Prenatal diagnosis of fetal cYtomegalovirus infection

Lynch, Lauren; Daffos, F.; Emanuel, David; Giovangrandi, Yves; Meisel, Richard; Forestier, F.; Cathomas, Gieri; Berkowitz, Richard L.

doi:10.1016/0002-9378(91)90315-i

Cited by 94 publications

(53 citation statements)

References 14 publications

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“…9). However, the utility of IgM determination in fetal blood remains to be fully assessed (58,149,167). In addition, while several studies have established the diagnostic and prognostic value of the determination of viral load in the blood of immunocompromised patients, the clinical significance of the presence of virus and viral components in the blood of fetuses exposed to HCMV has never been fully investigated.…”

Section: Fetal Bloodmentioning

confidence: 99%

“…These nonspecific tests, although per se not very useful as prognostic markers of fetal disease, could help as complementary assays (164). Among the HCMV-specific assays, IgM antibody, which can be determined after 20 weeks of gestation, may be more helpful, even though this assay is known to possess a limited diagnostic value due to its low (20% to 75%) sensitivity (58,149,167).…”

Section: Fetal Bloodmentioning

confidence: 99%

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Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant

2002

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Human cytomegalovirus (HCMV) is the leading cause of congenital viral infection and mental retardation. HCMV infection, while causing asymptomatic infections in most immunocompetent subjects, can be transmitted during pregnancy from the mother with primary (and also recurrent) infection to the fetus. Hence, careful diagnosis of primary infection is required in the pregnant woman based on the most sensitive serologic assays (immunoglobulin M [IgM] and IgG avidity assays) and conventional virologic and molecular procedures for virus detection in blood. Maternal prognostic markers of fetal infection are still under investigation. If primary infection is diagnosed in a timely manner, prenatal diagnosis can be offered, including the search for virus and virus components in fetal blood and amniotic fluid, with fetal prognostic markers of HCMV disease still to be defined. However, the final step for definite diagnosis of congenital HCMV infection is detection of virus in the blood or urine in the first 1 to 2 weeks of life. To date, treatment of congenital infection with antiviral drugs is only palliative both prior to and after birth, whereas the only efficacious preventive measure seems to be the development of a safe and immunogenic vaccine, including recombinant, subunit, DNA, and peptide-based vaccines now under investigation. The following controversial issues are discussed in the light of the most recent advances in the field: the actual perception of the problem; universal serologic screening before pregnancy; the impact of correct counseling on decision making by the couple involved; the role of prenatal diagnosis in ascertaining transmission of virus to the fetus; the impact of preconceptional and periconceptional infections on the prevalence of congenital infection; and the prevalence of congenitally infected babies born to mothers who were immune prior to pregnancy compared to the number born to mothers undergoing primary infection during pregnancy

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Section: Fetal Bloodmentioning

confidence: 99%

Section: Fetal Bloodmentioning

confidence: 99%

Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant

2002

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“…Other sonographic findings seen in association with CMV infection of the fetus include ascites, intrauterine growth retardation, and hydrops. 13 We assume that our patient was infected with CMV in the first, or early second, trimester of pregnancy. Abnormal echogenicity in the cerebral hemispheres of the fetus was present at 20 weeks.…”

Section: Discussionmentioning

confidence: 99%

Echogenic vessels in the fetal thalami and basal ganglia associated with cytomegalovirus infection

Estroff

Parad²,

Teele³

et al. 1992

Journal of Ultrasound in Medicine

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MDBranching Jinear echogenic areas in the thalami and basal ganglia of neonates have been reported in asso· dation with congenital infection, chromosomal abnormality, and anoxic or toxic injury to the developing brain. 1 -6 To our knowledge, such linear areas . in the thalami and basal ganglia have not been reported in the fetus. We describe a case of congenital cytomegalovirus infection discovered antenatally by the obser· vation of hyperechoic foci in the cerebral cortex and branching linear areas of echogenicity in. the basa) ganglia. CASE REPORTA 28 year old gravida 2, para 2 Hispanic woman was referred for prenatal sonography because of diaphragmatic hernia in a previous child. At 20 weeks, the structural fetal survey showed a hyperechoic rim in the periphery of the fetal cerebral cortex. Subsequent maternal serologic results were consistent with active cytomegalovirus (CMV) infection during pregnancy. The patient returned at 31 weeks, and a repeat scan was performed using the transvaginal probe for better visualization of the fetal head in deep vertex position. Branch· ing linear areas of echogenidty were seen in the fetal thalami,

