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Karen B Fowler - One of the best experts on this subject based on the ideXlab platform.
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Congenital Cytomegalovirus Infection
Seminars in Perinatology, 2018Co-Authors: Karen B Fowler, Suresh B BoppanaAbstract:Each year, thousands of children are born with or develop permanent disabilities such as hearing loss, vision loss, motor and cognitive deficits from Congenital CMV Infection (cCMV). However, awareness of cCMV and its associated sequelae is very low in pregnant women and healthcare providers. Both targeted and universal approaches to screen newborns for CMV Infection are now achievable due to recent scientific advances including the development of a rapid, high-throughput method for detecting CMV in saliva, the efficacy of antiviral treatment in symptomatic infants, and the demonstration of cost effectiveness of CMV screening. Future studies are needed to address gaps in our understanding on the role of non-primary maternal CMV Infections, the evaluation of antiviral treatment in asymptomatic infants, and the implementation of prevention strategies for cCMV.
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Congenital Cytomegalovirus Infection in pregnancy and the neonate consensus recommendations for prevention diagnosis and therapy
Lancet Infectious Diseases, 2017Co-Authors: William D. Rawlinson, David W Kimberlin, Sophie Alain, Kate Daly, Sara Doutre, Laura Gibson, Tiziana Lazzarotto, Karen B Fowler, Suresh B Boppana, Michelle L. GilesAbstract:Summary Congenital Cytomegalovirus is the most frequent, yet under-recognised, infectious cause of newborn malformation in developed countries. Despite its clinical and public health importance, questions remain regarding the best diagnostic methods for identifying maternal and neonatal Infection, and regarding optimal prevention and therapeutic strategies for infected mothers and neonates. The absence of guidelines impairs global efforts to decrease the effect of Congenital Cytomegalovirus. Data in the literature suggest that Congenital Cytomegalovirus Infection remains a research priority, but data are yet to be translated into clinical practice. An informal International Congenital Cytomegalovirus Recommendations Group was convened in 2015 to address these questions and to provide recommendations for prevention, diagnosis, and treatment. On the basis of consensus discussions and a review of the literature, we do not support universal screening of mothers and the routine use of Cytomegalovirus immunoglobulin for prophylaxis or treatment of infected mothers. However, treatment guidelines for infected neonates were recommended. Consideration must be given to universal neonatal screening for Cytomegalovirus to facilitate early detection and intervention for sensorineural hearing loss and developmental delay, where appropriate. The group agreed that education and prevention strategies for mothers were beneficial, and that recommendations will need continual updating as further data become available.
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clinical predictors of sensorineural hearing loss and cognitive outcome in infants with symptomatic Congenital Cytomegalovirus Infection
Pediatric Infectious Disease Journal, 2016Co-Authors: Swetha G Pinninti, Zdenek Novak, Karen B Fowler, Suresh B Boppana, William J. Britt, Shannon A. RossAbstract:The objective of this study was to determine newborn clinical findings predictive of adverse clinical outcomes in infants with symptomatic Congenital Cytomegalovirus Infection. Of 160 infants, significantly more children with central nervous system involvement had sensorineural hearing loss (P = 0.0
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Congenital Cytomegalovirus Infection clinical outcome
Clinical Infectious Diseases, 2013Co-Authors: Suresh B Boppana, Shannon A. Ross, Karen B FowlerAbstract:Congenital Cytomegalovirus (CMV) Infection is a leading cause of hearing loss and neurologic disabilities in children worldwide. Infants with symptomatic Congenital CMV Infection at birth are at significantly increased risk for developing adverse long-term outcomes. The vast majority of infants with Congenital CMV Infection have no clinical findings at birth (asymptomatic infants), and about 10%–15% of these children develop long-term sequelae. Currently, predictors of adverse outcome in asymptomatic Congenital CMV Infection are not known, and it is important that future studies address this issue.
