scholarly journals Recurrent maternal CMV infection associated with symptomatic congenital infection: results from a questionnaire study in Portugal

2019 ◽  
Vol 3 (1) ◽  
pp. e000455
Author(s):  
Paulo Paixão ◽  
Maria João Brito ◽  
Daniel Virella ◽  
Maria Teresa Neto
Keyword(s):  
Primary Infection ◽  
Recurrent Infection ◽  
Congenital Infection ◽  
High Avidity ◽  
Maternal Infection ◽  
Cmv Infection ◽  
Congenital Cmv Infection ◽  
Missed Diagnosis ◽  
Congenital Cmv

ObjectiveHuman cytomegalovirus (CMV) is the most widespread agent of congenital infection in humans and is still a challenging issue. Despite lower rates of vertical transmission being associated with recurrent infection when compared with primary infection, the first still represents the majority of congenital infections worldwide. Based on data from active reporting, we explored the influence of maternal primary/non-primary infection both on the presentation and outcome of congenital CMV infection in early childhood.DesignInfants with positive viruria during the first 3 weeks of life were reported through the Portuguese Paediatric Surveillance Unit.PatientsInfants born between 2006 and 2011 with confirmed congenital CMV infection.MethodsMaternal infection was considered primary if CMV IgG seroconversion occurred during pregnancy or low avidity IgG was documented; it was considered non-primary if positive IgG was documented before pregnancy or high avidity CMV IgG was present early in pregnancy. Follow-up questionnaires were sent up to 6 years of age.ResultsForty confirmed cases of congenital CMV infection were reported (6.6:105 live births, 95% CI 4.81 to 8.92); 22 out of 40 were asymptomatic. The odds for non-primary maternal infection if the offspring was symptomatic at birth were 6.2 (95% CI 1.2 to 32.27).ConclusionThe reported number of confirmed cases of congenital CMV infection was much lower than expected. Under-reporting and missed diagnosis were considered possible reasons. Non-primary maternal infections were associated with symptomatic congenital CMV infection in the offspring. Maternal recurrent infections can have a significant impact on the total number of symptomatic infections in Portugal.

Early high CMV seroprevalence in pregnant women from a population with a high rate of congenital infection

2012 ◽  
Vol 141 (10) ◽  
pp. 2187-2191 ◽  
Author(s):  
A. Y. YAMAMOTO ◽  
R. A. C. CASTELLUCCI ◽  
D. C. ARAGON ◽  
M. M. MUSSI-PINHATA
Keyword(s):  
Pregnant Women ◽  
Primary Infection ◽  
Congenital Infection ◽  
High Rate ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus ◽  
Younger Age ◽  
Congenital Cmv Infection ◽  
Stratified Sample ◽  
Congenital Cmv

SUMMARYCongenital cytomegalovirus (CMV) infection rates increase with maternal seroprevalence due to transmission from maternal non-primary infection. CMV seroprevalence estimates of pregnant women are needed for planning strategies against congenital CMV transmission. We aimed to determine the age-specific prevalence of serum antibodies for CMV in a representative age-stratified sample of unselected pregnant women from a Brazilian population. A total of 985 pregnant women, aged 12–46 years (median 24 years), were enrolled. Overall CMV seroprevalence was 97% (95% confidence interval 95·8–98·0), with age-specific (years) prevalence as follows: 12–19 (96·3%), 20–24 (97·7%), 25–29 (97·1%), and 30–46 (96·7%). CMV seroprevalence is almost universal (97%) and is found at similar levels in pregnant women of ages ranging from 12 to 46 years. Because high CMV seroprevalence is found even in women of a younger age in this population, this finding suggests that the majority of primary CMV infections occur early, in infancy or childhood. As a consequence, vaccines currently under development to prevent primary infection may not be a solution for the prevention of congenital CMV infection in this population.

