Prediction of Congenital Cytomegalovirus Infection in High-Risk Pregnant Women

Tanimura, Kenji; Tairaku, Shinya; Ebina, Yasuhiko; Morioka, Ichiro; Nagamata, Satoshi; Deguchi, Kana; Morizane, Mayumi; Deguchi, Masashi; Minematsu, Toshio; Yamada, Hideto

doi:10.1093/cid/ciw707

Cited by 31 publications

(42 citation statements)

References 23 publications

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“…borderline, 230-240; and positive, ≥240), but most of the results were significantly higher with mean 12 433 (1290-176 632) [25]. The serum titers of CMV IgG were not significantly different between the two groups -with and without congenital CMV, contrary to IgG avidity.…”

Section: Discussionmentioning

confidence: 75%

CMV-Specific Immune Reconstitution after Allogenic Stem Cell Transplantation: Central Role of Specific IgG in Immunodefense Against CMV Reactivation as a Leading Parameter during Profound and Long-Lasting Immune Deficiency

Zdziarski¹

2018

Preprint

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A b s t r a c t :Although the existing paradigm states that CMV reactivation is under control of cellular immune response, the role of humoral counterpart is underestimated.Anti-CMV positive woman after conditioning with Bu-Flu-ATG underwent stem cell transplantation from fully matched, seronegative sibling donor. In immunodeficient recipient fast and significant decrease of specific immune response was observed but reconstitution of marrow-derived B and NK cells was prior thymic origin T cells. The lowest CMV-IgG(89 U/ml) was observed just before CMV viremia. Noteworthy, the sole and exclusive factor of CMV-specific immune response is a residual recipient antibody class IgG. The CMVquantiferon increase was observed later, but in the first phase immune reconstitution of the PHA-induced IFNγ release was significantly lower than that CMV-induced. It corresponds with NK cells increase at the top of lymphocyte reconstitution and undetected CMV-specific CD8 cells by pentamer technique. Most of NK cells are CD16+, thus are stimulated by residual IgG. In immunocompetent donor the cellular and humoral immune response increases in parallel manner but symptoms of CMV mononucleosis were observed till the increase of specific IgG.Our observations shed light on a unique host-CMV interaction: indicate that significant decrease of CMV-IgG is a good predictor for CMV reactivation during secondary immunodeficiency.

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Section: Discussionmentioning

confidence: 75%

CMV-Specific Immune Reconstitution after Allogenic Stem Cell Transplantation: Central Role of Specific IgG in Immunodefense Against CMV Reactivation as a Leading Parameter during Profound and Long-Lasting Immune Deficiency

Zdziarski¹

2018

Preprint

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“…The investigators mainly discussed from the viewpoint of the etiology of sexual transmitted diseases, uterine cervical cancer, or vertical transmission of these viruses from mothers to their infants following ascending infection or birth canal infection [13,14]. In our study, the percentage of positive PCR results for the cervical secretion in pregnant women with congenital CMV infection was 50% but only 5.8% in women without congenital CMV infection [8]. It is known that CMV shedding in the genital secretions may be prolonged after primary infection [15] and could also represent reactivation of latent virus [16].…”

Section: Cmv-dna Pcr Test Of Uterine Cervical Secretion May Be a Novementioning

confidence: 65%

“…We conducted a prospective cohort study to determine maternal clinical, laboratory, and ultrasound findings that effectively and noninvasively predict the occurrence of congenital CMV infection among CMV IgM-positive pregnant women, who are at high risk for congenital CMV infection [8]. The maternal clinical and laboratory findings, including CMV IgG AI, antigenemia assay (C7-HRP), PCR for the detection of CMV-DNA in the maternal serum, urine, and uterine cervical secretion (SRL, Tokyo, Japan) (positive, ≥1.0 × 10 2 copies/ml), and prenatal ultrasound findings, were evaluated.…”

Section: Commonly Used Methods For Prenatal Detection Of Fetuses At Hmentioning

confidence: 99%

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PCR tests for uterine cervical secretion are promising noninvasive methods for predicting congenital cytomegalovirus infection

Tanimura

Ebina

Yamada

2017

Expert Review of Molecular Diagnostics

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“…As stated, we have previously demonstrated that the presence of fetal ultrasound abnormalities was a significant predictive factor for congenital CMV infection in pregnant women with positive CMV IgM tests . We prospectively showed that the presence of ultrasound fetal abnormalities yielded a 50.0% sensitivity, a 97.5% specificity, a 61.1% positive predictive value and a 96.1% negative predictive value for when predicting congenital CMV infection.…”

Section: Maternal Screening For Predicting Congenital CMV Infectionmentioning

confidence: 98%

Maternal and neonatal screening methods for congenital cytomegalovirus infection

Tanimura

Yamada

2018

J of Obstet and Gynaecol

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Human cytomegalovirus (CMV) is a common cause of congenital infection that may lead to severe long-term sequelae. Because there are no established vaccines, fetal interventions or neonatal treatments, neither maternal nor neonatal screening is recommended. However, recent studies have indicated that early antiviral treatment may improve neurological outcomes in symptomatic infants with congenital infection. Therefore, prenatal detection may be important in newborns at high risk of such infection. Polymerase chain reaction for CMV DNA in the amniotic fluid is considered the gold standard for diagnosis of intrauterine infection, but its use is limited because amniocentesis is an invasive procedure. In a prospective cohort study, we have reported that the presence of CMV DNA in secretions of the maternal uterine cervix were predictive of congenital infection in groups at high risk. However, we also recently demonstrated that maternal serological screening for primary CMV infection using specific immunoglobulin G, the immunoglobulin G avidity index or specific immunoglobulin M can overlook many cases. Previous research has indicated that the combination of early detection by universal neonatal screening of urinary CMV DNA combined with early antiviral therapy can improve outcomes in infants with symptomatic congenital infection. In this article, we review the current state of maternal and neonatal screening for congenital CMV infection.

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Prediction of Congenital Cytomegalovirus Infection in High-Risk Pregnant Women

Abstract: This is the first prospective cohort study to suggest that the presence of CMV-DNA in the maternal uterine cervical secretion and ultrasound fetal abnormalities are predictive of the occurrence of congenital CMV infection in high-risk pregnant women.

Cited by 31 publications

References 23 publications

CMV-Specific Immune Reconstitution after Allogenic Stem Cell Transplantation: Central Role of Specific IgG in Immunodefense Against CMV Reactivation as a Leading Parameter during Profound and Long-Lasting Immune Deficiency

CMV-Specific Immune Reconstitution after Allogenic Stem Cell Transplantation: Central Role of Specific IgG in Immunodefense Against CMV Reactivation as a Leading Parameter during Profound and Long-Lasting Immune Deficiency

PCR tests for uterine cervical secretion are promising noninvasive methods for predicting congenital cytomegalovirus infection

Maternal and neonatal screening methods for congenital cytomegalovirus infection

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