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GJB2 and GJB6 Mutations in Children with Congenital Cytomegalovirus Infection
Pediatric research, 2007Co-Authors: Shannon A. Ross, Zdenek Novak, Karen B Fowler, Rekha A. Kumbla, Kui Zhang, Suresh B BoppanaAbstract:Congenital Cytomegalovirus (CMV) Infection is a leading cause of sensorineural hearing loss (SNHL) in children. Whether connexin mutations are factors in the development of CMV-related hearing loss has not been explored. We examined gap junction protein beta-2 (GJB2) and gap junction protein beta-6 (GJB6) mutations in 149 children with Congenital CMV Infection and 380 uninfected neonates. Mutations in GJB2 and GJB6 were assessed by nucleotide sequencing and polymerase chain reaction (PCR) methods, respectively. The study population was predominantly African American, and 4.3% of the subjects were carriers of a connexin 26 mutation. The overall frequency of GJB2 mutations was significantly higher in the group of children with CMV Infection and hearing loss (21%) compared with those with CMV Infection and normal hearing (3%, p = 0.017) and the group of uninfected newborns (3.9%, p = 0.016). Eight previously reported mutations (M34T, V27I, R127H, F83L, R143W, V37I, V84L, G160S), and four novel mutations (V167M, G4D, A40T, and R160Q) were detected. None of the study children had the 342-kb deletion (delGJB6-D13S1830) in GJB6, which suggests that this mutation does not play a role in hereditary deafness in the African American population. Although GJB2 mutations were detected in children with and without CMV-related hearing loss, those with hearing loss had a higher frequency of GJB2 mutations.
Suresh B Boppana - One of the best experts on this subject based on the ideXlab platform.
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Congenital Cytomegalovirus Infection
Seminars in Perinatology, 2018Co-Authors: Karen B Fowler, Suresh B BoppanaAbstract:Each year, thousands of children are born with or develop permanent disabilities such as hearing loss, vision loss, motor and cognitive deficits from Congenital CMV Infection (cCMV). However, awareness of cCMV and its associated sequelae is very low in pregnant women and healthcare providers. Both targeted and universal approaches to screen newborns for CMV Infection are now achievable due to recent scientific advances including the development of a rapid, high-throughput method for detecting CMV in saliva, the efficacy of antiviral treatment in symptomatic infants, and the demonstration of cost effectiveness of CMV screening. Future studies are needed to address gaps in our understanding on the role of non-primary maternal CMV Infections, the evaluation of antiviral treatment in asymptomatic infants, and the implementation of prevention strategies for cCMV.
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Congenital Cytomegalovirus Infection in pregnancy and the neonate consensus recommendations for prevention diagnosis and therapy
Lancet Infectious Diseases, 2017Co-Authors: William D. Rawlinson, David W Kimberlin, Sophie Alain, Kate Daly, Sara Doutre, Laura Gibson, Tiziana Lazzarotto, Karen B Fowler, Suresh B Boppana, Michelle L. GilesAbstract:Summary Congenital Cytomegalovirus is the most frequent, yet under-recognised, infectious cause of newborn malformation in developed countries. Despite its clinical and public health importance, questions remain regarding the best diagnostic methods for identifying maternal and neonatal Infection, and regarding optimal prevention and therapeutic strategies for infected mothers and neonates. The absence of guidelines impairs global efforts to decrease the effect of Congenital Cytomegalovirus. Data in the literature suggest that Congenital Cytomegalovirus Infection remains a research priority, but data are yet to be translated into clinical practice. An informal International Congenital Cytomegalovirus Recommendations Group was convened in 2015 to address these questions and to provide recommendations for prevention, diagnosis, and treatment. On the basis of consensus discussions and a review of the literature, we do not support universal screening of mothers and the routine use of Cytomegalovirus immunoglobulin for prophylaxis or treatment of infected mothers. However, treatment guidelines for infected neonates were recommended. Consideration must be given to universal neonatal screening for Cytomegalovirus to facilitate early detection and intervention for sensorineural hearing loss and developmental delay, where appropriate. The group agreed that education and prevention strategies for mothers were beneficial, and that recommendations will need continual updating as further data become available.
