei A. Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensor neural hearing loss. EMHJ 2011; 17(11): 868-71.] and positive CMV- IgG in 100% of cases (previous immunity), none had recent infection (positive, IgM) [12Noorbakhsh S, Farhadi M, Daneshi A, Mohamadi Sh, Tabatabaei A. Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensor neural hearing loss. EMHJ 2011; 17(11): 868-71.]

Table 1
Comparison the serologic results between cases and controls.


Table 2
Correlation of age and serologic results in cases.


Yamamoto et al., described newborns with positive saliva CMV-DNA in the first 2 weeks of life, a prospective follow-up study was conducted to monitor hearing outcome [5Siadati SA, Noorbakhsh S. CMV infection in primiparus pregnant women in Tehran’. Acta Med Iran 2002; 40(3): 136-9.]. Out of 12,195 infants screened, 1% were infected with CMV while 10% had a symptomatic infection at birth. SNHL was observed in 9.8% in 12 months age.

Profound SNHL (>90 dB) was observed in 4/5 children with bilateral SNHL while all 5 children with unilateral SNHL had moderate to severe loss [5Siadati SA, Noorbakhsh S. CMV infection in primiparus pregnant women in Tehran’. Acta Med Iran 2002; 40(3): 136-9.]. Symptomatic CMV infection is not related to intrauterine growth retardation, gestational age, gravidity, and maternal age [5Siadati SA, Noorbakhsh S. CMV infection in primiparus pregnant women in Tehran’. Acta Med Iran 2002; 40(3): 136-9.].

Some Iranian authors reported the seroprevalence of CMV infection in Iranian pregnant women [5Siadati SA, Noorbakhsh S. CMV infection in primiparus pregnant women in Tehran’. Acta Med Iran 2002; 40(3): 136-9.-7Bagheri L, Mokhtarian H, Sarshar N, Ghahramani M. Seroprevalence of cytomegalovirus infection among pregnant women in Eastern Iran. Braz J Infect Dis 2012; 16(4): 402-3.[http://dx.doi.org/10.1016/j.bjid.2012.01.002] [PMID: 22846136] ]. Bagheri et al., described the seroprevalence of CMV (IgG and IgM) among 240 pregnant women in Eastern part. The IgG avidity test was used for all patients who were CMV-IgM+ and CMV-IgG+ to distinguish between primary and recurrent CMV infection [7Bagheri L, Mokhtarian H, Sarshar N, Ghahramani M. Seroprevalence of cytomegalovirus infection among pregnant women in Eastern Iran. Braz J Infect Dis 2012; 16(4): 402-3.[http://dx.doi.org/10.1016/j.bjid.2012.01.002] [PMID: 22846136] ]. All CMV- IgM+ were monitored until labor. The CMV seroprevalence rate was 72.1%, 69.6% had a previous CMV infection, 27.9% had never been infected with CMV, 2.5% were CMV-IgM+, 1.66% had recurrent CMV infection (IgM+ and high IgG avidity) and 0.84% had primary CMV infection (IgM+ and low IgG avidity) [7Bagheri L, Mokhtarian H, Sarshar N, Ghahramani M. Seroprevalence of cytomegalovirus infection among pregnant women in Eastern Iran. Braz J Infect Dis 2012; 16(4): 402-3.[http://dx.doi.org/10.1016/j.bjid.2012.01.002] [PMID: 22846136] ]. Indeed, CMV was reported to be the common cause of intrauterine infection in Iran [8Noorbakhsh S, Farhadi M, Siadati A, Tabatabaei A. Study of TORCH suspected infants. Iran J Pediatr 2005; 15(Suppl. 1): 87., 9Noorbakhsh S, Farhadi M, Tabatabaei A. Cytomegalovirus a common cause of intrauterine infection:A case-control study. Iran J Clin Infect Dis 2010; 5(1): 9-13.]. Congenital CMV infection was developed in 2.6% of neonates [9Noorbakhsh S, Farhadi M, Tabatabaei A. Cytomegalovirus a common cause of intrauterine infection:A case-control study. Iran J Clin Infect Dis 2010; 5(1): 9-13.]

