Preconceptional immunity to cytomegalovirus and the risk of symptomatic congenital infection (original) (raw)
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Journal of Evolution of Medical and Dental Sciences, 2018
BACKGROUND Maternal infections play a crucial role in pregnancy wastage, which are transmitted in utero during pregnancy. The TORCH infections are the most significant of all infections causing morbidity and mortality. Primary infection with Cytomegalovirus (CMV) is one of the most common congenital viral infections. Although, 90% of congenital infections are asymptomatic, 5 to 17% of infants born to mothers with primary CMV infection will be overtly symptomatic and have a mortality rate of 30% and severe neurological morbidity occurs in 90% of survivors. Acute CMV infection can be diagnosed by detection of antibodies by serology and by detection of CMV genomic sequences by RT-PCR. Seroconversion or significant rise in the titre of CMV IgM indicates recent CMV infection and may still be detected upto one year even if the individual presents after the symptoms have subsided. Hence, the present study was carried out. This study aims to screen antenatal women for IgM antibodies to CMV by ELISA and to study the seroprevalence of CMV in antenatal women. Further, the seropositivity was correlated with bad obstetric history cases in antenatal women. MATERIALS AND METHODS An observational cross-sectional study was conducted in a Government Maternity Hospital, Tirupathi, for a period of one year. By using a convenient sampling method, a total of 186 blood samples were collected from antenatal women with bad obstetrics history who attended during the period of July 2011 to Jan 2012. All samples collected were processed and screened for CMV specific IgM antibodies by Enzyme-Linked Immunosorbent Assay (ELISA) using "Anti-CMV IgM ELISA" kit of Euroimmune following the manufacturer's instructions. Chi-square test was applied to check the significance level. Finally, results were displayed in terms of percentages, bar diagrams, pie diagrams and tables. RESULTS A total number of 186 blood samples were collected and processed. Samples were screened for IgM antibodies against CMV using Anti-CMV IgM kit by ELISA as per the manufacturer's instructions. Of the 186 samples tested, 156 were from antenatal women with BOH (test group) and the remaining 30 were from the women with previous normal deliveries (control group). Of the test group, 12 (7.69%) serum samples were found to be positive for IgM antibodies to CMV. Among the control group, no sample was found to be positive for IgM antibodies to CMV. CONCLUSION It is concluded that CMV infections are responsible for some obstetrical losses. There is no vaccine for prevention and there is no way to prevent foetuses from being infected once the mother acquires the infection. It is suggested that women in the reproductive age group should be screened for CMV infections. It is observed that universal screening of pregnant women for CMV infection during an early prenatal visit is not yet recommended worldwide.
JPMA. The Journal of the Pakistan Medical Association, 2016
To determine the prevalence of cytomegalovirus in pregnant women and types of overt congenital infection in neonates. This cross-sectional study was conducted at the Pakistan Institute of Medical Sciences and Federal Government Services Hospital in Islamabad, Pakistan, from March 2010 to June 2011, and comprised blood samples of pregnant women. Seroprevalence of human cytomegalovirus, immunoglobulin G and immunoglobulin M was determined by enzyme-linked immunosorbent assay while its deoxyribonucleic acid was detected by nested polymerase chain reaction.The congenital human cytomegalovirus infection was also identified in newborn babies from actively infected pregnant women. SPSS 18 was used for data analysis. Of the 409 pregnant women enrolled, 399(97.55%) were seropositive for cytomegalovirus immunoglobulinG and 52(12.71%) for immunoglobulinM, while cytomegalovirus deoxyribonucleic acid was detected in 82(20%). Of the cytomegalovirus immunoglobulinM-positive women, sera of 40(80%) ...