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clinical predictors of sensorineural hearing loss and cognitive outcome in infants with symptomatic Congenital Cytomegalovirus Infection
Pediatric Infectious Disease Journal, 2016Co-Authors: Swetha G Pinninti, Zdenek Novak, Karen B Fowler, Suresh B Boppana, William J. Britt, Shannon A. RossAbstract:The objective of this study was to determine newborn clinical findings predictive of adverse clinical outcomes in infants with symptomatic Congenital Cytomegalovirus Infection. Of 160 infants, significantly more children with central nervous system involvement had sensorineural hearing loss (P = 0.0
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Congenital Cytomegalovirus Infection clinical outcome
Clinical Infectious Diseases, 2013Co-Authors: Suresh B Boppana, Shannon A. Ross, Karen B FowlerAbstract:Congenital Cytomegalovirus (CMV) Infection is a leading cause of hearing loss and neurologic disabilities in children worldwide. Infants with symptomatic Congenital CMV Infection at birth are at significantly increased risk for developing adverse long-term outcomes. The vast majority of infants with Congenital CMV Infection have no clinical findings at birth (asymptomatic infants), and about 10%–15% of these children develop long-term sequelae. Currently, predictors of adverse outcome in asymptomatic Congenital CMV Infection are not known, and it is important that future studies address this issue.
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Human Cytomegalovirus reInfection is associated with intrauterine transmission in a highly Cytomegalovirus-immune maternal population
American Journal of Obstetrics and Gynecology, 2010Co-Authors: Aparecida Yulie Yamamoto, Marisa Márcia Mussi-pinhata, Patricia De Frizzo Oliveira, Virginia Mara De Deus Wagatsuma, Zdenek Novak, Geraldo Duarte, Suresh B Boppana, William J. BrittAbstract:OBJECTIVE: To determine contribution of reInfection with new strains of Cytomegalovirus in Cytomegalovirus seromimmune women to incidence of Congenital Cytomegalovirus Infection. STUDY DESIGN: In 7848 women studied prospectively for Congenital Cytomegalovirus Infection from a population with near universal Cytomegalovirus seroimmunity, sera from 40 mothers of Congenitally infected infants and 109 mothers of uninfected newborns were analyzed for strain-specific antiCytomegalovirus antibodies. RESULTS: All women were Cytomegalovirus seroimmune at first prenatal visit. Reactivity for 2 Cytomegalovirus strains was found in 14 of 40 study mothers and in 17 of 109 control mothers at first prenatal visit (P = .009). Seven of 40 (17.5%) study women and 5 of 109 (4.6%) controls (P = .002) acquired antibodies reactive with new Cytomegalovirus strains during pregnancy. Evidence of Infection with more than 1 strain of Cytomegalovirus before or during current pregnancy occurred in 21 of 40 study mothers and 22 of 109 controls (P < .0001). CONCLUSION: Maternal reInfection by new strains of Cytomegalovirus is a major source of Congenital Infection in this population.
James F. Bale - One of the best experts on this subject based on the ideXlab platform.
