Congenital Cytomegalovirus Infection in Twin Pregnancies: Viral Load in the Amniotic Fluid and Pregnancy Outcome

Lazzarotto, Tiziana; Gabrielli, Liliana; Foschini, Maria Pia; Lanari, Marcello; Guerra, Brunella; Eusebi, Vincenzo; Landini, Maria Paola

doi:10.1542/peds.112.2.e153

Cited by 92 publications

(80 citation statements)

References 35 publications

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“…In contrast to the findings of Lazzarotto et al (19,20), Gouarin et al (13), and Guerra et al (15), our study could not demonstrate a correlation between the CMV viral load in AF and the outcome for the fetus. Instead, in most of the nonterminated pregnancies, the CMV viral load in AF seemed to be related to the time during the pregnancy when the amniocentesis was performed.…”

Section: Discussioncontrasting

confidence: 99%

“…The value of the results of quantitative PCR for CMV in AF as a prognostic indicator of symptomatic congenital infection is even more controversial. Some authors have found that a high CMV viral load in AF is associated with a high risk of symptomatic infection in the fetus (13,15,19,20). Others, however, failed to demonstrate such an association (27,29,36), whereas still others proposed a possible association between the viral load in AF and the gestational age at the time of amniocentesis (13,29).…”

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confidence: 99%

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Clinical Predictive Value of Real-Time PCR Quantification of Human Cytomegalovirus DNA in Amniotic Fluid Samples

Goegebuer¹,

Meensel²,

Beuselinck³

et al. 2009

J Clin Microbiol

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The aim of this study was to evaluate the diagnostic reliability and prognostic significance of the quantification of cytomegalovirus (CMV) DNA in amniotic fluid (AF). We retrospectively reviewed the results for 282 amniotic fluid samples that had been tested for CMV by a quantitative real-time PCR. We observed three cases in which no CMV genomes were detected in the AF but in which the children were nevertheless congenitally infected. Hence, we conclude that a negative result by PCR for CMV in AF cannot rule out the possibility of congenital infection. No false-positive PCR results were observed. A correlation between the CMV viral load in AF and the fetal and neonatal outcomes could not be demonstrated in our study. Instead, a correlation was found between the CMV viral load and the gestational age at the time of amniocentesis.Human cytomegalovirus (CMV) is the leading cause of congenital viral infection in developed countries, with the reported incidence varying between 0.2 and 2.2% of all live births (15,35). The transmission rate following primary infection of the mother is about 40%. Only 10 to 15% of the CMV-infected children are symptomatic at birth, and the symptoms range from mild to life-threatening disease. The remaining 85 to 90% of the children are asymptomatic at birth, but 10% of them will develop complications later on, mainly neurodevelopmental defects and sensorineural hearing loss. Among pregnant women with recurrent infection, the rate of transmission to the infant is about 1%. Despite a preexisting immunity in the mother, epidemiological data suggest that the frequency and the severity of symptoms might be in the same range as those for a primary CMV infection (11,12).The issue of whether pregnant women should be screened for CMV during pregnancy has been debated for many years, but no consensus has been agreed upon (6). None of the current international guidelines recommend routine serologic screening of pregnant women (1,7,16,23,26). Indeed, there is no prognostic marker in the mother to predict whether the virus will be transmitted to the fetus (32). To obtain more information, invasive prenatal diagnostic techniques, such as amniocentesis or cordocentesis, have been used. Moreover, CMV infection of the fetus can lead to a great variety of clinical and biological conditions, but there is no reliable marker that can be used to predict which infected fetuses will have serious sequelae (32, 33). Finally, no vaccine or prophylactic therapy is available at present (24, 32). Nigro et al. examined whether CMV-specific hyperimmune globulin therapy could be useful for the prevention and treatment of congenital CMV infection, yet the results of the study did not allow any conclusions to be drawn (28). Despite the drawbacks of the diagnosis and treatment of a congenital CMV infection, gynecologists do screen their patients for CMV (18). Supporters of routine prenatal screening argue that the use of precautionary hygienic measures can be suggested to CMV-seronegative pregnant women. Otherwise, the k...