Here, as detailed above, the rate of recent T.Gondii infection (IgM) was higher in the cases (17.7% vs. 0% controls); but in previous cases, the immunity (IgG) was very low (2.2% vs. 60% controls). The previous immunity in the controls (probably Trans placental origin) might prevent the neonates against T.Gondii intrauterine infection. The present study is very close to other reports in our country [22S Noorbakhsh*, N Khosravi, V Zarabi, M Farhadi and A Tabatabaei. Congenital infection with toxoplasma Gondii: A case control study in Tehran, Iran. Open Access Scientific Reports. J Bacteriol Parasitol 2012; 1(3): 1-4.-24Noorbakhsh S, Memari F, Farhadi M, Tabatabaei A. Sensory hearing loss due to Toxoplasma Gondii in children: A case-control study. Clin otolary 2008; 33: 265-84.]. At least 2 studies confirm these results [22S Noorbakhsh*, N Khosravi, V Zarabi, M Farhadi and A Tabatabaei. Congenital infection with toxoplasma Gondii: A case control study in Tehran, Iran. Open Access Scientific Reports. J Bacteriol Parasitol 2012; 1(3): 1-4., 24Noorbakhsh S, Memari F, Farhadi M, Tabatabaei A. Sensory hearing loss due to Toxoplasma Gondii in children: A case-control study. Clin otolary 2008; 33: 265-84.].

The study to search the congenital toxoplasmosis in 51 cases (mean age = 4.7 months + 3.7 month), and 30 controls in our center had been published recently [22S Noorbakhsh*, N Khosravi, V Zarabi, M Farhadi and A Tabatabaei. Congenital infection with toxoplasma Gondii: A case control study in Tehran, Iran. Open Access Scientific Reports. J Bacteriol Parasitol 2012; 1(3): 1-4.]. It showed recent T.Gondii infection (IgM) in 10% of cases but none of the controls; previous immunity (IgG) was found in 18% cases and 60% of controls [22S Noorbakhsh*, N Khosravi, V Zarabi, M Farhadi and A Tabatabaei. Congenital infection with toxoplasma Gondii: A case control study in Tehran, Iran. Open Access Scientific Reports. J Bacteriol Parasitol 2012; 1(3): 1-4.]. Like here, previous immunity (IgG) was significantly higher in the control healthy group (P value =0.00) [22S Noorbakhsh*, N Khosravi, V Zarabi, M Farhadi and A Tabatabaei. Congenital infection with toxoplasma Gondii: A case control study in Tehran, Iran. Open Access Scientific Reports. J Bacteriol Parasitol 2012; 1(3): 1-4.]. Similar results were presented in our previous studies. None of the controls were detected in the recent T.Gondii infection (IgM) in comparison with 12% of SNHL cases (P value =0.00). Previous immunity (IgG) against T.Gondii infection was significantly higher in the control healthy group (48% vs. 21%; P value < 0.001) [24Noorbakhsh S, Memari F, Farhadi M, Tabatabaei A. Sensory hearing loss due to Toxoplasma Gondii in children: A case-control study. Clin otolary 2008; 33: 265-84., 25Noorbakhsh S, Farhadi M, Daneshi A, Tabatabaei A, jomeh H Emam, Ghavami Y. Associations between antibodies against the endothelial cell and T. Gondii; Cytomegalovirus in serum of children with cochlear implant surgery. J AIDS Clin Res 2013; 4: 3.].

All results confirmed the relative role for T.Gondii in studied cases.(19,24) The rate of seropositivity in severe SNHL which is 4 fold lower than the previous study (63.6%) had applied upon all type of SNHL in our center. 2.2% of cases with severe SNHL had recent T.Gondii infection (vs. 10% previous study) [24Noorbakhsh S, Memari F, Farhadi M, Tabatabaei A. Sensory hearing loss due to Toxoplasma Gondii in children: A case-control study. Clin otolary 2008; 33: 265-84.]. It means that T.Gondii infection might have a higher role in mild to moderate SNHL in our pediatric population. Most of the infected SNHL cases never require cochlear implant surgery.