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mondini dysplasia and Congenital Cytomegalovirus Infection
The Journal of Pediatrics, 1994Co-Authors: Nancy M Bauman, Linda Kirbykeyser, David B Wexler, Brian F Mccabe, Bruce J Gantz, Kenneth D. Dolan, James F. BaleAbstract:Abstract We report a case of bilateral temporal bone anomalies in a child with symptomatic Congenital Cytomegalovirus Infection and severe, bilateral sensorineural hearing loss identified at 3 months of age. High-resolution temporal bone computed tomography (HRCT) revealed bilateral findings of a short, malformed cochlea lacking an interscalar septum, a short and wide internal auditory canal, and an enlarged vestibular aqueduct, features diagnostic of bilateral Mondini dysplasia. To determine the importance of this observation, we completed HRCT in five additional children between 7 months and 9 years of age who had evidence of symptomatic Congenital Cytomegalovirus Infection. One child with profound sensorineural hearing loss had severe bilateral temporal bone dysplasia with a small cochlea lacking an interscalar septum, an abnormal vestibule, and a large cochlear aqueduct. Of the remaining four children, hearing thresholds ranged from normal to profoundly decreased, but their HRCT scans were normal to visual inspection. When inner ear dimensions of these temporal bones were compared with norms established by Pappas and co-workers, however, seven of the eight ears had short cochleas and narrow lateral semicircular canals, and three ears had short or narrow vestibules. These results indicate that Congenital Cytomegalovirus Infection may cause anomalies or growth disturbances of the temporal bone. (J P EDIATR 1994;124:71-8)
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mondini dysplasia and Congenital Cytomegalovirus Infection
The Journal of Pediatrics, 1994Co-Authors: Nancy M Bauman, Linda Kirbykeyser, David B Wexler, Brian F Mccabe, Bruce J Gantz, Kenneth D. Dolan, James F. BaleAbstract:Abstract We report a case of bilateral temporal bone anomalies in a child with symptomatic Congenital Cytomegalovirus Infection and severe, bilateral sensorineural hearing loss identified at 3 months of age. High-resolution temporal bone computed tomography (HRCT) revealed bilateral findings of a short, malformed cochlea lacking an interscalar septum, a short and wide internal auditory canal, and an enlarged vestibular aqueduct, features diagnostic of bilateral Mondini dysplasia. To determine the importance of this observation, we completed HRCT in five additional children between 7 months and 9 years of age who had evidence of symptomatic Congenital Cytomegalovirus Infection. One child with profound sensorineural hearing loss had severe bilateral temporal bone dysplasia with a small cochlea lacking an interscalar septum, an abnormal vestibule, and a large cochlear aqueduct. Of the remaining four children, hearing thresholds ranged from normal to profoundly decreased, but their HRCT scans were normal to visual inspection. When inner ear dimensions of these temporal bones were compared with norms established by Pappas and co-workers, however, seven of the eight ears had short cochleas and narrow lateral semicircular canals, and three ears had short or narrow vestibules. These results indicate that Congenital Cytomegalovirus Infection may cause anomalies or growth disturbances of the temporal bone. (J P EDIATR 1994;124:71-8)
Frans Gordts - One of the best experts on this subject based on the ideXlab platform.
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hearing loss with Congenital Cytomegalovirus Infection
Pediatrics, 2019Co-Authors: Ina Foulon, Yannick De Brucker, Ronald Buyl, Elke Lichtert, Katia Verbruggen, Denis Pierard, Fleur Anne Camfferman, Leonardo Gucciardo, Frans GordtsAbstract:OBJECTIVE: In this study, we determined the prevalence of hearing loss in 157 children with proven Congenital Cytomegalovirus (cCMV) Infection. We looked at possible risk determinants for developing hearing loss and proposed recommendations for screening and follow-up in the newborn. METHODS: In a prospective 22-year study, 157 children with proven cCMV Infection were evaluated for sensorineural hearing loss (SNHL). The development of SNHL was correlated with the type of maternal Infection (primary versus nonprimary), the gestational age of maternal primary Infection, imaging findings at birth, and the presence of symptomatic or asymptomatic Infection in the newborn. RESULTS: Of all children, 12.7% had SNHL, and 5.7% needed hearing amplification because of SNHL. Improvement, progression, and fluctuations of hearing thresholds were seen in 45%, 53.8%, and 5.7% of the children, respectively. Hearing loss was more common in the case of a symptomatic Infection at birth (P = .017), after a maternal primary Infection in the first trimester of pregnancy (P = .029), and in the presence of abnormalities on a neonatal brain ultrasound and/or MRI (P CONCLUSION SNHL is a common sequela in children with cCMV Infection. Risk factors for SNHL were primary maternal Infections before the 14th week of pregnancy, the presence of a disseminated Infection at birth, and imaging abnormalities in the newborn. These children may benefit from a more thorough investigation for SNHL than children who do not present with those risk factors.
