Clinical manifestations and abnormal laboratory findings in pregnant women with primary cytomegalovirus infection

Abstract

The names of collaborators may be found on page 576Objective To compare the clinical manifestations and laboratory abnormalities associated with primary cytomegalovirus (CMV) infection in pregnancy with recurrent and non-active CMV infection (controls). Design A prospective cohort study.Setting Rome, Latium and other Italian regions.Population Three hundred and sixteen pregnant women with CMV infection: 102 had primary infection, 105had recurrent infection and 109 with non-active infection were followed up as controls. Methods CMV diagnosis was based on serological examinations (CMV IgG, IgM and IgG avidity) and detection of CMV DNA by polymerase chain reaction in maternal serum, urine and cervical samples. The clinical history and laboratory evaluations were carried out at enrolment and at each subsequent visit, every one to three months. Main outcome measures Identification of clinical and laboratory indicators of primary CMV infection in pregnancy. Results Compared with women with recurrent or non-active infection, women with primary infection had a statistically significant higher prevalence of fever, asthenia, myalgia and flu-like syndrome ( P < 0.001). In particular, relevant symptomatology was observed in 32 women (31.4%), of whom 25 had flu-like syndrome and 7 persistent fever as a single manifestation. Moreover, women with primary infection showed a significantly increased rate of lymphocytes !40% (39.2% vs 5.7% or 3.7%, respectively, P < 0.001) and elevated aspartate aminotransferase and/or alanine aminotransferase levels (35.3% vs 3.9% or 0.9%, respectively, P < 0.001): lymphocytosis and/or increased aminotransferases occurred in 53 patients (52%). In total, clinical manifestations and/or laboratory abnormalities occurred in 61 women with primary infection (59.8%) compared with 20 with recurrent infection (19%) and 13 controls (11.9%) ( P < 0.001). Conclusion Clinical manifestations (i.e. flu-like syndrome, fever) and abnormal laboratory findings (i.e. lymphocytes !40%, elevated aminotransferases) may suggest the presence of primary CMV infection and should prompt subsequent virological investigations.

Symptomatic infant characteristics of congenital cytomegalovirus disease in Australia

“…The most common clinical manifestation of primary CMV infection in healthy adults is a mononucleosis‐like illness 24,25 . In the current study, 54.8% of mothers noted a febrile illness during pregnancy; however, given the numerous causes of fever, it represents a non‐specific indicator of maternal CMV infection.…”

Washing our hands of the congenital cytomegalovirus disease epidemic

“…For example, a number of authors have urged prevention education for women on the one hand but on the other hand, they have noted that "CMV is neither preventable nor treatable..."[34],"...it is not certain that infections in pregnant women can be prevented by avoiding exposure" [35], "...it is doubtful whether parents will comply with these [behavioral measures in nonstudy settings..." [36], "...there is very little evidence for the efficacy of these strategies and even less for their practical implementation...", and "The only effective prevention strategy relies upon the development of a vaccine." [37] Given the relative invisibility of CMV disease and these mixed messages about prevention education, it is not surprising that healthcare providers do not discuss CMV with their patients and that women are unaware of the risks of CMV infection.…”

Perinatal outcome after maternal primary cytomegalovirus infection in the first trimester: a practical update and counseling aid

“…Testing for primary CMV infection in pregnancy may be triggered because of suspicious clinical symptoms or the presence of laboratory abnormalities on routine blood tests in pregnancy. 11 In some settings, testing is performed according to risk factors for seroconversion or individual practitioner preference. Diagnosis of primary maternal CMV infection in pregnancy should be based on de-novo appearance of virus-specific IgG in the serum of a pregnant woman who was previously seronegative or on detection of specific IgM antibody associated with IgG antibodies with low avidity.…”