Placental cytomegalovirus infection withoutfetal involvement following primary infection in pregnancy

In the absence of a cytomegalovirus (CMV) vaccine, other strategies for prevention of primary infection in pregnancy should be considered. Behavioural interventions have been reported to significantly decrease seroconversion rate among seronegative pregnant women. We report here on a recently completed controlled study in which seronegative women at high risk of infection because of close contacts with children <36 months, were identified and informed about risky and protective behaviours. Informed women seroconverted at a significantly lower rate than non-informed women.

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Congenital Human Cytomegalovirus Infection: A Narrative Review of Maternal Immune Response and Diagnosis in View of the Development of a Vaccine and Prevention of Primary and Non-Primary Infections in Pregnancy

Microorganisms ◽

10.3390/microorganisms9081749 ◽

2021 ◽

Vol 9 (8) ◽

pp. 1749

Author(s):

Giuseppe Gerna ◽

Chiara Fornara ◽

Milena Furione ◽

Daniele Lilleri

Keyword(s):

Immune Response ◽

Human Cytomegalovirus ◽

Primary Infection ◽

Cytomegalovirus Infection ◽

Hcmv Infection ◽

Antiviral Treatment ◽

Virus Transmission ◽

Immune Correlates ◽

Maternal Immune Response ◽

In Pregnancy

Congenital cytomegalovirus infection (cCMV) may affect about 1% of all newborns all over the world as a result of either a primary or recurrent human cytomegalovirus (HCMV) infection. While about 90% of infants affected by cCMV are asymptomatic at birth, the remaining 10% are symptomatic often with neurodevelopmental impairment and sensorineural hearing loss. In view of identifying the best approach to vaccine prevention of cCMV, this review will examine the most important steps made in the study of the immune response to, and diagnosis of, HCMV infection. The maternal immune response and immune correlates of protection are being partially identified with a partial contribution given by our laboratory. The diagnosis of primary infection is often difficult to achieve in the first three months of pregnancy, which is the time primarily involved in virus transmission to the fetus in association with the most severe symptoms and sequelae. Prevention of cCMV is anticipated by prevention of primary infection in early pregnancy by means of different measures, such as (i) behavioral-educational measures, (ii) immunoglobulin administration, (iii) antiviral treatment with valaciclovir. However, the most promising approach to cCMV prevention appears to be the development of a non-living vaccine, including at least three viral antigens: gB, pentamer complex gHgLpUL128L, and pp65, which have been shown to be able to stimulate both the humoral and the cellular arms of the maternal immune response. Primary HCMV infection may be managed in pregnancy by counseling of the couples involved by a team of specialists that includes virologists, obstetricians, infectivologists and neonatologists.

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Methods for estimating the incidence of primary infection in pregnancy: a reappraisal of toxoplasmosis and cytomegalovirus data

Epidemiology and Infection ◽

10.1017/s0950268800049839 ◽

1992 ◽

Vol 108 (2) ◽

pp. 367-375 ◽

Cited By ~ 27

Author(s):

A. E. Ades

Keyword(s):

Confidence Intervals ◽

Statistical Methods ◽

Infection Rate ◽

Primary Infection ◽

Cytomegalovirus Infection ◽

Incidence Rates ◽

The Uk ◽

In Pregnancy

SUMMARYAccurate incidence information is required to plan and evaluate screening programmes which have been proposed for the detection of primary toxoplasmosis and cytomegalovirus infection in pregnancy. Appropriate statistical methods are described for deriving incidence rates and their confidence intervals from three types of data: change in age-specific seroprevalence, seroconversion, and IgM studies. These methods are applied to seven published studies on toxoplasmosis and cytomegalovirus carried out in the UK. In these publications only one estimate of the infection rate per pregnancy was correctly derived, and none were accompanied by confidence intervals. Using the proposed methods, most estimates of the primary toxoplasmosis rate in these studies were between 2·5 and 5·5 per 1000 pregnancies, compared to the 2 per 1000 usually cited. Most cytomegalovirus incidence estimates were between 4 and 10 per 1000 pregnancies.

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PLACENTAL CYTOMEGALOVIRUS INFECTION WITHOUT FETAL INVOLVEMENT FOLLOWING PRIMARY INFECTION IN PREGNANCY

Obstetrical & Gynecological Survey ◽

10.1097/00006254-197203000-00012 ◽

1972 ◽

Vol 27 (3) ◽

pp. 170

Author(s):

KATHLEEN HAYES ◽

HALINA GIBAS

Keyword(s):

Primary Infection ◽

Cytomegalovirus Infection ◽

In Pregnancy

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LB20. Valacyclovir to Prevent Vertical Transmission of Cytomegalovirus After Maternal Primary Infection During Pregnancy

Open Forum Infectious Diseases ◽

10.1093/ofid/ofz415.2503 ◽

2019 ◽

Vol 6 (Supplement_2) ◽

pp. S1002-S1002 ◽

Cited By ~ 13

Author(s):

Keren Shahar-Nissan ◽

Joseph Pardo ◽

Orit Peled ◽

Irit Krause ◽

Efraim Bilavsky ◽

...

