Infants with congenitally (38) and natally (17) acquired cytomegalovirus infection were prospectively studied by means of virologic and multiple serologic assays. These infections were characterized by chronic viral excretion (measured in years). The quantity of virus excreted in the urine during early infancy was significantly greater in infants who acquired infection in utero, particularly amon those born with overt disease; thereafter, all three groups (congenital symptomatic, congenital asymptomatic, and natal) excreted similar amounts of virus. The patterns of antibody responses, particularly the fluorescent antibody response to the early antigen and the complement-fixing antibody response, further indicated that congenitally infected infants (especially symptomatic ones) bear a greater antigenic burden than do natally infected infants. From a diagnostic standpoint, the test for fluorescent antibody to the late antigen was the most sensitive assay, whereas the test for complement-fixing antibody proved to be the least useful, The indirect hemagglutination assay, although performed only in infants with natal infection, was only slightly less sensitive than the fluorescent antibody procedure; by the former technique, diagnostic rises were detected in all but one infant after the onset of viruria.

Comparison of 659 pregnant and 202 nonpregnant women with similar demographic characteristics showed overall rates of cervical cytomegalovirus excretion that were identical (9.5% vs. 9.4%) and were surprisingly high, especially since 89% of the pregnant group possessed antibody to cytomegalovirus when admitted to the study. Prevalence of cytomegalovirus among gravidas was significantly lower during the first (1.6%) than during the third (11.3%) trimester. Thus, early pregnancy appeared to exert a suppressive effect on viral excretion that waned with advancing gestation. A similar but less significant occurrence was observed in the two groups with respect to viuria. Increasing age also appeared to suppress the virologic expression of cervical and urinary tract infection, whereas multiparity seemingly produced such an effect only in the cervix. Among both cervical and urinary excreters, a few shed virus thoughout pregnancy, and others shed virus intermittently; however, viral shedding most commonly began in late gestation and frequently continued into the postpartum period. Primary infection was not documented, and antibody status remained unchanged with the advent of viral excretion in most cases. Thus, reactivation of endogenous virus seems the most likely explanation for viral shedding in our population. Similar rates of isolation of Neisseria gonorrhoeae in excreters and nonexcreters further argue against the other major possibility, venereal reinfection.

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Complement fixation (C-F) anti body t e s t has been comnonly employed t o assess the role of CMV in human disease. But res u l t s have been controversial f o r unknown reasons. To determine the adequacy of t h i s approach, C-F, indirect IgG fluorescent (FA), and hemagglutination (IHA) antibody responses were determined s e r i a l l y in 33 congenitally and 17 natally infected infants between birth and 5 years (mean ages 31 and 15 months, respectively). Both F A and IHA were f a r more sens i t i v e f o r detection of CMV antibody throughout the study interval with AD-169 as antigen. The FA and IHA levels were high and remained significantly elevated from birth onward in s p i t e of s l i g h t waning. In contrast, C-F levels waned unpredictably and rapidly in the f i r s t year; low levels which fluctuated between + and -were observed in the l a t t e r half. Thus only F A and IHA consistently monitored the continuing active viral infection in both groups. In natal infections, IHA proved the b e t t e r monitor f o r infant antibody production in the presence of maternal antibody, probably due t o i t s increased responsiveness t o IgM antibody moieties. The data indicate t h a t both F A and IHA a r e more appropriate diagnostic and sero-epidemiologic tools f o r study of perinatal CMV infections. In f a c t , validity of the results of prior sero-epidemiologic studies using C-F t e s t s should be reexamined. M. Pn. screening was undertaken i n a tumor c l i n i c popul a t i o n because of t h e high incidence of symptomatic respiratory i l l n e s s . Forty-five p a t i e n t s (Gp. I ) , ages 18 mos.-22 yrs., with neoplastic d i s e a s e on immunosuppressive therapy.were cultured over a 6 mo. period and compared t o a general p e d i a t r i c out-patient population (Gp. 11). The p o s i t i v e isol a t i o n r a t e from throat swabs was 33/45 (73%) i n Gp. I and 23/55 (42%) i n Gp. 11. I n Gp. I during t h i s period, 13/33 remained f r e e of r e s p i r a t o r y symptoms and had negative chest x-rays; 15/33 had pharyngitis, r h i n i t i s o r cough; 15/33 had fever; 8/33 had x-rays p o s i t i v e f o r pneumonia; 7/33 had a c u t e o t i t i s media and 2/33 had c o n j u n c t i v i t i s . Of t h e 12 c u l t u r e negative p a t i e n t s i n Gp. I (2-5 c u l t u r e s / p a t i e n t ) , 7/12 were well; 3/12 had URI; 1/12 had fever; and 1/12 had a p o s i t i v e x-ray f o r pneumonia. There were 8/33 p a t i e n t s i n Gp. I who remained p o s i t i v e f o r a t l e a s t 3 mos. with i n t e r m i t t e n t symptoms and mean H.I. t i t e r r i s e s of 2.5 f o l d compared t o 1.3 f o l d i n t h e remaining 25/33 short-term p o s i t i v e p a t i e n t s (p = 0.04).Absolute white counts and s p e c i f i c chemotherapeutic agents did not appear r e l a t e d t o incidence or course of infection. Erythromycin therapy produced d e f i n i t e c l i n i c a l improvement i n 4/14 p a t i e n t s with M. Pn. M. Pn. appears t o be an agent of high prevalence i n p a t i e n t s with malig...