FEATURES OF THE CONGENITAL CMV INFECTION IN THE UNBORN AND NEWBORN INFANT

2007 ◽  
Vol 18 (3) ◽  
pp. 181-199 ◽  
Author(s):  
G BENOIST ◽  
Y VILLE
Keyword(s):  
Primary Infection ◽  
Transmission Rate ◽  
Sensorineural Deafness ◽  
Recurrent Infection ◽  
Maternal Infection ◽  
Cmv Infection ◽  
Live Births ◽  
Vertical Transmission Rate ◽  
Fetal Infection ◽  
Congenital Cmv Infection

Cytomegalovirus (CMV) is the most frequent cause of congenital viral infection,1with a prevalence of 0.5 to 1% of all live births, and the leading infectious cause of sensorineural deafness and mental retardation.1As otherHerpesviridae, CMV fetal infection can develop following both primary and recurrent maternal infection. Vertical transmission rate is around 30% following primary infection and 2 to 3% following recurrent infection.2Effects on the unborn as well as on the newborn are widely variable. It is estimated that only 5 to 10% of infected newborns have symptoms at birth, whereas around 90% of congenitally infected infants are asymptomatic although 5–15% of these infants will develop some degree of sensorineural hearing loss.3

Congenital cytomegalovirus infection presenting as a fetal intra-abdominal cyst

2019 ◽  
Vol 8 (2) ◽  
Author(s):  
Emily Mills ◽  
Mary Beth Janicki ◽  
Reinaldo Figueroa
Keyword(s):  
Maternal Serum ◽  
Free Fluid ◽  
High Avidity ◽  
Maternal Infection ◽  
Cmv Infection ◽  
Female Fetus ◽  
Congenital Cmv Infection ◽  
Abdominal Cyst ◽  
Infectious Etiology ◽  
Congenital Cmv

Abstract Background Fetal intra-abdominal cysts have an incidence of 1/500–1/1000 live births. Cysts can be physiologic or pathologic and can either spontaneously regress or require intervention and treatment. Cytomegalovirus (CMV) is the most common cause of congenital infection in the USA with an incidence of 0.2–2%. The risk of transmission is greatest with a primary maternal infection and the severity of fetal injury increases when transmission occurs in the first half of the pregnancy. An infectious etiology for a fetal intra-abdominal cyst has not been reported to the best of our knowledge. Case presentation A 31-year-old multigravida presented at 19 weeks’ gestation for an anatomical survey. The female fetus was noted to have a 2.4 × 2.0 × 3.1 cm echolucent cyst in the right side of the abdomen. Three weeks later, the cyst was not seen; however, there was free fluid and a few echogenic areas within the fetal abdomen. Maternal serum tested positive for CMV IgM and IgG titers, and the CMV IgG avidity test was 0.75, consistent with high avidity. At 27 weeks’ gestation, ascites remained and a pericardial effusion was noted. Amniocentesis resulted in >2,000,000 copies of CMV DNA by polymerase chain reaction (PCR) in the amniotic fluid. The patient underwent termination of the pregnancy at 29 weeks of gestation. Conclusion It would be important to consider an infectious etiology in the differential diagnosis of fetal intra-abdominal cysts as the outcome in the fetus with congenital CMV infection could be much different. Amniocentesis is considered the best option for the diagnosis of fetal congenital CMV infection if performed after 21 weeks’ gestation and more than 6 weeks from maternal infection.

scholarly journals Intra-uterine transmission of cytomegalovirus in women known to be immune before conception

1984 ◽  
Vol 92 (1) ◽  
pp. 89-95 ◽  
Author(s):  
P. D. Griffiths ◽  
C. Baboonian
Keyword(s):  
Prospective Study ◽  
Pregnant Women ◽  
Congenital Infection ◽  
Infected Child ◽  
Cmv Infection ◽  
Previous Pregnancy ◽  
Congenital Cmv Infection ◽  
Retrospective Testing ◽  
A Prospective Study ◽  
Congenital Cmv

