Prospective study of congenital cytomegalovirus infection

The overall incidence of neonates with urinary cytomegalovirus (CMV) excretion was 0.9% of 954 tested. The incidence was twice as high in the lower as in the upper socioeconomic group (SEG). Mothers of infants with CMV infection in the lower SEG reported a greater number of chronic and gestational medical problems and showed a lower mean age than mothers of CMV-infected infants in the upper SEG. The mean age of mothers of CMV-infected infants was not significantly different from the respective control group in either upper or lower SEG. There was no impairment of immune responses in nine prospective or in two referred cases. Although eight of nine prospective cases might have been considered asymptomatic at birth, careful evaluation in the neonatal period showed significant growth inhibition in five, specific clinical changes in seven, and nonspecific clinical changes in all of the nine infants. Thus, "asymptomatic" neonates may demonstrate effects of the infection during the neonatal period.

Generalized cytomegalic inclusion disease in neonates and infants

Cytomegalic inclusion disease (C.M.I.) is caused by the salivary gland virus which is species-specific, and characterized by formation of inclusion-bearing cells in various organs. From the view point of spreading, it is divided into the localized and generalized type. We studied 18 generalized cases of infants in whom inclusion-bearing cells were detected in more than three organs. As to the portal of entry and the time of infection, cytomegalic inclusion disease can be classified into three subgroups in infants; congenital form (2 cases), early acquired form (8 cases) and acquired form with other debilitating diseases (8 cases).

A prospective study of primary cytomegalovirus infection in pregnant women

During a four year study, sera were obtained from 5575 women attending for antenatal care and 3188 (57.2 per cent) were shown to possess complement fixing antibodies to cytomegalovirus (CMV). A total of 1608 seronegative women were followed to term and 14 (0.87 per cent) primary CMV infections occurred in either the second or third trimester. Transplacental spread of CMV occurred in 3 out of 12 (25 per cent) of the 14 babies born to infected mothers. All 14 babies were apparently normal at birth but short term clinical follow-up has already revealed that one child has impaired hearing whilst another is microcephalic. The women were also monitored serologically throughout pregnancy for evidence of rubella infections. Only 12 infections were detected and 7 of these occurred during the large rubella epidemic of 1978. Of the 10 pregnancies which were allowed to proceed to term, transplacental spread of rubella virus occurred in 1 out of 7 (14 per cent). During this study period, CMV infections occurred as frequently as did rubella infections. We therefore conclude that, apart from those years when extensive epidemics occur, many more pregnant women are infected with CMV than with rubella virus.

Comparative study of diagnostic procedures for congenital cytomegalovirus infection

In a prospective study the incidence of congenital cytomegalovirus (CMV) infection was 2.2% (31 OF 1,412) as evidenced by viruria during the first week of life. Among immunoserologic methods used to screen these neonates, the rheumatoid factor test, although non-specific, proved to be the most convenient; its sensitivity for identifying infants with CMV infection was 35% to 45% with no false-positives. The rates for correct and incorrect identification of neonates at risk was, respectively, 33% and 3.1% when testing for increased levels of IgM; 5% and 10% when testing for increased levels of IgA; 76% and 21% when testing for IgM anti-CMV (IgM immunofluorescent test) antibody, and 0% when testing for IgA anti-CMV antibody. Rapid virologic diagnosis was achieved by assessing urine specimens. Confirmation by electron microscopy was possible in less than one hour in 92% of cases. The detection of early induced CMV-specific nuclear antigens by anticomplement immunofluorescence was diagnostic in 91% of cases within one day of inoculation of specimens in tissue culture. Infectivity of CMV in urine was well preserved for a least seven days at 4 C. Thus, in order to achieve a rapid diagnosis of congenital CMV infection, in sick as well as asymptomatic neonates, urine specimens may, if necessary, be transported at 4 C to distant laboratories.

Transfer of measles, mumps, and rubella antibodies from mother to infant. Its effect on measles, mumps, and rubella immunization

Sera from 42 mother-infant pairs were examined to determine the effect of passively acquired enhanced neutralizing (ENt) antibody on immunization. The ENt antibodies to measles, mumps, and rubella were greater in term newborns than in their mothers, with mean ratio of 1.8:1, 1.3:1, and 1.2:1, respectively. In 21% to 25% of the children, these antibodies persisted until 12 months of age. When immunized with trivalent measles-mumps-rubella vaccine, children who had persisting ENt measles and rubella titers had significantly lower mean antibody responses than children without detectable antibodies to the two viruses. Persisting ENt mumps antibodies did not affect the postimmunization titers. Seroconversion rates to any of the three viruses were not different in children with or without preexisting ENt antibody.

Application of case series review results to the evaluation of individual cases in diagnostic radiology

Probability theory provides a simple method for physicians to use their "intellectual linkages" to their past clinical experience in making current diagnoses. Only a pencil and paper are required for making a few likelihood calculations. To illustrate this method, evaluation was done of a new diagnostic sign (presence of knee ossification centers) for differentiating rubella from cytomegalovirus infection in young infants. Two practical questions can be answered by use of this method for calculating probabilities: (1) How certain can one be about either diagnosis when centers are present or absent? (2) How can other radiologists apply these results to their individual cases?

