Evaluation of Cytomegalovirus (CMV) IgM level and IgG Avidity in Detection of Primary Infection in Pregnant Women

Primary infection occurs when seronegative women are infected by human cytomegalovirus (HCMV). Diagnosis of primary infection is based on the following: antibody seroconversion, presence of IgM and low IgG avidity index (AI), and presence of DNAemia. The kinetics of HCMV-specific IgM antibody and maturation of AI might be very rapid or long-lasting during primary infection, which makes serological diagnosis insidious. The aims of this study were as follows: (i) to report atypical kinetics of HCMV-specific IgM antibody and AI early after onset of primary HCMV infection in a population of pregnant women, and (ii) to assess the frequency of such results. Altogether, 1309 sequential serum samples collected from 465 pregnant women with primary HCMV infection were included in the study. As a general rule, using the LIAISON®CMVIgMII and LIAISON®CMVIgGAvidityII assays, virus-specific IgM antibody levels decreased, while IgG AI increased over time during the first three months after infection onset. However, early clearance of IgM antibody and/or early IgG AI maturation occurred in 46/426 (10.7%) women. In more details, 20/426 (4.7%) and 26/418 (6.2%) women had undetectable IgM antibody or high IgG AI, respectively, when tested within 1–3 months after well-defined infection onset. Twenty sera from as many women with high IgG AI by the LIAISON assay were further tested for IgG AI by VIDAS®CMVIgGAvidityII and Mikrogen recomLineCMVIgG Avidity assays. Comparable results were obtained with VIDAS, whereas 14/20 sera gave low AI with the Mikrogen assay. In conclusion, about 11% of pregnant women undergoing a primary HCMV infection showed misleading serological results. Additional and appropriate testing might help in reducing the risk of missing HCMV primary infection in pregnancy. Furthermore, preconceptional testing should be strongly recommended.

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

Clinical and Vaccine Immunology ◽

10.1128/cvi.00487-14 ◽

2014 ◽

Vol 21 (10) ◽

pp. 1377-1384 ◽

Cited By ~ 79

Author(s):

Harry E. Prince ◽

Mary Lapé-Nixon

Keyword(s):

Pregnant Women ◽

Primary Infection ◽

Viral Reactivation ◽

Published Data ◽

Specific Method ◽

High Avidity ◽

Cmv Infection ◽

Igg Avidity ◽

Increased Risk

ABSTRACTThe 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.

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Distinguishing between primary infection and reinfection with rubella vaccine virus by IgG avidity assay in pregnant women

Eastern Mediterranean Health Journal ◽

10.26719/2009.15.1.94 ◽

2009 ◽

Vol 15 (1) ◽

pp. 94-103 ◽

Cited By ~ 3

Author(s):

R. Hamkar ◽

S. Jalilvand ◽

M.H. Abdol Baghi ◽

K.N. Jelyani ◽

A. Esteghamati ◽

...

Keyword(s):

Pregnant Women ◽

Primary Infection ◽

Vaccine Virus ◽

Rubella Vaccine ◽

Avidity Assay ◽

Igg Avidity

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Comparison of the LIAISON ® CMV IgG Avidity II and the VIDAS ® CMV IgG Avidity II assays for the diagnosis of primary infection in pregnant women

Journal of Clinical Virology ◽

10.1016/j.jcv.2015.08.018 ◽

2015 ◽

Vol 72 ◽

pp. 46-48 ◽

Cited By ~ 15

Author(s):

Yann Sellier ◽

Tiffany Guilleminot ◽

Yves Ville ◽

Marianne Leruez-Ville

Keyword(s):

Pregnant Women ◽

Primary Infection ◽

Igg Avidity

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Do the placental barrier, parasite genotype and Toll-like receptor polymorphisms contribute to the course of primary infection with various Toxoplasma gondii genotypes in pregnant women?

European Journal of Clinical Microbiology & Infectious Diseases ◽

10.1007/s10096-013-2017-3 ◽

2013 ◽

Vol 33 (5) ◽

pp. 703-709 ◽

Cited By ~ 21

Author(s):

W. Wujcicka ◽

J. Wilczyński ◽

D. Nowakowska

Keyword(s):

Toxoplasma Gondii ◽

Pregnant Women ◽

Primary Infection ◽

Placental Barrier ◽

Toll Like Receptor ◽

Parasite Genotype

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Maternal IgG Avidity and IgM Detected by Blot as Diagnostic Tools to Identify Pregnant Women at Risk of Transmitting Cytomegalovirus

Viral Immunology ◽

10.1089/vim.2000.13.137 ◽

2000 ◽

Vol 13 (1) ◽

pp. 137-141 ◽

Cited By ~ 61

Author(s):

TIZIANA LAZZAROTTO ◽

STEFANIA VARANI ◽

PATRIZIA SPEZZACATENA ◽

LILIANA GABRIELLI ◽

PAOLA PRADELLI ◽

...