The prevalence of T Gondii antibodies ranges from 24% to 57.7% in Iranian population [19Noorbakhsh S, Mamishi S, Rimaz S, Monavari SHR. Toxoplasmosis in primiparus pregnant women and their neonates. Iran J Public Health 2002; 31: 51-4., 20Keshavarz H. Seroprevalence of toxoplasmosis in pregnant women in ilam province in iran. Iran J Parasitol 2008; 3: 34-7.].One study determined the previous and acute T Gondii infection in 34.7% and 7.1% of young pregnant women in Tehran [19Noorbakhsh S, Mamishi S, Rimaz S, Monavari SHR. Toxoplasmosis in primiparus pregnant women and their neonates. Iran J Public Health 2002; 31: 51-4.]. Recent infection observed in 9.8% of TORCH suspected infants(<2y old) in Tehran; but previous immunity(positive IgG) was higher in normal children [8Noorbakhsh S, Farhadi M, Siadati A, Tabatabaei A. Study of TORCH suspected infants. Iran J Pediatr 2005; 15(Suppl. 1): 87.]. So, the congenital toxoplasmosis can be prevented by the treatment of Active T.Gondii infection in pregnant women [13Lebas F, Ducrocq S, Mucignat V, et al. Congenital toxoplasmosis: A new case of infection during pregnancy in an previously immunized and immunocompetent woman. Arch Pediatr 2004; 11(8): 926-8.[http://dx.doi.org/10.1016/j.arcped.2004.04.017] [PMID: 15288083] -15del Castillo Martin F. Congenital toxoplasmosis. A disease with too many questions. A Pediatr (Barc) 2004 Aug; 61(2): 115-7.]. Treatment of congenital toxoplasmosis in the first year of life could prevent this late sequel [16Wallon M, Kodjikian L, Binquet C, et al. Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics 2004; 113(6): 1567-72.[http://dx.doi.org/10.1542/peds.113.6.1567] [PMID: 15173475] -20Keshavarz H. Seroprevalence of toxoplasmosis in pregnant women in ilam province in iran. Iran J Parasitol 2008; 3: 34-7.]. In our opinion, the neonatal screening test (Guthrie cards) might be helpful to detect at least 2 common treatable infections (; CMV / T.Gondii) in our country.

We observed recent CMV infection (positive IgM) in 23% of cases (vs 3.3% controls); and previous immunity (positive IgG) in 51% of cases (vs. 90% controls).

So, we recommend rapid diagnosis and suitable treatment of the indolent infections in SNHL children to decrease the requirement of cochlear implantation surgery.

At least 1-year treatment is required in infants (positive IgM) for the prevention of its sequels [10Noorbakhsh S, Farhadi M, Tabatabaei A. Infection in childhood. SNHL SMJ 29(10): 1470-4., 13Lebas F, Ducrocq S, Mucignat V, et al. Congenital toxoplasmosis: A new case of infection during pregnancy in an previously immunized and immunocompetent woman. Arch Pediatr 2004; 11(8): 926-8.[http://dx.doi.org/10.1016/j.arcped.2004.04.017] [PMID: 15288083] ]

CONCLUSION

CMV infection is one of the most common infection found in profound idiopathic SNHL children especially in younger cases (< 2 years) even in highly immune Iranian populations. Probably T.Gondii infection has a relative role in younger cases with profound SNHL but a higher role in mild to moderate SNHL in our pediatric population. Most of the T.Gondii infected SNHL cases never require cochlear implant surgery.

In the future, a cohort study for prenatal diagnosis of intrauterine infection and the role of infection in producing SNHL would be very helpful. We recommend to search the specific antibodies against these two common infections in all type of SNHL in pediatric groups, which are treatable especially in younger cases (< 2 year).

