Congenital cytomegalovirus, parvovirus and enterovirus infection in Mozambican newborns at birth: A cross-sectional survey

Abstract

BackgroundCongenital cytomegalovirus (cCMV) infection is the most prevalent congenital infection acquired worldwide, with higher incidence in developing countries and among HIV-exposed children. Less is known regarding vertical transmission of parvovirus B19 (B19V) and enterovirus (EV). We aimed to assess the prevalence of CMV, B19V and EV vertical transmission and compare results of screening of congenital CMV obtained from two different specimens in a semirural Mozambican maternity.MethodsA cross sectional study was conducted among pregnant mothers attending Manhiça District Hospital upon delivery. Information on maternal risk factors was ascertained. Dried umbilical cord (DUC) samples were collected in filter paper for CMV, B19V and EV detection by real-time polymerase chain reaction (RT-PCR), and nasopharyngeal aspirates (NPA) to test for CMV by RT-PCR. Maternal blood samples and placental biopsy samples were also obtained to investigate CMV maternal serology, HIV status and immunopathology.ResultsFrom September 2014 to January 2015, 118 mothers/newborn pairs were recruited. Prevalence of maternal HIV infection was 31.4% (37/118). CMV RT-PCR was positive in 3/115 (2.6%) of DUC samples and in 3/96 (6.3%) of NPA samples obtained from neonates. The concordance of the RT-PCR assay through DUC with their correspondent NPA sample was moderate (Kappa = 0.42 and p<0.001. No differences on cCMV prevalence were found among HIV-exposed and unexposed. All (100%) mothers were seropositive for CMV IgG. RT-PCR of EV and B19V in DUC were both negative in all screened cases. No histological specific findings were found in placental tissues. No risk factors associated to vertical transmission of these viral infections were found.ConclusionsThis study indicates the significant occurrence of vertical transmission of CMV in southern Mozambique. Larger studies are needed to evaluate the true burden, clinical relevance and consequences of congenital infections with such pathogens in resource-constrained settings.

Impact of Maternal Immunity on Congenital Cytomegalovirus Birth Prevalence and Infant Outcomes: A Systematic Review

“…Other studies show that transmission rates for primary infections can be as high as 78%, with the rate increasing with gestational age, as it can range from 30.1% transmission in the first trimester to 72.2% in the third trimester [49,50]. These high transmission rates in women who are acutely infected are in stark contrast to the low birth prevalence in seropositive populations found from our systematic review, which ranged from 0.4% to 6% [19,26,27,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43], despite expected high CMV exposure rate in these populations. This range mirrors work by Fowler et al, (2003) in whichupon comparing primary versus non-primary maternal CMV infections they found that 3% of infants were infected by primary maternal infection versus 1% by non-primary maternal infection [34].…”

“…Of those, 16 studies reported symptoms of affected infants. Overall, cCMV birth prevalence ranged from 0.4% to 6% [19,26,27,[29][30][31][32][33][34][35][36][37][38][39][40][41][42][43]. Tier 1 studies, which differentiated primary versus chronic CMV maternal infections, had a median birth prevalence rate of 1%.…”

“…Among the Tier 2 studies, 5 out of 12 utilized dried blood PCR for diagnosis of cCMV, whereas the remaining 7 studies utilized saliva or urine PCR and/or urine culture for diagnosis of cCMV. In these Tier 2 studies, the birth prevalence rate ranged from 0.4% to 3%, with a median of 1.85% [28][29][30][31][32][33][34][35][36][37][38][39]. These studies did not utilize avidity testing to indicate specifically if the maternal infection was recent.…”

Presumed neonatal cytomegalovirus retinitis treated with intravenous ganciclovir

“…[ 2 ] Congenital symptomatic CMV infection is characterized by intrauterine growth restriction; hepatosplenomegaly, hematological abnormalities like anemia, thrombocytopenia, pneumonitis, and gastrointestinal tract disease. [ 3 ] Treatment of CMV retinitis is usually done with systemic (oral/intravenous) or intravitreal ganciclovir. Untreated retinitis can progress to blindness because of extensive retinal necrosis, optic nerve involvement, or retinal detachment.…”

Advances in pediatrics in 2017: current practices and challenges in allergy, endocrinology, gastroenterology, genetics, immunology, infectious diseases, neonatology, nephrology, neurology, pulmonology from the perspective of Italian Journal of Pediatrics

“…Moreover, CMV was four-fold more prevalent among HIV-infected infants compared with uninfected infants born to HIV-infected mothers not receiving antiretrovirals during pregnancy. On the contrary, a cross-sectional Mozambican survey showed no differences in the prevalence of CMV infection among HIV-exposed and unexposed neonates [ 98 ]. Unfortunately, there is still a lack of preventive approaches and behavioural procedures for CMV infection during pregnancy.…”