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Section: Discussioncontrasting

confidence: 99%

mentioning

confidence: 99%

Clinical Predictive Value of Real-Time PCR Quantification of Human Cytomegalovirus DNA in Amniotic Fluid Samples

Goegebuer¹,

Meensel²,

Beuselinck³

et al. 2009

J Clin Microbiol

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“…[7][8][9] Although the fetus can be affected by CMV during all trimesters of pregnancy the risk of transplacental infection in first trimester reaches up to 40%. [10][11][12] Of these babies 10 to 15% are acutely symptomatic at birth, and among these infants up to 80% will have serious sequelae. 2,3 Clinical presentation of cCMV can involve all systems that are commonly explained by the spread of CMV virus during fetal viremia and subsequent T-cell response to CMV antigens expressed on the interstitial cells of different organs (liver, brain, lungs, etc.).…”

Section: Discussionmentioning

confidence: 99%

Untitled

2016

AJP Rep

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The mother of our patients was an asymptomatic 22-year-old gravida 5, para 2 woman with two previous term vaginal deliveries and two miscarriages at 12 and 13 weeks. She had a spontaneous dichorionic pregnancy with inconsistent prenatal care, marijuana use in the first trimester, and smoking throughout the entire pregnancy. Her prenatal screening showed normal serology, and she denied any history of viral infection during pregnancy. Her first prenatal ultrasound was done at 26 weeks of postmenstrual age and revealed twin A (male) to be small for gestational age with an estimated fetal weight in the 5th percentile and head circumference below the 3rd percentile. Twin B (female) was appropriate for gestational age. Repeated ultrasound at 30 weeks of gestational age showed that twin A continue to have intrauterine AbstractBackground Cytomegalovirus (CMV) is one of the most common causes of serious viral intrauterine infections. It is universally distributed among the human population with an average incidence of 0.15 to 2%. Indeed, at least half of the women in the reproductive age have evidence of prior CMV infection. Epidemiology and Pathogenicity However, it is not a usual practice to screen asymptomatic pregnant woman or neonates for CMV. Even if a mother developed a primary CMV infection during pregnancy, up to 90% of the newborns with congenital CMV will be asymptomatic at the time of birth. Only 5 to 7% of the infected babies will be acutely symptomatic, and the typical clinical presentation includes intrauterine growth restriction, microcephaly, various cutaneous manifestations (including petechiae and purpura), hematological abnormalities (particularly resistant thrombocytopenia), hepatosplenomegaly, chorioretinitis, hepatitis, etc. In contrast, acquired CMV infection is extremely unlikely to cause any serious sequelae for the infant. Cases We present a case of congenital and acquired CMV infection in twins with a focus of dissimilarity in presentation, clinical course, and outcome.

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“…Lazarotto et al studied three sets of multiple pregnancies showed that CMV DNA in amniotic fluid of at least 1000 genome equivalents gave a 100% chance of predicting fetal infection. 20 Higher viral loads (>100,000 genome equivalents) predicted the development of symptomatic infections. A similar study of 68 pregnancies diagnosed with maternal CMV also analyzed CMV viral load in amniotic fluid as a diagnostic tool for the prediction of congenital CMV infection.…”

Section: Prenatal Diagnosismentioning

confidence: 99%

CMV Infection in Pregnancy

Goh¹,

Sauvage²

2010

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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Cytomegalovirus (CMV) is a common and serious congenital infection affecting between 1 to 4% of newborns. Congenital infections can occur after both primary and recurrent maternal infections and are the major cause of childhood deafness, visual impairment, mental retardation and motor spastic or convulsive syndromes. Ultrasound findings including IUGR, ventriculomegaly, brain and hepatic and bowel calcifications, polyhydramnios, hydrops fetalis and pleural effusions are helpful and can aid in the prenatal diagnosis and followup of congenital CMV infection. CMV hyperimmunoglobulin is safe, and may be an effective treatment to minimize the morbidity and mortality of fetal CMV disease. There is ongoing research into the development of an effective vaccine for the prevention of CMV infection during pregnancy. Objectives Understand why CMV is an important cause of congenital injections Understand the role of ultrasound in the diagnosis of intrauterine CMV infections Understand the possible treatment options for a fetus infected with CMV

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Congenital Cytomegalovirus Infection in Twin Pregnancies: Viral Load in the Amniotic Fluid and Pregnancy Outcome

Cited by 92 publications

References 35 publications

Clinical Predictive Value of Real-Time PCR Quantification of Human Cytomegalovirus DNA in Amniotic Fluid Samples

Clinical Predictive Value of Real-Time PCR Quantification of Human Cytomegalovirus DNA in Amniotic Fluid Samples

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CMV Infection in Pregnancy

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