Diagnosis and Screening for Cytomegalovirus Infection in Pregnant Women in Cuba as Prognostic Markers of Congenital Infection in Newborns

Kourí, Vivian; Correa, Consuelo; Verdasquera, Denis; Martinez, Pedro A; Álvarez, Alina; Alemán, Yoan; Pérez, Lissette; Golpe, Maria A; Someilan, Tatiana; Chong, Y.; Fresno, Clara; Navarro, María Amparo Gilabert; Pérez, Elevina; Moro, I.; Sánchez, Rebeca; Llanusa, Celia; Melin, Pierrette

doi:10.1097/inf.0b013e3181eb7388

Cited by 19 publications

(24 citation statements)

References 37 publications

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“…Many laboratories using CMV IgG avidity to discriminate primary from nonprimary CMV infection follow a reflexive algorithm whereby only CMV IgG-positive samples that are also CMV IgM positive are tested for CMV IgG avidity (6,17,18,31,34,48,58); yet, investigators that have tested all CMV IgG-positive samples for avidity, regardless of the CMV IgM result, have consistently found that 1% to 3% of IgG-positive, IgMnegative samples exhibit low IgG avidity (16,48,57), suggesting an increased risk of intrauterine transmission. Indeed, transmission has been documented in patients who lacked CMV IgM but exhibited low IgG avidity (14,61); it is likely that these women were in the narrow time window when IgM reversion has occurred but avidity is still low (3,(28)(29)(30)(31).…”

Section: How Should Intermediate CMV Igg Avidity Results Be Used?mentioning

confidence: 99%

“…The other 3 groups modified a CMV IgG kit to include a urea buffer wash step; the Brussels and Paris groups employed 8 M urea, whereas the Stuttgart group used 6 M urea. Other investigators have taken the latter approach of modifying CMV IgG kits from different manufacturers and typically employ 6 M urea (16,17,20,22,41,42). Table 2 lists the currently available CMV IgG avidity assays known to the authors.…”

Section: Commercially Available CMV Igg Avidity Assaysmentioning

confidence: 99%

Section: Ongenital Cytomegalovirus (Cmv) Infection Is the Most Commmentioning

confidence: 99%

“…Studies assessing CMV IgG avidity showed that low CMV IgG avidity is both a sensitive and a specific marker of primary CMV infection (1-3). Indeed, CMV IgG avidity is increasingly considered the "gold standard" for distinguishing primary from nonprimary CMV infection (1,11,12,16) and is being used worldwide to identify primary CMV infection during pregnancy (14,(17)(18)(19)(20)(21).This minireview focuses on 4 aspects of CMV IgG avidity testing: (a) the definition of avidity and the basic methodology used in initial studies linking CMV IgG avidity and primary infection; (b) a summary of results from the major studies demonstrating the utility of CMV IgG avidity assessment in pregnancy, including the advantages of avidity testing over CMV IgM testing alone; (c) a discussion of commercially available CMV IgG avidity assays, including newer automated assays; and (d) current issues and controversies in diagnosing primary CMV infections during pregnancy. …”

mentioning

confidence: 99%

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Role of Cytomegalovirus (CMV) IgG Avidity Testing in Diagnosing Primary CMV Infection during Pregnancy

Prince

Lapé-Nixon

2014

Clin Vaccine Immunol

184

141

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The risk of intrauterine transmission of cytomegalovirus (CMV) during pregnancy is much greater for women who contract primary CMV infection after conception than for women with evidence of infection (circulating CMV antibodies) before conception. Thus, laboratory tests that aid in the identification of recent primary CMV infection are important tools for managing the care of pregnant women suspected of having been exposed to CMV. CMV IgM detection is a sensitive marker of primary CMV infection, but its specificity is poor because CMV IgM is also produced during viral reactivation and persists following primary infection in some individuals. Studies conducted over the last 20 years convincingly demonstrate that measurement of CMV IgG avidity is both a sensitive and a specific method for identifying pregnant women with recent primary CMV infection and thus at increased risk for vertical CMV transmission. IgG avidity is defined as the strength with which IgG binds to antigenic epitopes expressed by a given protein; it matures gradually during the 6 months following primary infection. Low CMV IgG avidity is an accurate indicator of primary infection within the preceding 3 to 4 months, whereas high avidity excludes primary infection within the preceding 3 months. In this minireview, we summarize published data demonstrating the clinical utility of CMV IgG avidity results for estimating time since primary infection in pregnant women, describe commercially available CMV IgG avidity assays, and discuss some of the issues and controversies surrounding CMV IgG avidity testing during pregnancy. C ongenital cytomegalovirus (CMV) infection is the most common intrauterine infection, occurring in approximately 40,000 newborns each year in the United States (1-4). The clinical manifestations include sensorineural hearing loss, visual impairment, mental retardation, and cognitive defects; 4% of infected infants do not survive (1,2,5,6).Several studies have demonstrated a strong link between primary CMV infection of the mother and in utero CMV transmission. The risk of congenital infection is approximately 40% in babies born to mothers who acquire a primary (initial) CMV infection after conception; in contrast, the risk is only about 1% in infants born to mothers who have evidence of CMV infection (i.e., circulating CMV antibodies) before conception (1,3,(6)(7)(8)(9). The few cases of CMV transmission in seropositive mothers reflect nonprimary CMV infections, defined as either viral reactivation or infection with a different strain of CMV during pregnancy (2, 3, 5). Preexisting maternal antibodies thus appear to offer substantial protection against congenital infection, most likely due to the ability of antibodies to control viremia (2, 9, 10).The established link between primary CMV infection during pregnancy and congenital infection makes identification of primary CMV infection an important goal in maternal and neonatal health care. However, Ͼ95% of pregnant women with primary CMV infection are asymptomatic and thus cannot be ...