LIMITATIONS OF THE STUDY

This study followed the known cases of SNHL for intrauterine infection after birth. This time of diagnosis is late for specific treatment. In contrast to the developed countries, the prenatal /perinatal screening for intrauterine infection is not available in Iran. We should diagnose the indolent (intrauterine) infections in SNHL children and treatment should be started as soon as possible to decrease the need of the cochlear implantation surgery

ETHICS APPROVAL AND CONSENT TO PARTICIPATE

Ethical Committee in the Pediatric Infectious Diseases (affiliates by Iran University of Medical Sciences) has reviewed and approved the Waiver of Authorization for use of protected health information (PHI) for research purposes for this study.

HUMAN AND ANIMAL RIGHTS

No Animals were used in this research. All human research procedures followed were in accordance with the ethical standards of the committee responsible for human experimentation (institutional and national), and with the Helsinki Declaration of 1975, as revised in 2013.

CONSENT FOR PUBLICATION

Informed consent was obtained from all individual parents of the participants.

CONFLICT OF INTEREST

The authors declare no conflict of interest, financial or otherwise.

ACKNOWLEDGEMENTS

This study was supported by the Research Center of Pediatric Infectious Diseases, Iran University of Medical Sciences.

REFERENCES

[1] Chen YS, Emmerling O, Ilgner J, Westhofen M. Idiopathic sudden sensor neural hearing loss in childrenInt. J Pediatr Otorhinolaryngol 2005 Jun; 69(6): 817-21.
[2] Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol 2007; 17(4): 253-76.[http://dx.doi.org/10.1002/rmv.535] [PMID: 17579921]
[3] Cannon MJ. Congenital cytomegalovirus (CMV) epidemiology and awareness. J Clin Virol 2009; 46(Suppl. 4): S6-S10.[http://dx.doi.org/10.1016/j.jcv.2009.09.002] [PMID: 19800841]
[4] Yamamoto Aparecida Y, Mussi-Pinhata Marisa M, Isaac Myriam de L, et al. Congenital cytomegalovirus infection as a cause of sensor neural hearing loss in a highly immune population. Pediatric Infectious Disease Journal 2011 December; 30(12): 1043-6.
[5] Siadati SA, Noorbakhsh S. CMV infection in primiparus pregnant women in Tehran’. Acta Med Iran 2002; 40(3): 136-9.
[6] Sotoodeh A, Jamshidi M, Farjam MR, et al. Cytomegalovirus immunity in South of Iran. Am J Infect Dis 2010; 6: 8-12.[http://dx.doi.org/10.3844/ajidsp.2010.8.12]
[7] Bagheri L, Mokhtarian H, Sarshar N, Ghahramani M. Seroprevalence of cytomegalovirus infection among pregnant women in Eastern Iran. Braz J Infect Dis 2012; 16(4): 402-3.[http://dx.doi.org/10.1016/j.bjid.2012.01.002] [PMID: 22846136]
[8] Noorbakhsh S, Farhadi M, Siadati A, Tabatabaei A. Study of TORCH suspected infants. Iran J Pediatr 2005; 15(Suppl. 1): 87.
[9] Noorbakhsh S, Farhadi M, Tabatabaei A. Cytomegalovirus a common cause of intrauterine infection:A case-control study. Iran J Clin Infect Dis 2010; 5(1): 9-13.
[10] Noorbakhsh S, Farhadi M, Tabatabaei A. Infection in childhood. SNHL SMJ 29(10): 1470-4.
[11] Samileh N, Ahmad S, Mohammad F, Framarz M, Azardokht T, Jomeht E. Role of cytomegalovirus in sensorineural hearing loss of children: A case-control study Tehran, Iran. Int J Pediatr Otorhinolaryngol 2008; 72(2): 203-8.[http://dx.doi.org/10.1016/j.ijporl.2007.10.009] [PMID: 18054797]
[12] Noorbakhsh S, Farhadi M, Daneshi A, Mohamadi Sh, Tabatabaei A. Viral infections detected by serology and PCR of perilymphatic fluid in children with idiopathic sensor neural hearing loss. EMHJ 2011; 17(11): 868-71.
[13] Lebas F, Ducrocq S, Mucignat V, et al. Congenital toxoplasmosis: A new case of infection during pregnancy in an previously immunized and immunocompetent woman. Arch Pediatr 2004; 11(8): 926-8.[http://dx.doi.org/10.1016/j.arcped.2004.04.017] [PMID: 15288083]