SUMMARYA prospective study identified 785 pregnant women who had been shown to possess complement fixing antibodies against cytomegalovirus (CMV) during a previous pregnancy. As these women were thus known to have been immune prior to their subsequent conception, their neonates were examined for evidence of congenital CMV infection. Specimens were obtained from 725(92%) of the neonatcs and congenital infection was found in only one (0·14%). The elder sister of the infected child was also shown, by retrospective testing of her stored cord serum for specific IgM antibodies, to have been infected in utero. Thus, one woman was identified who had delivered consecutive siblings congenitally infected with CMV. We conclude that some women have a propensity for intra-uterine transmission of CMV, despite being immune prior to conception, and speculate that such women may have acquired their infections perinatally.

scholarly journals A Novel Non-Replication-Competent Cytomegalovirus Capsid Mutant Vaccine Strategy Is Effective in Reducing Congenital Infection

2016 ◽  
Vol 90 (17) ◽  
pp. 7902-7919 ◽  
Author(s):  
K. Yeon Choi ◽  
Matthew Root ◽  
Alistair McGregor
Keyword(s):  
Guinea Pig ◽  
Small Animal ◽  
Congenital Infection ◽  
T Cell Response ◽  
Control Group ◽  
Cmv Infection ◽  
Vaccine Strategy ◽  
Congenital Cmv Infection ◽  
Guinea Pig Cytomegalovirus ◽  
Congenital Cmv

ABSTRACTCongenital cytomegalovirus (CMV) infection is a leading cause of mental retardation and deafness in newborns. The guinea pig is the only small animal model for congenital CMV infection. A novel CMV vaccine was investigated as an intervention strategy against congenital guinea pig cytomegalovirus (GPCMV) infection. In thisdisabledinfectioussingle-cycle (DISC) vaccine strategy, a GPCMV mutant virus was used that lacked the ability to express an essential capsid gene (theUL85homologGP85) except when grown on a complementing cell line. In vaccinated animals, the GP85 mutant virus (GP85 DISC) induced an antibody response to important glycoprotein complexes considered neutralizing target antigens (gB, gH/gL/gO, and gM/gN). The vaccine also generated a T cell response to the pp65 homolog (GP83), determined via a newly established guinea pig gamma interferon enzyme-linked immunosorbent spot assay. In a congenital infection protection study, GP85 DISC-vaccinated animals and a nonvaccinated control group were challenged during pregnancy with wild-type GPCMV (105PFU). The pregnant animals carried the pups to term, and viral loads in target organs of pups were analyzed. Based on live pup births in the vaccinated and control groups (94.1% versus 63.6%), the vaccine was successful in reducing mortality (P= 0.0002). Additionally, pups from the vaccinated group had reduced CMV transmission, with 23.5% infected target organs versus 75.9% in the control group. Overall, these preliminary studies indicate that a DISC CMV vaccine strategy has the ability to induce an immune response similar to that of natural virus infection but has the increased safety of a non-replication-competent virus, which makes this approach attractive as a CMV vaccine strategy.IMPORTANCECongenital CMV infection is a leading cause of mental retardation and deafness in newborns. An effective vaccine against CMV remains an elusive goal despite over 50 years of CMV research. The guinea pig, with a placenta structure similar to that in humans, is the only small animal model for congenital CMV infection and recapitulates disease symptoms (e.g., deafness) in newborn pups. In this report, a novel vaccine strategy against congenital guinea pig cytomegalovirus (GPCMV) infection was developed, characterized, and tested for efficacy. Thisdisabledinfectioussingle-cycle (DISC) vaccine strategy induced a neutralizing antibody or a T cell response to important target antigens. In a congenital infection protection study, animals were protected against CMV in comparison to the nonvaccinated group (52% reduction of transmission). This novel vaccine was more effective than previously tested gB-based vaccines and most other strategies involving live virus vaccines. Overall, the DISC vaccine is a safe and promising approach against congenital CMV infection.

scholarly journals A congenital CMV infection model for follow-up studies of neurodevelopmental disorders, neuroimaging abnormalities, and treatment