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hearing loss in children with Congenital Cytomegalovirus Infection in relation to the maternal trimester in which the maternal primary Infection occurred
Pediatrics, 2008Co-Authors: Ina Foulon, Anne Naessens, Walter Foulon, Ann Casteels, Frans GordtsAbstract:OBJECTIVES. The purpose of this work was to study the relation between maternal trimester of primary Infection with Cytomegalovirus and the occurrence of sensorineural hearing loss in the Congenitally infected offspring. PATIENTS AND METHODS. Thirty-four consecutive live-born children diagnosed with a Congenital Cytomegalovirus Infection after maternal primary Cytomegalovirus Infections were included in the study. Five were lost for follow-up, and 1 died. Of the remaining 28 Congenitally infected children, an estimation of the maternal trimester in which Cytomegalovirus primary Infection occurred was performed. All of the children were investigated for potential sensorineural hearing loss. RESULTS. Five of the maternal Infections occurred in the first trimester, 12 in the second trimester, and 11 in the third trimester of pregnancy. Sensorineural hearing loss was detected in 4 (80%) of the 5 Congenitally infected children who were infected after a primary maternal Infection in the first trimester of pregnancy and in 1 (8%) of the 12 children when the maternal Infection occurred in the second trimester of pregnancy. No sensorineural hearing loss was detected after primary maternal Infection occurring in the third trimester. Fluctuation and improvement of sensorineural hearing loss were seen regardless the trimester of pregnancy during which maternal primary Infection occurred. Progression of sensorineural hearing loss occurred in 2 children born after a maternal primary Infection of the first trimester. CONCLUSIONS. Hearing loss seemed more common in infants with Congenital Cytomegalovirus Infection who were born to women who experienced a primary Cytomegalovirus Infection in the first trimester of pregnancy than when Infection took place later in pregnancy.
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a 10 year prospective study of sensorineural hearing loss in children with Congenital Cytomegalovirus Infection
The Journal of Pediatrics, 2008Co-Authors: Ina Foulon, Anne Naessens, Walter Foulon, Ann Casteels, Frans GordtsAbstract:Objective To determine the incidence, characteristics, and evolution of sensorineural hearing loss (SNHL) in infants with a Congenital Cytomegalovirus Infection (cCMV). Study design In a prospective 10-year study, 14 021 unselected live-born infants were screened for cCMV by virus isolation in urine. Congenitally infected newborns were evaluated for SNHL during the first 5 years of life. Results A total of 74 of the 14 021 infants (0.53%) were Congenitally infected; of these, 4 (5.4%) were symptomatic at birth. Hearing testing could be performed in 60 of the infants. SNHL was found in 21% of the asymptomatic and in 33% of symptomatic Congenitally infected infants. Late-onset hearing loss was detected in 5%, progression in 11%, fluctuation in 16%, and improved hearing threshold in 18% of the infants with cCMV. SNHL was observed in 15% of infected infants born after a maternal primary Infection, in 7% born after a maternal recurrent Infection, and in 40% after a maternal Infection of indeterminate timing. Conclusions In our study population, 0.53% of the infants had cCMV Infection, 22% of whom developed SNHL. Long-term follow up and repeated audiologic testing is needed, because progression, fluctuation, improvement, and late-onset hearing loss are important features of cCMV Infection. The search for a neonatal screening program to detect all cCMV is worthwhile.
Marcello Lanari - One of the best experts on this subject based on the ideXlab platform.