Data Revues 00029378 V187i4 S0002937802002764, 2011
We report here the results of a study on the prenatal diagnosis of congenital cytomegalovirus (CMV) infection. The study was carried out by both PCR and virus isolation from amniotic fluid (AF) for 82 pregnant women at risk of transmitting CMV for the detection of (i) seroconversion to CMV immunoglobulin G (IgG) positivity during the first trimester of pregnancy, (ii) symptomatic CMV infection in the mother during the first trimester of pregnancy or intrauterine growth retardation detected by ultrasound or abnormal ultrasonographic findings suggestive of fetal infections, and (iii) seropositivity for CMV-specific IgM. For 50 women, fetal blood (FB) was also obtained and tests for antigenemia and PCR were performed. The results indicate that AF is better than FB for the prenatal diagnosis of CMV infection. PCR with AF has a sensitivity (SNS) of 100%, a specificity (SPE) of 83.3%, a positive predictive value (PPV) of 40%, and a negative predictive value (NPV) of 100%; rapid virus isolation with the same material has an SNS of 50%, an SPE of 100%, a PPV of 100%, and an NPV of 94.7%. Fewer than 10% of the women positive for IgM by enzyme immunoassay (EIA) had a congenitally infected fetus or newborn infant. When EIA IgM positivity was confirmed by Western blotting (WB) and the WB profile was considered, the percent transmission detected among women with an "at-risk" profile was higher than that observed among IgM-positive women and was the same as that among women who seroconverted during the first trimester of pregnancy (transmission rates of 29 and 25%, respectively).
The Journal of Infection in Developing Countries, 2012
Introduction: This study aimed to determine the prevalence of congenital and perinatal human cytomegalovirus (HCMV) infections among newborns in two major neonatal intensive care units (NICU) in Bahrain. Methodology: One hundred newborns comprised of 84 preterm and 16 term babies admitted to the NICUs were enrolled in the study. During the first six weeks of life, urine and saliva was obtained from the babies weekly and serial breast milk samples were obtained from the mothers. Maternal serum HCMV IgG was measured. Virus isolation and detection was done by shell vial culture and nested PCR. Results: Maternal HCMV IgG-seropositivity was 100%. Eight HCMV infections were detected comprising of three congenital and five perinatal infections. Congenital HCMV infection was found in preterm (2/84; 1.9%) and term (1/16; 6.3%) babies. HCMV DNA was detected in breast milk samples obtained during the first 10 days postpartum from all mothers whose babies had congenital HCMV. Fortynine women provided breast milk samples between four and six weeks post-partum and HCMV DNA was detected in the breast milk of 11 women. Five (45.5%) of these eleven were mothers of babies with perinatal HCMV infection. There was no significant difference in the detection of HCMV using shell vial culture versus nested PCR method. Conclusion: The findings indicate occurrence of congenital and perinatal HCMV transmission in this setting of high maternal seropositivity. The use of shell vial culture and PCR amplification for HCMV screening in the NICU for rapid detection of infection during the early postnatal period is recommended.
Prenatal diagnosis of congenital cytomegalovirus infection
2001
We report here the results of a study on the prenatal diagnosis of congenital cytomegalovirus (CMV) infection. The study was carried out by both PCR and virus isolation from amniotic fluid (AF) for 82 pregnant women at risk of transmitting CMV for the detection of (i) seroconversion to CMV immunoglobulin G (IgG) positivity during the first trimester of pregnancy, (ii) symptomatic CMV infection in the mother during the first trimester of pregnancy or intrauterine growth retardation detected by ultrasound or abnormal ultrasonographic findings suggestive of fetal infections, and (iii) seropositivity for CMV-specific IgM. For 50 women, fetal blood (FB) was also obtained and tests for antigenemia and PCR were performed. The results indicate that AF is better than FB for the prenatal diagnosis of CMV infection. PCR with AF has a sensitivity (SNS) of 100%, a specificity (SPE) of 83.3%, a positive predictive value (PPV) of 40%, and a negative predictive value (NPV) of 100%; rapid virus isolation with the same material has an SNS of 50%, an SPE of 100%, a PPV of 100%, and an NPV of 94.7%. Fewer than 10% of the women positive for IgM by enzyme immunoassay (EIA) had a congenitally infected fetus or newborn infant. When EIA IgM positivity was confirmed by Western blotting (WB) and the WB profile was considered, the percent transmission detected among women with an "at-risk" profile was higher than that observed among IgM-positive women and was the same as that among women who seroconverted during the first trimester of pregnancy (transmission rates of 29 and 25%, respectively).