Keyword(s):

At Risk ◽

Pregnant Women ◽

Diagnostic Tools ◽

Igg Avidity ◽

Maternal Igg

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Immunoglobulin G Avidity in Diagnosis of Toxoplasmic Lymphadenopathy and Ocular Toxoplasmosis

Clinical and Diagnostic Laboratory Immunology ◽

10.1128/cdli.6.4.514-518.1999 ◽

1999 ◽

Vol 6 (4) ◽

pp. 514-518 ◽

Cited By ~ 27

Author(s):

Malgorzata Paul

Keyword(s):

Pregnant Women ◽

Immunoglobulin G ◽

Large Range ◽

Congenital Toxoplasmosis ◽

Chronic Phase ◽

Ocular Toxoplasmosis ◽

Enzyme Linked Immunosorbent Assay ◽

Ocular Infection ◽

High Avidity ◽

Igg Avidity

ABSTRACT Traditional serological techniques have some limitations in evaluating the duration of Toxoplasma gondii infection in pregnant women, patients with lymphadenopathy, and older children suspected of having congenital toxoplasmosis. In these three groups of patients, two variants of T. gondii immunoglobulin G (IgG) avidity tests were used: an EIA Kit (Labsystems) and a noncommercial enzyme-linked immunosorbent assay specially elaborated in the laboratory. The avidity of specific IgG in sera from 23 patients with a known recently acquired infection (mainly pregnant women) was low (less than 30%), whereas that in sera from 19 patients with toxoplasmic lymphadenopathy of 3 weeks to 6 months in duration (mean, 8.3 weeks) covered a large range (between 0.2 and 57.8%; mean, 25.7%); high avidity results were observed for 10 of 19 patients (52.6%). The large range of IgG avidity in patients with toxoplasmic lymphadenopathy suggests various durations of infection in these patients, with a tendency for a chronic phase of toxoplasmosis. According to the avidity marker, five patients with lymphadenopathy for less than 3 months did not have a recent Toxoplasma infection. In 6 of 19 patients with lymphadenopathy (31.6%), low IgG avidity values persisted until 5 months after the first serological examination. In all four patients with a documented chronic course of Toxoplasma infection (6 months to 8 years after the first positive serology), high IgG avidity values were observed. Among sera from 10 children and young immunocompetent adults suspected of having ocular reactivation of congenital toxoplasmosis, all had high IgG avidity values (over 40%), suggesting congenitally acquired ocular infection rather than noncongenital infection. In conclusion, the avidity of IgG is a valuable marker of recent toxoplasmosis in pregnant women, suggests the duration of invasion in patients with lymphadenopathy, and may be helpful for differentiation between reactivation of congenital infection and recently acquired ocular toxoplasmosis in immunocompetent patients. A low IgG avidity does not always identify a recent case of toxoplasmosis, but a high IgG avidity can exclude primary infections of less than 5 months’ duration.

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Increase in Percentage of Seronegative Toxoplasma gondii and Cytomegalovirus in Pregnant Women: An Improvement in Hygienic Conditions in Certain Areas?

Timisoara Medical Journal ◽

10.35995/tmj20200109 ◽

2020 ◽

Vol 2020 (1) ◽

pp. 1 ◽

Cited By ~ 1

Author(s):

Dan-Bogdan Navolan ◽

Florin Gorun ◽

Cristian Oancea ◽

Ioana-Mihaela Ciohat ◽

Daniel Malița ◽

...

Keyword(s):

Toxoplasma Gondii ◽

Pregnant Women ◽

Rural Areas ◽

Urban Areas ◽

Primary Infection ◽

Food Quality Control ◽

Fetal Infection ◽

Increasing Trend ◽

Urban And Rural Areas ◽

Pathogenic Agents

(1) Background: Toxoplasma gondii and cytomegalovirus belong to a group of pathogens entities called TORCH agents. TORCH represents an acronym which derives from the name of a series of certain pathogenic agents (Toxoplasma gondii, Other agents, Rubella virus, Cytomegalovirus, Herpes virus). They could cross the placenta barrier and cause serious damage to the fetus if a primary infection occurs in a pregnant woman. Immunized women are relatively protected against a reinfection and the risk of a materno-fetal infection in these categories of pregnant women is considered low. (2) Aim of the study: To analyze changes in the percentage of pregnant women seronegative to Toxoplasma gondii and cytomegalovirus along a period of ten years, from 2008 to 2018. (3) Material and Methods: We studied the changes in percentage of seronegative Toxoplasma gondii and Cytomegalovirus pregnant women along two periods: 2008–2010 and 2015–2018. Only pregnant women with declared medium of provenience and unequivocal results were enrolled in the study. (4) Results: In urban areas, we found an increase in the percentage of pregnant women seronegative to Toxoplasma gondii (RR = 1.488, p < 0.0001), respectively to cytomegalovirus (RR = 1.985, p < 0.0001), from 2008–2010 to 2015–2018. A similar increasing trend was found also in rural areas: Toxoplasma gondii (RR = 1.136, p < 0.0322), respectively cytomegalovirus (RR = 1.088, p < 0.8265) but it did not reach a significant threshold for cytomegalovirus. (5) Conclusion: Our study showed that the percentage of women seronegative to Toxoplasma gondii and cytomegalovirus antibodies increases along a period of ten years, from 2008–2010 to 2015–2018, in both urban and rural areas. Probably, the main cause of this trend is represented by the improvement in hygienic condition and food quality control. These results present an argument for continuing the TORCH screening of pregnant women.

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