Four-Year Follow-Up of the Maternal Immunological, Virological and Clinical Settings of a 36-Year-Old Woman Experiencing Primary Cytomegalovirus Infection Leading to Intrauterine Infection (original) (raw)
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Clinical Infectious Diseases, 2015
Background. Human cytomegalovirus (CMV) represents one of the leading causes of congenital infections worldwide. Early diagnosis of fetal infection and consequent rapid therapeutic intervention with immunoglobulin treatment may prevent fetal transmission and virus-related sequelae. In this study, the cell-mediated immunity and immunoglobulin avidity were evaluated as potential predictors of congenital transmission of the infection. Methods. CMV immunoglobulin G (IgG) avidity and CMV enzyme-linked immunospot (ELISpot) assays were employed in 80 pregnant women including 57 primary and 23 nonprimary CMV infections. Congenital infection was assessed using CMV DNA quantitative polymerase chain reaction on amniotic fluid or offspring urine. Logistic regression and receiver operating characteristic statistical methods were employed to determine the association with congenital infection. Results. Low CMV IgG avidity (25%) alone correlated with a probability of congenital transmission of 18.2% (95% confidence interval, 7.7%-28.8%). In contrast to the expectations, an increase in CMV ELISpot levels was statistically associated with congenital transmission (P = .006). The combined use of CMV ELISpot and low CMV IgG avidity resulted in a higher level of association than either method alone with the incidence of fetal transmission (area under the curve, 0.8685). Conclusions. CMV-specific cell-mediated immunity represents a relevant marker in assessing the likelihood of congenital CMV transmission, particularly in combination with CMV IgG avidity.
Nonprimary Cytomegalovirus Fetal Infection
Revista Brasileira de Ginecologia e Obstetrícia / RBGO Gynecology and Obstetrics, 2016
Cytomegalovirus (CMV) is the most common congenital viral infection, causing hearing, visual and psychomotor impairment. Preexisting maternal CMV immunity substantially reduces, but not eliminates, the risk of fetal infection and affectation. This article is about a case of nonprimary maternal CMV infection during pregnancy, with vertical transmission, resulting in severe fetal affectation. Preconceptional analysis indicated maternal CMV past infection. Pregnancy progressed uneventfully until the 20th week ultrasound (US), which revealed cerebral abnormalities: thin and hyperechogenic cerebral cortex with prominent lateral ventricles, bilateral periventricular hyperechogenicities, cerebellar vermis hypoplasia and absent corpus callosum. The MRI suggested these findings were compatible with congenital infection rather than primary brain malformation. The fetal karyotype was normal. The title of CMV's IgG antibodies almost tripled. Since the first semester, analysis of the polymerase chain reaction (PCR) for CMV DNA in the amniotic fluid was negative. The pregnancy was terminated at 23 weeks. Neuropathological findings at autopsy showed severe brain lesions associated with CMV infection.
Patterns of human cytomegalovirus infection in term placentas: A preliminary analysis
Journal of Clinical Virology, 2006
Background: Primary maternal CMV infection is the major risk factor for symptomatic congenital infection as maternal immunity reduces the risk of transmission to the fetus. Analysis of first trimester placentas showed that virus replicates in the uterus and is transmitted to the placenta causing focal infection. Objectives and study design: We examined 78 term placentas from uncomplicated deliveries for the presence of CMV DNA and evaluated evidence of infection by means of immunohistological and serological analysis. Results: PCR analysis of villus biopsy samples and decidua showed that CMV DNA was present in 62% of tissues. Seven placentas with neutralizing titers were further examined by immunohistology for expression of viral proteins. In placentas with high levels of CMV DNA, fetal blood vessels in the villus core contained neutrophils with viral replication proteins, and macrophages/dendritic cells with glycoprotein B (gB). Cord blood samples from 1 of 11 placentas contained CMV DNA, an indication of replication in the fetal compartment. In placentas with low levels of viral DNA, macrophage/dendritic cells in the villus core contained CMV gB. This pattern was comparable to that seen in early gestation placentas from women with strong neutralizing antibodies.
Cytomegalovirus a common cause of intrauterine infection: A case-control study
Iranian Journal of Clinical Infectious Diseases, 2010
Background: Congenital cytomegalovirus (CMV) infection affects nearly 1% of live births in the United States. Ten percent of these infants have symptoms at birth and another 10 to 15% develop hearing loss or developmental problems. The aim of this study was to compare CMV infection (IgM and IgG) rate in infants suspected for intrauterine infection with the control group. Patients and methods: A case-control study was performed in the Pediatrics Department of Hazrat Rasool Akram Hospital in Tehran. The study population included 74 suspected cases of intrauterine infection (mean age, 4.7±3.7 months) and 65 normal healthy controls (mean age, 5.3±3.1 months). We compared serum CMV antibodies (IgM, IgG) with ELISA kits. Results: Acute and previous immunity to CMV (IgM and IgG) was found in 41.9% (31/74) and 74% (54/74) of cases, respectively. These figures were 6.2% (4/65) and 95.4% (62/65) in controls, respectively. Acute infection (CMV-IgM) was more common among cases (p<0.0001), bu...
Placental and fetal manifestations of cytomegalovirus infection
Virchows Archiv B Cell Pathology, 1974
Five cases of fetal cytomegalovirus infection are presented to illustrate the nature of the placental disease and the difference in fetal infectious sequelae. Widespread fetal infection occurred in very early dissemination of the virus with little inflammatory participation, In later stages both placental and fetal tissues sponsor an intense inflammatory infiltration with numerous plasma cells, and thrombotic phenomena are important sequelae. Viruria without recognizable disease was found in a newborn of a mother who suffered cervical virus infection in late pregnancy. It is emphasized that villous inflammatory lesions are characteristically associated with fetal CMV infection. Their identification can lead to early clarification of neonatal disease states.
Journal of Medical Virology, 1993
Serological screening of pregnant women in this and a previous study identified 28 cases of primary infection with cytomegalovirus, 7 (25%) of whom transmitted the infection to their fetuses. Risk factors for intrauterine infection were 1) age less than 20 years, 2) Caucasian rather than non-Caucasian race, 3) a weak response to cytomegalovirus antigen i n the lymphocyte transformation test, and 4) the excretion of cytomegalovirus in the urine. The greatest risk was when a weak lymphoproliferative response was detected in combination with a positive result for virus isolation, in which case the chance of fetal infection was 83%. Despite these associations, there was one important anomalous result of a woman who demonstrated a strong lymphocyte response during pregnancy and a negative result for virus isolation, but who gave birth to an infected baby who developed unilateral hearing IOSS.