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“…Moreover, the direct detection of viral components, including pp65 antigenemia and DNAemia, can be helpful for acute infection diagnosis. Prenatal diagnosis of HCMV congenital infection relies on virus isolation from amniotic fluid (AF) and/or viral DNA detection by PCR in AF samples (4,12,24,25,36,42). In a previous study, we reported that the combination of culture and PCR on AF samples allows a reliable prenatal diagnosis, with 72% sensitivity and 97.6% specificity (18).…”

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confidence: 99%

Real-Time PCR Quantification of Human Cytomegalovirus DNA in Amniotic Fluid Samples from Mothers with Primary Infection

Gault²,

et al. 2002

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A real-time PCR assay was developed to quantify human cytomegalovirus (HCMV) DNA in amniotic fluid (AF) samples collected from 30 pregnant women with primary HCMV infection as detected either from HCMV-immunoglobulin G (IgG) seroconversion or by the presence of HCMV-specific IgG and IgM associated with a low IgG avidity. Clinical information available for each case included ultrasonographic examination and fetal or newborn outcome. HCMV infection of fetuses or newborns was confirmed for the 30 studied cases. AF samples were subdivided into three groups. In group A (n ‫؍‬ 13), fetuses presented major ultrasound abnormalities, and pregnancy was terminated. In group B (n ‫؍‬ 13), fetuses had normal ultrasound findings, the pregnancy went to term, and the newborns were asymptomatic at birth. In group C (n ‫؍‬ 4), fetuses had no or minor ultrasonographic signs, and pregnancy was terminated. The HCMV DNA load values in AF samples were significantly higher in group A (median, 2.8 ؋ 10 5 genome equivalents [GE]/ml) than in group B (median, 8 ؋ 10 3 GE/ml) (P ‫؍‬ 0.014). Our findings suggest that HCMV load level in AF samples correlates with fetal clinical outcome but might also be dependent on other factors, such as the gestational age at the time of AF sampling and the time elapsed since maternal infection.Human cytomegalovirus (HCMV) is the most common cause of viral intrauterine infection in developed countries, affecting 0.5 to 2% of all live births (1,32,40). Although the possibility of severe symptomatic fetal infection following recurrent maternal infection has been reported (8), fetal damage is mostly related to primary maternal infection (16,38,39). In this case, the transmission of the virus to the fetus may occur in 20 to 50% of pregnancies (18,27,38). It has been reported that HCMV transmission rates increase with gestational age and that a major risk of transmission is observed for seroconversion occurring late in pregnancy (5).Congenitally infected infants are asymptomatic at birth in about 90% of cases, and for symptomatic infants, infection ranges from mild to severe disseminated life-threatening disease resulting in up to 20% perinatal mortality (9,16,22,28,31,37). Up to 90% of the surviving symptomatic newborns will exhibit psychomotor and perceptual sequelae such as sensorineural hearing loss, mental retardation, cerebral palsy, seizures, and visual defects (2). Additionally, 10% of the infants who are asymptomatic at birth will later develop complications, mainly neurodevelopmental defects and deafness (7,15,40).The diagnosis of maternal primary HCMV infection is based mostly on serological testing, including HCMV immunoglobulin G (IgG) seroconversion and the presence of specific HCMV IgG and IgM (35). Moreover, the direct detection of viral components, including pp65 antigenemia and DNAemia, can be helpful for acute infection diagnosis. Prenatal diagnosis of HCMV congenital infection relies on virus isolation from amniotic fluid (AF) and/or viral DNA detection by PCR in AF samples (4,12,24,25,36,42)...

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Prenatal diagnosis of fetal cYtomegalovirus infection

Cited by 94 publications

References 14 publications

Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant

Diagnosis and Management of Human Cytomegalovirus Infection in the Mother, Fetus, and Newborn Infant

Echogenic vessels in the fetal thalami and basal ganglia associated with cytomegalovirus infection

Real-Time PCR Quantification of Human Cytomegalovirus DNA in Amniotic Fluid Samples from Mothers with Primary Infection

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