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human fetal inner ear involvement in Congenital Cytomegalovirus Infection
Acta neuropathologica communications, 2013Co-Authors: Liliana Gabrielli, Brunella Guerra, Marcello Lanari, Maria Paola Bonasoni, Donatella Santini, Giulia Piccirilli, Angela Chiereghin, Maria Paola Landini, Maria Grazia Capretti, Tiziana LazzarottoAbstract:Congenital Cytomegalovirus (CMV) Infection is a leading cause of sensorineural hearing loss (SNHL). The mechanisms of pathogenesis of CMV-related SNHL are still unclear. The aim is to study Congenital CMV-related damage in the fetal inner ear, in order to better understand the underlying pathophysiology behind CMV-SNHL. We studied inner ears and brains of 20 human fetuses, all at 21 week gestational age, with a high viral load in the amniotic fluid, with and without ultrasound (US) brain abnormalities. We evaluated histological brain damage, inner ear Infection, local inflammatory response and tissue viral load. Immunohistochemistry revealed that CMV was positive in 14/20 brains (70%) and in the inner ears of 9/20 fetuses (45%). In the cases with inner ear Infection, the marginal cell layer of the stria vascularis was always infected, followed by Infection in the Reissner’s membrane. The highest tissue viral load was observed in the inner ear with infected Organ of Corti. Vestibular labyrinth showed CMV Infection of sensory cells in the utricle and in the crista ampullaris. US cerebral anomalies were detected in 6 cases, and in all those cases, the inner ear was always involved. In the other 14 cases with normal brain scan, histological brain damage was present in 8 fetuses and 3 of them presented inner ear Infection. CMV-Infection of the marginal cell layer of the stria vascularis may alter potassium and ion circulation, dissipating the endocochlear potential with consequent SNHL. Although abnormal cerebral US is highly predictive of brain and inner ear damage, normal US findings cannot exclude them either.
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Congenital Cytomegalovirus Infection patterns of fetal brain damage
Clinical Microbiology and Infection, 2012Co-Authors: Liliana Gabrielli, Brunella Guerra, Maria Paola Bonasoni, Donatella Santini, Giulia Piccirilli, Angela Chiereghin, Evangelia Petrisli, Riccardo Dolcetti, M Piccioli, Marcello LanariAbstract:Abstract Cytomegalovirus (CMV) is the most prevalent infectious agent causing neurological dysfunction in the developing brain. This study analysed the different patterns of tissue damage, particularly in the brain, of fetuses with documented CMV Infection. We studied 45 fetuses at 20-21 weeks of gestation with Congenital CMV Infection documented by invasive positive prenatal diagnosis. At the time of amniocentesis, abnormal ultrasound findings had been recorded for 13 of the 45 fetuses (29%). Histological and immunohistochemical characterization was performed on the placenta, brain, heart, lung, liver, kidney, and pancreas. The different degrees of brain damage were correlated with tissue viral load, inflammatory response, placental functionality, and extramedullary haematopoiesis. Even though a high CMV load was detected in all amniotic fluids, brain Infection occurred in only 62% of the fetuses and with different degrees of severity. Tissues with a low viral load showed a globally weak inflammatory response, and fetuses had only mild brain damage, whereas tissues with a high CMV load showed prominent infiltration of the activated cytotoxic CD8 + T-lymphocytes responsible for immune-mediated damage. Furthermore, severe placental Infection was associated with diffuse villitis and necrosis, consistent with functional impairment and possible consequent hypoxic cerebral damage. Brain injury induced by CMV Congenital Infection may be the result of uncontrolled viral replication, immune-mediated damage by cytotoxic CD8 + T-lymphocytes, and, in the presence of placental insufficiency, fetal hypoxia.
