Lymphocyte responses and virus excretion as risk factors for intrauterine infection with cytomegalovirus

Fernando, S.S.N.; Pearce, J. M.; Booth, James C.

doi:10.1002/jmv.1890410205

Cited by 21 publications

(17 citation statements)

References 28 publications

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“…Only a small percentage (1.2%) of CMV seropositive women in the present study were found to be shedding CMV compared to published data (46). Urinary shedding has a poor correlation with intrauterine infection, although it has been identified as a risk factor (15,42). In the present study one of the women from group B who seroconverted and was viremic at the time of testing was also shedding CMV in her urine and gave birth to a child with asymptomatic congenital CMV infection.…”

Section: Discussioncontrasting

confidence: 85%

Diagnosis of and Screening for Cytomegalovirus Infection in Pregnant Women

et al. 2005

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No single diagnostic test for cytomegalovirus (CMV) infection is currently available for pregnant women at all stages of gestation. Improved accuracy in estimating the timing of primary infections can be used to identify women at higher risk of giving birth to congenitally infected infants. A diagnostic algorithm utilizing immunoglobulin G (IgG), IgM, and IgG avidity was used to prospectively screen serum from 600 pregnant women enrolled from two groups: <20 weeks gestation (n ‫؍‬ 396) or >20 weeks gestation (n ‫؍‬ 204). PCR testing of urine and/or blood was performed on all seropositive women (n ‫؍‬ 341). The majority (56.8%) of women were CMV IgG seropositive, with 5.5% being also CMV IgM positive. In the IgM-positive women, 1.2% had a low-avidity IgG, indicating a primary CMV infection and a high risk of intrauterine transmission. Two infants with asymptomatic CMV infection were born of mothers who had seroconverted in the second trimester of pregnancy. Baseline, age-stratified CMV serostatus was established from 1,018 blood donors. Baseline seropositivity from a blood donor population increased with age from 34.9% seroprevalence at less than 20 years of age to 72% seroprevalence at 50 years of age. Women at high risk of intrauterine transmission of CMV were identified at all stages of gestation. Women infected with CMV during late gestation may be more likely to transmit the virus, so failure to detect seroconversions in late gestation may result in failure to detect infected neonates.Human cytomegalovirus (CMV) is the most common cause of congenital malformation resulting from viral intrauterine infection in developed countries (12,21,48). Primary CMV infection occurs in 0.15 to 2.0% of all pregnancies and may be transmitted to the fetus in up to 40% of cases (48). Up to 15% of intrauterine CMV infections result in symptomatic congenital disease at birth, and 10 to 15% of those born with asymptomatic congenital CMV will develop significant clinical sequelae in infancy (7,10,18). In utero transmission of CMV can occur during primary maternal infection, reactivation, or reinfection of seropositive mothers. Most concern centers on primary maternal infection, due to the potential for significant fetal damage when the infection is acquired and transmitted during the first trimester (30, 48). Perinatal infections can result through virus transmission from many parts of the birth canal (39); however, the majority of these infections are asymptomatic (43).The usefulness of prenatal testing for CMV has been questioned due to the absence of clearly effective intervention (1, 27) and to evidence for severe congenital malformation resulting from viral reactivation (6,8,20). Continuing advancements in technology, however, mean reliable and inexpensive serologic tests are available, prenatal diagnostic procedures with acceptable negative predictive values (NPV) can be performed, and trials of neonatal antiviral treatments are ongoing (25,34,37,50,52). Proposed diagnostic algorithms have focused on first-trimester screeni...

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Section: Discussioncontrasting

confidence: 85%

Diagnosis of and Screening for Cytomegalovirus Infection in Pregnant Women

et al. 2005

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“…In conclusion, these data cast some doubts on the value of some maternal factors, such as humoral and cellular immune response, as possible prognostic markers of intrauterine transmission, as postulated by some researchers (29,71,157,269). They should also be taken into consideration when testing the hypothesis that reinfection with a different HCMV strain may be responsible for the unfavorable outcome observed in some infants born to mothers with existing immunity (30).…”

Section: Congenital Infection In Twinsmentioning

confidence: 88%

Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant

2002

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Human cytomegalovirus (HCMV) is the leading cause of congenital viral infection and mental retardation. HCMV infection, while causing asymptomatic infections in most immunocompetent subjects, can be transmitted during pregnancy from the mother with primary (and also recurrent) infection to the fetus. Hence, careful diagnosis of primary infection is required in the pregnant woman based on the most sensitive serologic assays (immunoglobulin M [IgM] and IgG avidity assays) and conventional virologic and molecular procedures for virus detection in blood. Maternal prognostic markers of fetal infection are still under investigation. If primary infection is diagnosed in a timely manner, prenatal diagnosis can be offered, including the search for virus and virus components in fetal blood and amniotic fluid, with fetal prognostic markers of HCMV disease still to be defined. However, the final step for definite diagnosis of congenital HCMV infection is detection of virus in the blood or urine in the first 1 to 2 weeks of life. To date, treatment of congenital infection with antiviral drugs is only palliative both prior to and after birth, whereas the only efficacious preventive measure seems to be the development of a safe and immunogenic vaccine, including recombinant, subunit, DNA, and peptide-based vaccines now under investigation. The following controversial issues are discussed in the light of the most recent advances in the field: the actual perception of the problem; universal serologic screening before pregnancy; the impact of correct counseling on decision making by the couple involved; the role of prenatal diagnosis in ascertaining transmission of virus to the fetus; the impact of preconceptional and periconceptional infections on the prevalence of congenital infection; and the prevalence of congenitally infected babies born to mothers who were immune prior to pregnancy compared to the number born to mothers undergoing primary infection during pregnancy

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“…Pre-and post-immunization guinea-pig sera with complementindependent neutralizing activity, specific for HCMV gB, were the generous gift of Dirk Gheysen (SmithKline Beecham). Acute and convalescent sera from pregnant women undergoing primary infection with HCMV (Fernando et al, 1993) were used in final dilutions of 1 : 100-1 : 500.…”

Section: Methodsmentioning

confidence: 99%