HCMV seroprevalence and associated risk factors in pregnant women, Havana City, 2007 to 2008
Prenatal Diagnosis, 2010
ObjectiveTo prenatally identify pregnant women at risk of developing congenital infection due to human cytomegalovirus (HCMV).MethodsOne thousand one hundred and thirty‐one pregnant women from three municipalities from Havana City were serologically screened for HCMV infection (IgM/IgG, IgG avidity) from January 2007 to January 2008. Demographical, epidemiological, and clinical variables were correlated to serologic status to identify predictors of seroconversion in pregnancy.ResultsThe majority of women were seropositive to HCMV (92.6%); 27 women (2.4%) developed HCMV active infection during pregnancy, defined by the detection of IgG+ and IgM+ (7 women), IgM+ and IgG− (2 women), and IgG seroconversion (18 women). Susceptibility of active HCMV infection during pregnancy was associated with maternal age < 20 years and nulligravidity. Primary infection was detected in 20 pregnant women (1.8%), whereas 7 patients (0.6%) had active non‐primary infection.ConclusionAlthough pregnant wo...
Journal of Medical Microbiology and Infectious Diseases, 2014
Introduction : Human cytomegalovirus (HCMV) is able to go into latency and is the most common cause of congenital infections in humans. Its clinical manifestations range from asymptomatic forms to severe fetal damage, and in rare cases, fetal death due to abortion. This prospective cross-sectional study was designed to determine the seroprevalence of HCMV infection in pregnant women attending antenatal clinics of the University of Maiduguri Teaching Hospital, Nigeria, and to identify its possible risk factors. Methods: Blood samples were collected from 182 pregnant women aged 16 to 40 years. Samples were tested for anti-CMV specific IgG and IgM antibodies using the commercial ELISA Kits. A brief structured questionnaire was used to obtain some of their sociodemographic characteristics. Results: Seroprevalence of CMV-specific IgG and IgM were 79.1% and 2.2%, respectively. Of 182 women, 144 had previous exposure to CMV [IgG (+) IgM (-)], 3 had CMV reactivated infection [IgG (+) IgM (+)], 37 were susceptible to CMV [IgG (-) IgM (-)], and only one woman had recent infection [IgG (-) IgM (+)]. There was no significant association between seroprevalence and any of the studied sociodemographic data (p>0.05). Conclusion: The findings of this study indicated that a large number of the studied pregnant women were non-immune (susceptible) to HCMV infection, while four of them had active HCMV infection, which places their unborn children at risk of acquiring congenital HCMV infections. Therefore, it is necessary to screen pregnant women for CMV infection as part of their antenatal care and follow-up them to assess the effect that CMV might have on their fetuses.
Epidemiology and Infection, 2012
SUMMARYCongenital cytomegalovirus (CMV) infection rates increase with maternal seroprevalence due to transmission from maternal non-primary infection. CMV seroprevalence estimates of pregnant women are needed for planning strategies against congenital CMV transmission. We aimed to determine the age-specific prevalence of serum antibodies for CMV in a representative age-stratified sample of unselected pregnant women from a Brazilian population. A total of 985 pregnant women, aged 12–46 years (median 24 years), were enrolled. Overall CMV seroprevalence was 97% (95% confidence interval 95·8–98·0), with age-specific (years) prevalence as follows: 12–19 (96·3%), 20–24 (97·7%), 25–29 (97·1%), and 30–46 (96·7%). CMV seroprevalence is almost universal (97%) and is found at similar levels in pregnant women of ages ranging from 12 to 46 years. Because high CMV seroprevalence is found even in women of a younger age in this population, this finding suggests that the majority of primary CMV infe...