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ultrasound prediction of symptomatic Congenital Cytomegalovirus Infection
American Journal of Obstetrics and Gynecology, 2008Co-Authors: Brunella Guerra, Chiara Puccetti, Marcello Lanari, Tiziana Lazzarotto, Antonio Fariña, Giuliana Simonazzi, Nicola RizzoAbstract:Objective The objective of the study was to assess the effectiveness of ultrasound in the antenatal prediction of symptomatic Congenital Cytomegalovirus (CMV) Infection. Study Design The sonograms of 650 fetuses from mothers with primary CMV Infection were correlated to fetal or neonatal outcome. Infection status was disclosed by viral urine isolation at birth or CMV tissue inclusions at autopsy. Classification of symptomatic disease was based on postnatal clinical or laboratory findings or macroscopic evidence of tissue damage at autopsy. Results Ultrasound abnormalities were found in 51 of 600 mothers with primary Infection (8.5%) and 23 of 154 Congenitally infected fetuses (14.9%). Symptomatic Congenital Infection resulted in 1 of 23 and 68 of 131 cases with or without abnormal sonographic findings, respectively. Positive predictive values of ultrasound vs symptomatic Congenital Infection was 35.3% relating to all fetuses or infants from mothers with primary Infection and 78.3% relating to fetuses or infants with Congenital Infection. Conclusion When fetal Infection status is unknown, ultrasound abnormalities predict symptomatic Congenital Infection in only a third of cases.
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new advances in the diagnosis of Congenital Cytomegalovirus Infection
Journal of Clinical Virology, 2008Co-Authors: Tiziana Lazzarotto, Brunella Guerra, Marcello Lanari, Liliana Gabrielli, Maria Paola LandiniAbstract:Abstract Although the diagnosis of Congenital CMV Infection is still complex, important goals have been achieved in recent years, among which are: the availability of more reliable IgM tests for screening pregnant women whose pre-pregnancy serological status for CMV is unknown, tests to determine the avidity index of anti-CMV IgG, allowing the diagnosis of a primary CMV Infection and innovative and traditional virological tests to detect the virus in amniotic fluid. When a woman is found to be IgM-positive, further diagnostic evaluation focused on determining whether this is due to a primary Infection should be carried out. Maternal primary Infections that were difficult to determine until a few years ago unless documented by seroconversions can now be readily diagnosed from the presence of low/moderate avidity anti-CMV antibody which persists for approximately 18–20 weeks after primary Infection. In mothers at risk of transmitting the virus prenatal diagnosis can be performed between 21 and 22 weeks of gestation, and the amniotic fluid represents the pathological material of choice to determine intrauterine virus transmission. At birth or in the first 2/3 weeks of life, it is essential to use appropriate tests for diagnosis of CMV Congenital Infection.
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prenatal indicators of Congenital Cytomegalovirus Infection
The Journal of Pediatrics, 2000Co-Authors: Tiziana Lazzarotto, Brunella Guerra, Marcello Lanari, Stefania Varani, Alfredo Nicolosi, Maria Paola LandiniAbstract:Abstract Objective: To assess the validity of a diagnostic protocol designed to predict the outcome of newborns of mothers suspected to have primary Cytomegalovirus (CMV) Infection during the first 4 months of pregnancy. Study design: Anti-CMV immunoglobulin (Ig) M detection by enzyme immunoassay and immunoblot together with the determination of anti-CMV IgG avidity allowed us to classify 456 women as (1) uninfected, (2) undergoing either a primary or a recurrent Infection, or (3) having an undefined serologic condition. Prenatal diagnosis was carried out at 21 to 23 weeks’ gestation for women. The presence of the virus in the amniotic fluid was determined by culture, polymerase chain reaction, and quantitative polymerase chain reaction. Macroscopic and histologic examinations were undertaken on tissue from aborted fetuses, whereas for newborns culture was performed on urine sampled during the first week of life. Results: Congenital Infections were found exclusively among women undergoing a primary Infection. The quantitative determination of CMV DNA in the amniotic fluid of at least 10 3 genome equivalents gave a 100% certainty of detecting an infected fetus. Higher viral loads were associated with fetuses or newborns with symptoms. Conclusions: IgM tests and the IgG avidity determination can identify all women at risk of transmitting CMV. Furthermore, a high CMV DNA load in amniotic fluid could be an indicator of symptomatic Congenital Infection at a relatively early stage of pregnancy. (J Pediatr 2000;137:90-5)