JCI Insight ◽  
2022 ◽  
Vol 7 (1) ◽  
Author(s):  
Yue-Peng Zhou ◽  
Meng-Jie Mei ◽  
Xian-Zhang Wang ◽  
Sheng-Nan Huang ◽  
Lin Chen ◽  
...  
Keyword(s):  
Neurodevelopmental Disorders ◽  
Infection Model ◽  
Cmv Infection ◽  
Congenital Cmv Infection ◽  
Follow Up Studies ◽  
Congenital Cmv

Vaccination for cytomegalovirus: when, where and how

2015 ◽  
Vol 36 (4) ◽  
pp. 175
Author(s):  
Vijayendra Dasari ◽  
Rajiv Khanna
Keyword(s):  
Congenital Infection ◽  
Neurological Complications ◽  
Medical Attention ◽  
Transplacental Transmission ◽  
Cmv Infection ◽  
Seizure Disorders ◽  
Congenital Cmv Infection ◽  
Preclinical And Clinical Studies ◽  
Cmv Disease ◽  
Congenital Cmv

Although following primary human cytomegalovirus (CMV) infection in many individuals no overt symptoms are observed, CMV came to medical attention due to its significant morbidity and mortality associated with congenital infection and immunosuppressed individuals. Congenital infection occurs following transplacental transmission during pregnancy as a result of primary infection, reactivation or re-infection with a different isolate. Estimates suggest at least a million cases of congenital CMV occur annually worldwide. Congenital infection is a leading cause of neurological complications such as mental retardation, cerebral palsy, developmental delay and seizure disorders and also causes permanent disabilities, such as hearing loss and vision impairment. In addition, other common manifestation of CMV infection are stillbirth, preterm delivery and intrauterine growth restriction (IUGR) and cardiovascular disease, which are risk factors for perinatal and lifetime morbidity. Recent reports have estimated that the economic costs to public health and families due to congenital CMV infection are immense, with direct annual costs of billions of dollars. An effective CMV vaccine that could prevent transplacental transmission, reduce CMV disease and CMV-associated stillbirths has been recognised as an urgent medical need. Over the past 40 years several CMV vaccine candidates have been evaluated in a series of clinical trials and found to be effective in preclinical and clinical studies. However, in spite of extensive efforts over many decades, successful licensure of an effective CMV vaccine formulation to prevent congenital CMV infection remains elusive.

First-line noninvasive management of cytomegalovirus primary infection in pregnancy

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Marie Denef ◽  
Laure Noel ◽  
Gaëlle Bruck ◽  
Justine Gudelj ◽  
Malek Tebache ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Primary Infection ◽  
Brain Mri ◽  
Neurodevelopmental Outcome ◽  
Fetal Outcome ◽  
Cmv Infection ◽  
First Line ◽  
Congenital Cmv Infection ◽  
Magnetic Resonance Imaging Mri ◽  
Congenital Cmv

Abstract Objectives To introduce a first-line noninvasive antenatal management of maternal cytomegalovirus (CMV) primary infection based on ultrasound (US) and magnetic resonance imaging (MRI). Amniocentesis (AC) is used as a second-line tool in cases of abnormalities compatible with fetal CMV infection on US and/or MRI screening. Methods Between January 2011 and October 2018, pregnant women referred with a CMV primary infection on antibody screening were followed up by monthly US scans and a brain MRI at approximately 32 weeks. In cases with US and/or MRI abnormalities compatible with congenital CMV infection, AC was performed to confirm the diagnosis. Results Ninety pregnant women with a primary CMV infection were included (89 singleton and one twin pregnancy). The first-line screening by US and/or MRI was normal for 72 of 91 fetuses (79%). At birth, 19 of these 72 neonates (26%) had a positive urine sample for CMV but were asymptomatic. US and/or MRI abnormalities were identified in 19 fetuses (21%). AC confirmed a fetal CMV infection in 16 fetuses (84%); 12 pregnancies were terminated, and four were continued, with three symptomatic neonates at birth and one poor neurodevelopmental outcome at postnatal follow-up. Conclusions First-line noninvasive management of maternal CMV primary infection based on serial US scans and brain MRI can be offered to identify fetuses with severe symptomatic congenital CMV infection and reduce the number of ACs without compromising the fetal outcome.