[14] Boyer K, Mc Leod R, Karrison T, et al. Congenital toxoplasmosis study; Outcome of treatment for congenital toxoplasmosis, 1981–2004. Clin Infect Dis 2006; 42: 1383-94.[http://dx.doi.org/10.1086/501360] [PMID: 16619149]
[15] del Castillo Martin F. Congenital toxoplasmosis. A disease with too many questions. A Pediatr (Barc) 2004 Aug; 61(2): 115-7.
[16] Wallon M, Kodjikian L, Binquet C, et al. Long-term ocular prognosis in 327 children with congenital toxoplasmosis. Pediatrics 2004; 113(6): 1567-72.[http://dx.doi.org/10.1542/peds.113.6.1567] [PMID: 15173475]
[17] McLeod R, Boyer K, Karrison T, et al. Outcome of treatment for congenital toxoplasmosis, 1981-2004: The national collaborative chicago-based, congenital toxoplasmosis study. Clin Infect Dis 2006; 42(10): 1383-94.[http://dx.doi.org/10.1086/501360] [PMID: 16619149]
[18] Trenque T, Simon N, Villena I, et al. Population pharmacokinetics of pyrimethamine and sulfadoxine in children with congenital toxoplasmosis. Br J Clin Pharmacol 2004; 57(6): 735-41.[http://dx.doi.org/10.1111/j.1365-2125.2004.02077.x] [PMID: 15151 519]
[19] Noorbakhsh S, Mamishi S, Rimaz S, Monavari SHR. Toxoplasmosis in primiparus pregnant women and their neonates. Iran J Public Health 2002; 31: 51-4.
[20] Keshavarz H. Seroprevalence of toxoplasmosis in pregnant women in ilam province in iran. Iran J Parasitol 2008; 3: 34-7.
[21] Assmar A, Yassaei A, Terhovanesian AR, Esmaeili N, Hassan Z, et al. Prenatal diagnosis of congenital toxoplasmosis: Validity of PCR using amniotic fluid against indirect fluorescent antibody assay in mothers. Iran J Public Health 2004; 33: 1-4.
[22] S Noorbakhsh*, N Khosravi, V Zarabi, M Farhadi and A Tabatabaei. Congenital infection with toxoplasma Gondii: A case control study in Tehran, Iran. Open Access Scientific Reports. J Bacteriol Parasitol 2012; 1(3): 1-4.
[23] Saki J. The role of toxoplasmosis in ophthalmic disorders. Iran J Public Health 2007; 36: 1-2.
[24] Noorbakhsh S, Memari F, Farhadi M, Tabatabaei A. Sensory hearing loss due to Toxoplasma Gondii in children: A case-control study. Clin otolary 2008; 33: 265-84.
[25] Noorbakhsh S, Farhadi M, Daneshi A, Tabatabaei A, jomeh H Emam, Ghavami Y. Associations between antibodies against the endothelial cell and T. Gondii; Cytomegalovirus in serum of children with cochlear implant surgery. J AIDS Clin Res 2013; 4: 3.

Endorsements



"Open access will revolutionize 21st century knowledge work and accelerate the diffusion of ideas and evidence that support just in time learning and the evolution of thinking in a number of disciplines."


Daniel Pesut
(Indiana University School of Nursing, USA)

"It is important that students and researchers from all over the world can have easy access to relevant, high-standard and timely scientific information. This is exactly what Open Access Journals provide and this is the reason why I support this endeavor."


Jacques Descotes
(Centre Antipoison-Centre de Pharmacovigilance, France)

"Publishing research articles is the key for future scientific progress. Open Access publishing is therefore of utmost importance for wider dissemination of information, and will help serving the best interest of the scientific community."


Patrice Talaga
(UCB S.A., Belgium)

"Open access journals are a novel concept in the medical literature. They offer accessible information to a wide variety of individuals, including physicians, medical students, clinical investigators, and the general public. They are an outstanding source of medical and scientific information."


