Prognostic markers of symptomatic congenital cytomegalovirus infection

Abstract

The objective of this research was to identify maternal and fetal characteristics as prognostic markers of congenital cytomegalovirus (CMV) infection. This is a descriptive study of 13 cases of congenital CMV infection referred to Institute de Puericulture et Perinatologie de Paris (IPP) from January 2005 to October 2006. Amniotic fluid puncture was performed to research CMV polimerase chain reaction (PCR). Cordocentesis and cord blood samples at delivery were also analyzed to determinate fetal platelets count, GGT, ASAT, ALAT, CMV-DNA and IgM antibody. Variables of symptomatic and asymptomatic infants were then compared. Data were analyzed by SPSS -15.0. Mean gestational age of amniocentesis was 24.6 weeks and there was no difference of mean viral load in amniotic fluid considering infant features. Mean gestational age of cordocentesis was 26.1 weeks. There were no statistical differences of fetal viral load, IgM, platelets, GGT, ASAT and ALAT analyzed at cordocentesis samples, but at delivery, mean values of IgM and ASAT of fetal blood were increased in symptomatic ones (p= 0.03 for both parameters). When considering groups with normal and abnormal parameters, ASAT of cordon samples was also increased in symptomatic infants (p= 0.02). Sensibility, specificity, positive and negative predictive value of fetal ultrasound anomalies to detect symptomatic infants were, respectively, 80%, 62.5%, 57.1% and 83.3%. Thus, identification of markers of CMV symptomatic infants should be aimed. Prenatal diagnosis, identification and follow up of congenital CMV infected infants are important to consider treatment for symptomatic infants, trying to avoid or reducing some possible sequels.

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

“…31,32 More recently, the availability of quantitative PCR-assays has increased interest in the potential role of viral load in predicting disease outcome, development of hearing loss and monitoring response to antiviral therapy in congenital HCMV infection; however, in practice many questions are still open. 2 Revello et al, and Romanelli et al, have not found association between the viral load and the prediction of the symptom in the newborns or the appearance of sequelae 33,34 which is in agreement with the lack of associations also reported in the present study. However, the 2 newborn with retarded intrauterine growth and severe jaundice showed high viral load (Ͼ1000 copies/L), but a statistically significant association was not found since the sample size is small.…”

Passive Immunization against Congenital Cytomegalovirus Infection: Current State of Knowledge

“…Contrary to what physicians might anticipate, the viral load in the amniotic sac does not seem to be a reliable predictor of neonatal clinical outcome [46,47]. Furthermore, data on the usefulness of CMV specific IgM and CMV-DNA concentrations in fetal umbilical cord blood as prognostic parameters are conflicting [41,48,49]. …”

Sequence and Timing of Intracranial Changes in Cytomegalovirus in Pregnancy: A Case Report and Literature Review

“…Infected women often present with nonspecific signs and symptoms, but the majority are asymptomatic [6]. Approximately 10% of newborns show symptoms at birth [1, 3–5] but this increases to 20–30% if their mothers were infected in the first trimester [7]. There is a 30% mortality in the affected infants and 90% will have long-term neurological impairment [4, 5].…”

“…Approximately 10% of newborns show symptoms at birth [1, 3–5] but this increases to 20–30% if their mothers were infected in the first trimester [7]. There is a 30% mortality in the affected infants and 90% will have long-term neurological impairment [4, 5]. Of the asymptomatic neonates, 10% will develop permanent sequelae, including hearing loss and mental retardation [1, 3–5].…”