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Section: How Should Intermediate CMV Igg Avidity Results Be Used?mentioning

confidence: 99%

Section: Commercially Available CMV Igg Avidity Assaysmentioning

confidence: 99%

Section: Ongenital Cytomegalovirus (Cmv) Infection Is the Most Commmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Role of Cytomegalovirus (CMV) IgG Avidity Testing in Diagnosing Primary CMV Infection during Pregnancy

Prince

Lapé-Nixon

2014

Clin Vaccine Immunol

184

141

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“…In this population, CMV acquisition occurs at a rate of 1 to 7% per year (31) and usually follows frequent and prolonged contact with young children (less than 3 years of age) (31)(32)(33)(34). By comparison, in resource-poor communities in industrialized countries and in developing countries, CMV is usually acquired very early in life owing to breast milk transmission and crowded living conditions, and far fewer adult women are seronegative (7,(35)(36)(37)(38)(39)(40)(41).…”

Section: Epidemiology and Clinical Outcomesmentioning

confidence: 99%

The “Silent” Global Burden of Congenital Cytomegalovirus

et al. 2013

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SUMMARYHuman cytomegalovirus (CMV) is a leading cause of congenital infections worldwide. In the developed world, following the virtual elimination of circulating rubella, it is the commonest nongenetic cause of childhood hearing loss and an important cause of neurodevelopmental delay. The seroprevalence of CMV in adults and the incidence of congenital CMV infection are highest in developing countries (1 to 5% of births) and are most likely driven by nonprimary maternal infections. However, reliable estimates of prevalence and outcome from developing countries are not available. This is largely due to the dogma that maternal preexisting seroimmunity virtually eliminates the risk for sequelae. However, recent data demonstrating similar rates of sequelae, especially hearing loss, following primary and nonprimary maternal infection have underscored the importance of congenital CMV infection in resource-poor settings. Although a significant proportion of congenital CMV infections are attributable to maternal primary infection in well-resourced settings, the absence of specific interventions for seronegative mothers and uncertainty about fetal prognosis have discouraged routine maternal antibody screening. Despite these challenges, encouraging results from prototype vaccines have been reported, and the first randomized phase III trials of prenatal interventions and prolonged postnatal antiviral therapy are under way. Successful implementation of strategies to prevent or reduce the burden of congenital CMV infection will require heightened global awareness among clinicians and the general population. In this review, we highlight the global epidemiology of congenital CMV and the implications of growing knowledge in areas of prevention, diagnosis, prognosis, and management for both low (50 to 70%)- and high (>70%)-seroprevalence settings.

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Viral inoculum dose impacts memory T‐cell inflation

2014

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Diagnosis and Screening for Cytomegalovirus Infection in Pregnant Women in Cuba as Prognostic Markers of Congenital Infection in Newborns

Abstract: Mothers with active infection during the pregnancy and with HCMV excretion had significant risks, RR = 1.16 and RR = 1.35, respectively, to have congenitally infected children.

Cited by 19 publications

References 37 publications

Role of Cytomegalovirus (CMV) IgG Avidity Testing in Diagnosing Primary CMV Infection during Pregnancy

Role of Cytomegalovirus (CMV) IgG Avidity Testing in Diagnosing Primary CMV Infection during Pregnancy

The “Silent” Global Burden of Congenital Cytomegalovirus

Viral inoculum dose impacts memory T‐cell inflation

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