Jeffrey M. Weinberg
(St. Luke's-Roosevelt Hospital Center, USA)

"Open access journals are extremely useful for graduate students, investigators and all other interested persons to read important scientific articles and subscribe scientific journals. Indeed, the research articles span a wide range of area and of high quality. This is specially a must for researchers belonging to institutions with limited library facility and funding to subscribe scientific journals."


Debomoy K. Lahiri
(Indiana University School of Medicine, USA)

"Open access journals represent a major break-through in publishing. They provide easy access to the latest research on a wide variety of issues. Relevant and timely articles are made available in a fraction of the time taken by more conventional publishers. Articles are of uniformly high quality and written by the world's leading authorities."


Robert Looney
(Naval Postgraduate School, USA)

"Open access journals have transformed the way scientific data is published and disseminated: particularly, whilst ensuring a high quality standard and transparency in the editorial process, they have increased the access to the scientific literature by those researchers that have limited library support or that are working on small budgets."


Richard Reithinger
(Westat, USA)

"Not only do open access journals greatly improve the access to high quality information for scientists in the developing world, it also provides extra exposure for our papers."


J. Ferwerda
(University of Oxford, UK)

"Open Access 'Chemistry' Journals allow the dissemination of knowledge at your finger tips without paying for the scientific content."


Sean L. Kitson
(Almac Sciences, Northern Ireland)

"In principle, all scientific journals should have open access, as should be science itself. Open access journals are very helpful for students, researchers and the general public including people from institutions which do not have library or cannot afford to subscribe scientific journals. The articles are high standard and cover a wide area."


Hubert Wolterbeek
(Delft University of Technology, The Netherlands)

"The widest possible diffusion of information is critical for the advancement of science. In this perspective, open access journals are instrumental in fostering researches and achievements."


Alessandro Laviano
(Sapienza - University of Rome, Italy)

"Open access journals are very useful for all scientists as they can have quick information in the different fields of science."


Philippe Hernigou
(Paris University, France)

"There are many scientists who can not afford the rather expensive subscriptions to scientific journals. Open access journals offer a good alternative for free access to good quality scientific information."


Fidel Toldrá
(Instituto de Agroquimica y Tecnologia de Alimentos, Spain)

"Open access journals have become a fundamental tool for students, researchers, patients and the general public. Many people from institutions which do not have library or cannot afford to subscribe scientific journals benefit of them on a daily basis. The articles are among the best and cover most scientific areas."


M. Bendandi
(University Clinic of Navarre, Spain)

"These journals provide researchers with a platform for rapid, open access scientific communication. The articles are of high quality and broad scope."


Peter Chiba
(University of Vienna, Austria)

"Open access journals are probably one of the most important contributions to promote and diffuse science worldwide."


Jaime Sampaio
(University of Trás-os-Montes e Alto Douro, Portugal)

"Open access journals make up a new and rather revolutionary way to scientific publication. This option opens several quite interesting possibilities to disseminate openly and freely new knowledge and even to facilitate interpersonal communication among scientists."


Eduardo A. Castro
(INIFTA, Argentina)

"Open access journals are freely available online throughout the world, for you to read, download, copy, distribute, and use. The articles published in the open access journals are high quality and cover a wide range of fields."


Kenji Hashimoto
(Chiba University, Japan)

"Open Access journals offer an innovative and efficient way of publication for academics and professionals in a wide range of disciplines. The papers published are of high quality after rigorous peer review and they are Indexed in: major international databases. I read Open Access journals to keep abreast of the recent development in my field of study."


Daniel Shek
(Chinese University of Hong Kong, Hong Kong)

"It is a modern trend for publishers to establish open access journals. Researchers, faculty members, and students will be greatly benefited by the new journals of Bentham Science Publishers Ltd. in this category."


Jih Ru Hwu
(National Central University, Taiwan)


Browse Contents



Webmaster Contact: info@benthamopen.net
Copyright © 2019 Bentham Open