Testing for Cytomegalovirus in Pregnancy

Abstract

Congenital cytomegalovirus (CMV) infection represents a relevant cause of deafness and neurological damage in newborns. Intrauterine CMV transmission might result after primary or nonprimary infections, though at different rates (30% versus 0.2%, respectively). At present, a prenatal diagnosis of CMV infection is based mainly on maternal serology, the detection of CMV-DNA in amniotic fluid and fetal blood, and ultrasound (US) and magnetic resonance imaging (MRI). Recent evidences suggest that congenital CMV infection may be an immune-mediated disease and that evaluation of humoral and especially T-cell immunities may improve the overall prenatal diagnosis. This review summarizes the most recent advancements in the diagnosis of maternal and prenatal CMV infections.KEYWORDS human cytomegalovirus, laboratory assays, congenital infections, IgG avidity, CMV-ELISPOT, CMV-QuantiFERON, immunoserology, imaging T he human cytomegalovirus (CMV) is a ubiquitous betaherpesvirus causing morbidity and mortality in immunocompromised patients and congenitally infected fetuses and newborns, resulting in a broad range of disabilities, including sensorineural hearing loss (SNHL), visual impairment, and motor and cognitive deficits. Other transient symptoms of congenital CMV infection (cCMV) may include hepatosplenomegaly, thrombocytopenia, and jaundice. The global prevalence of cCMV has been estimated at 0.7% (1), and fetal CMV transmission may arise from a maternal primary or nonprimary infection. The highest rate of cCMV occurs after primary infections in seronegative mothers (30 to 40%), while nonprimary infections, including CMV reactivations or reinfections, result in cCMV in 0.2 to 2% of cases, suggesting that preconceptional immunity may play a role in preventing intrauterine transmission (2). If the main burden of congenital infections in Europe and North America results from primary infections, then nonprimary infections represent the main cause of cCMV in developing countries or in poor socioeconomical contexts, since the seroprevalences among the resident populations are much higher (3). The severities of infections in neonates and infants are highly variable. It has been estimated that 10 to 15% of congenitally infected neonates are symptomatic at birth, and 40 to 58% of them will experience permanent long-term sequelae. Moreover, 13.5% of children with asymptomatic infections will develop late-onset sequelae, mainly consisting of hearing impairments and neurologic deficits. The effectiveness of antiviral treatment during pregnancy is still debated. Most of the concerns are related to the potential genotoxicity and teratogenicity of the drugs. The clinical benefits of CMV-specific hyperimmune globulin treatment are also disputed, due to discordant results obtained from different studies (4,5).In the last decade, major efforts have been made to improve the early laboratory diagnosis of maternal and fetal infections. Despite these efforts, at present, many countries in the world have not yet adopted a consolidate...

Seroepidemiology of Cytomegalovirus Infection in Pregnant Women in the Central Mexican City of Aguascalientes

“…Congenital CMV transmission rates are as high as 50% in women who acquired primary CMV infection during pregnancy, and less than 2% in women with non-primary infection [ 3 ]. Intrauterine CMV transmission rates for primary and non-primary infections are about 30% and 0.2%, respectively [ 6 ]. CMV can also be transmitted from mother-to-child intrapartum or during breastfeeding [ 3 ].…”

“…Primary CMV infection is mostly asymptomatic in immunocompetent adults; however, infection may manifest as a mild mononucleosis or flu-like syndrome with persistent fever and fatigue [ 3 ]. Congenital CMV infection represents a relevant cause of deafness and neurological damage in newborns [ 6 , 7 ]. In addition, congenital CMV infection may lead to intrauterine growth retardation, microcephalia, petechiae, jaundice, hepatosplenomegaly, and ophthalmological disorders [ 8 ].…”

Microsphere-Based IgM and IgG Avidity Assays for Human Parvovirus B19, Human Cytomegalovirus, and Toxoplasma gondii

“…Combinations of serological tests are practicable for the detection of infections during pregnancy (20)(21)(22)(23). While IgM in general is a sensitive indicator of recent primary infection, in many contexts, it lacks clinical specificity, hence calling for additional markers for infection dating.…”

Diagnóstico tardio de Citomegalovirose em recém-nascido pré-termo, por carência de triagem no período gestacional: uma realidade do Brasil - Relato de Caso

“…A maioria das crianças infectadas é assintomática (LANZIERI, et al, 2014;TOWNSEND;PECKHAM;TOOKEY, 2011apud LANZIERI et al, 2017, sendo que, aproximadamente 5 a 18% dos recém-nascidos infectados intra-útero terão sintomas ao nascer, caracterizando a doença congênita por CMV; destes, 5% apresentam a doença citomegálica clássica e outros 5% manifestam quadro clínico atípico (JUNQUEIRA; SANCHO; SANTOS, 2008). Nos pacientes sintomáticos, os principais achados são: hepatoesplenomegalia, esplenomegalia isolada, icterícia, petéquias e alterações neurológicas (BOPPANA;FOWLER, 2013apud HADAR et al, 2017SALDAN et al, 2017;BRITT, 2017).…”

“…Nos casos de pacientes com alterações neurológicas, o PCR pode ser realizado no Líquor. A realização de tomografia computadorizada e ressonância magnética contribui para a verificação de alterações encefálicas que podem estar presentes na doença (SALDAN et al, 2017).…”