Keyword(s):

Amniotic Fluid ◽

Vertical Transmission ◽

Primary Infection ◽

Antiviral Drug ◽

First Trimester ◽

Controlled Study ◽

Therapeutic Drug ◽

Control Group ◽

Cmv Infection ◽

In Pregnancy

Abstract Background Cytomegalovirus (CMV) is the most common cause of congenital infection in humans. The highest risk of fetal injury follows a maternal primary infection early in pregnancy. Despite the potential for severe fetal injury, to date there are no proven means to prevent viral transmission. Valacyclovir is an antiviral drug proven effective in decreasing the risk for CMV infection among transplant recipients. Valacyclovir is safe for use in pregnancy, and concentrates in the amniotic fluid without accumulating. A dose of 8 g/day creates therapeutic drug levels in the amniotic fluid and fetal blood. Methods This is a randomized, double-blind, placebo-controlled study comprising pregnant women with serologic evidence of primary CMV infection during the periconceptional period and first trimester. After informed consent, patients were randomly assigned to a treatment group (8 g/day of Valacyclovir) or control group (placebo). Treatment was initiated at the time of serological detection, and continued until amniocentesis. The primary endpoint was the rate of vertical transmission of CMV—determined by amniotic fluid CMV PCR. Secondary endpoints included evidence of symptomatic congenital CMV infection—in utero or postnatally. Results One hundred women were recruited, 90 were included in the data analysis; 45 patients received Valacyclovir and 45 placebo. There were 2 twin pregnancies, and therefore 92 amniocentesis Amongst the Valacyclovir group, 5 (11.1%) amniocentesis were positive for CMV, compared with 14 (29.8%) in the placebo group (P GLMM = 0.03), corresponding with an odds ratio of 0.29 (95% CI: 0.09–0.90) for vertical CMV transmission. Amongst patients infected during the first trimester, a positive amniocentesis for CMV was significantly (P = 0.02) less likely in the Valacyclovir arm (2/19) compared with placebo (11/23). No significant differences (P = 0.91) in CMV-positive amniocentesis were observed between study arms amongst patients infected periconceptionally. Conclusion Valacyclovir at a dose of 8 g/day is effective in reducing the rate of fetal CMV infection following early maternal primary infection during pregnancy. The drug reduces the rate of fetal infection by 71%. Disclosures All authors: No reported disclosures.

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Experimental primary cytomegalovirus infection in pregnancy: Timing and fetal outcome

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(83)90339-3 ◽

1983 ◽

Vol 145 (1) ◽

pp. 56-60 ◽

Cited By ~ 20

Author(s):

Mary L. Kumar ◽

Sandra L. Prokay

Keyword(s):

Cytomegalovirus Infection ◽

Fetal Outcome ◽

Primary Cytomegalovirus Infection ◽

In Pregnancy

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Assessing patient perceptions of cytomegalovirus infection in pregnancy

American Journal of Obstetrics and Gynecology ◽

10.1016/j.ajog.2018.10.044 ◽

2018 ◽

Vol 219 (6) ◽

pp. 647

Author(s):

C. Clinton ◽

A. Post ◽

T. Truong ◽

B.L. Hughes

Keyword(s):

Cytomegalovirus Infection ◽

Patient Perceptions ◽

In Pregnancy

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An early marker of fetal infection after primary cytomegalovirus infection in pregnancy.

BMJ ◽

10.1136/bmj.292.6522.718 ◽

1986 ◽

Vol 292 (6522) ◽

pp. 718-720 ◽

Cited By ~ 33

Author(s):

H Stern ◽

G Hannington ◽

J Booth ◽

D Moncrieff

Keyword(s):

Cytomegalovirus Infection ◽

Early Marker ◽

Fetal Infection ◽

Primary Cytomegalovirus Infection ◽

In Pregnancy

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Coccidioidomycosis

Oxford Textbook of Medicine ◽

10.1093/med/9780199204854.003.070703_update_001 ◽

2010 ◽

pp. 1020-1023

Author(s):

Gregory M. Anstead ◽

John R. Graybill

Keyword(s):

Central Nervous System ◽

United States Of America ◽

Primary Infection ◽

Soft Tissues ◽

Community Acquired Pneumonia ◽

Immunocompromised Patients ◽

System Diagnosis ◽

The Central Nervous System ◽

Disseminated Disease ◽

In Pregnancy

Coccidioidomycosis results from inhalation of arthroconidia of Coccidioides spp., which are soil fungi endemic to the south-western United States of America and parts of Latin America. Most infections are asymptomatic, but primary infection may resemble community-acquired pneumonia, sometimes with hypersensitivity manifestations such as erythema nodosum, erythema multiforme, and arthritis. Acute pulmonary infection usually resolves spontaneously, but—especially in immunocompromised patients, African Americans, and Filipinos—it may progress to persistent pulmonary disease or disseminate to skin, soft tissues, the osteoarticular system, and the central nervous system. Diagnosis is by culture, histopathology or serology. Fluconazole and itraconazole are usually the initial drugs of choice, with amphotericin B reserved for severe pulmonary and disseminated disease, and in pregnancy. In refractory cases, posaconazole and voriconazole are alternative antifungal agents....

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