The IgG avidity value for the prediction of congenital cytomegalovirus infection in a prospective cohort study

2014 ◽  
Vol 42 (6) ◽  
Author(s):  
Yasuhiko Ebina ◽  
Toshio Minematsu ◽  
Ayako Sonoyama ◽  
Ichiro Morioka ◽  
Naoki Inoue ◽  
...  
Keyword(s):  
Cohort Study ◽  
Predictive Value ◽  
Congenital Infection ◽  
Cmv Infection ◽  
Avidity Index ◽  
Infection Group ◽  
Cutoff Value ◽  
Igg Avidity ◽  
Congenital Cmv Infection ◽  
Congenital Cmv

AbstractCytomegalovirus (CMV) causes congenital infection with high mortality and morbidity rates in affected neonates.To evaluate the maternal IgG avidity value for the prediction of congenital CMV infection.The serum IgG avidity in all mothers was measured, and the urine of their neonates was assessed for CMV DNA in a prospective cohort study.Of 759 women with a positive test for CMV IgG, 14 had congenital CMV infection. CMV IgG avidity indices in the congenital infection group (median 35.1%) were significantly lower than those in the non-congenital infection group (70.4%). A cutoff value of <40% IgG avidity index with 96.1% specificity and 64.3% sensitivity for congenital infection was determined by receiver operating characteristic curve analyses. The highest sensitivity (88.9%), 96.2% specificity, 27.6% positive predictive value, 99.8% negative predictive value, and 96.1% accuracy were found when IgG avidity was measured in <28 weeks of gestation.The IgG avidity measurement with a cutoff value of <40% IgG avidity index might be helpful in predicting congenital CMV infection, especially in <28 weeks of gestation.

scholarly journals Birth Prevalence of Congenital Cytomegalovirus (CMV) infection in a cohort of pregnant women in Bangladesh

2018 ◽  
Vol 43 (2) ◽  
pp. 77-81
Author(s):  
Munira Jahan ◽  
Nahida Sultana ◽  
Ridwana Asma ◽  
Shahina Tabassum ◽  
Md. Nazrul Islam
Keyword(s):  
Pregnant Women ◽  
Viral Infections ◽  
Congenital Infection ◽  
High Seroprevalence ◽  
Cmv Infection ◽  
Congenital Cytomegalovirus ◽  
Birth Prevalence ◽  
Congenital Cmv Infection ◽  
Cmv Reactivation ◽  
Congenital Cmv

Cytomegalovirus (CMV) is a frequent cause of congenital infection in humans in all regions of the world. In contrast to most congenital viral infections, congenital CMV infection and disease have been consistently demonstrated in populations with a high seroprevalence. Three hundred pregnant women were studied prospectively in their 1st, 2nd and 3rd trimester to determine the seroprevalence and seroconversion of CMV in pregnancy. After birth, babies were also tested for anti CMV IgM to determine the rate of birth prevalence. Anti CMV IgG and IgM tests were performed by chemiluminescence methods. All 300 (100%) pregnant women were anti CMV IgG positive and 180 (60%) were subsequently anti CMV IgM positive during different trimesters of pregnancy. Birth prevalence of CMV IgM antibody was 1.3% among babies of anti CMV IgM positive mothers whereas none in CMV IgM negative mothers (OR 1.01, 95% CI .996-1.027).It may be concluded that CMV IgG seroprevalence is high among Bangladeshi pregnant women and the rate of CMV reactivation is also high during pregnancy. Despite protection by maternal immunity a certain percent of babies acquire congenital CMV infection.

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