Specific cell-mediated immunity in children with congenital and neonatal cytomegalovirus infection and their mothers

Cell-mediated immunity (CMI) to cytomegalovirus (CMV) and herpes simplex virus type 1 (HSV-1) was examined in 35 mothers and 30 of their offspring with congenital or neonatal CMV infection by means of the lymphocyte transformation assay. Eleven offspring did not respond to CMV antigen, and 15 of the 19 positive children displayed lower responses than those of normal immune adults. Productive infection in the younger children at the time of assay and the presence of disease correlated strongly with the absence of responses. The mothers as a group also demonstrated impaired CMI to CMV while reacting normally to HSV-1 antigen. Neither time after transmission of infection nor viral excretion was significantly associated with impaired CMI, although a trend toward diminished responses was evident among women who were shedding virus. Mitogen stimulation was normal in all test subjects. These findings imply that deficient specific CMI may play a role in the genesis of persistent CMV infection and fetal pathology.

Congenital cytomegalovirus and hearing loss: clinical and experimental observations

The effects of congenital cytomegalovirus infection vary from severe central nervous system destruction to asymptomatic viuria. Yet children with the latter have a high incidence of unsuspected hearing loss. Histopathology of temporal bones from children who die with cytomegalic inclusion disease shows viral infected cells in non-sensory endolabyrinthine epithelium. Experimental mouse cytomegalovirus causes an age related cranial neuronitis and perilabyrinthitis. Immunopathologic localization of different viral antigens in experimental inner ear infections shows differential vulnerability of labyrinthine structures to infections. Adaptation of such techniques to human temporal bone pathology could yield information regarding pathogenesis of viral labyrinthitis. The development of a human cytomegalovirus vaccine may eliminate the risks of this congenital infection.

Osseous lesions and pathologic fractures in congenital cytomegalic inclusion disease: report of a case

A newborn infant with congenital cytomegalic inclusion disease had spontaneous fractures of the distal radii bilaterally, and involvement of the metaphyseal portions of the humeri, ulnas, femurs, and tibias. The fractures healed promptly without complications under ordinary management. At the present time, one can only speculate on the cause of these lesions. Viral osteomyelitis, osteomalacia secondary to hepatitis and malabsorption and a disturbance of endochondral ossification are all possibilities. There is a need for additional cases with histologic and biochemical studies of the bone lesions in congenital cytomegalic inclusion disease.

Impaired cellular immunity to cytomegalovirus in congenitally infected children and their mothers

Cell-mediated immunity to cytomegalovirus (CMV) was determined in congenitally infected children and their mothers by use of assays for CMV-specific lymphocyte blastogenesis and interferon production. Six viruric children responded poorly in both assays. Two older nonviruric children responded in the blastogenesis assay, and lymphocytes from one of them produced interferon. Mothers of older children usually responded in the blastogenesis assay, but only one of them produced interferon. Mothers whose infected infants were younger than nine months of age responded poorly in both assays, while control seropositive postpartum women generally responded normally. The cell-mediated immune defects detected in this study may play a role in the pathogenesis of congenital CMV infection.

[Thrombocytopenic purpura of the young infant caused by perinatal infection by cytomegaloviruses]

Two cases of idiopathic trombocytopenic purpura, in infants 37 and 42 days old, and one case of atypical congenital cytomegaloviral disease are presented, the latter proved at necropsy. Cytomegalic inclusion cells are found in urine in both cases of purpura with hepatosplenomegaly and mononucleosis syndrome. In one of the cases, cytomegalovirus cultures are positive in urine and blood. The hemorrhagic syndrome is mild and recuperation is achieved in less than thirty days, without relapse. The use of corticosteroids is not recommended. With these two new cases, thirteen similar clinical observation of thrombocytopenic purpura in infants, six of them in 1977, are completed. Thus, a new entity is added to the growing list of clinical manifestations caused by human CMV infection.

A prospective study on congenital and acquired cytomegalovirus infections in infants

A preliminary report is presented on a current prospective virological and clinical study of congenital and acquired infant cytomegalovirus (CMV) infections. During a 1-year period, 7/2200 newborn Swedish infants investigated (0.3%) had a congenital CMV infection as shown by positive virus isolation. Two of them had typical symptoms, hepatosplenomegaly and petechiae in one case and splenomegaly in the other one. All of them had a normal birth weight and normal head circumference. No sequelae have been observed during an observation period of up to 9 months. Five out of 10 control infants followed-up acquired a CMV infection within a few months. 5/7 mothers of the congenitally infected infants and 3/14 mothers of the control infants were primiparas.

Progressive hearing impairment in children with congenital cytomegalovirus infection

Audiological assessment of 86 children with congenital cytomegalovirus infection revealed progressive hearing loss in four of 12 subjects with sensorineural hearing impairments. Case descriptions are presented documenting the progression of the hearing loss. In view of the findings, children with congenital cytomegalovirus should be monitored closely to insure detection of possible delayed or progressive hearing impairment and delivery of appropriate habilitative services.

A prospective study on the incidence and significance of congenital cytomegalovirus infection

Screening of 3060 neonates for congenital cytomegalovirus (CMV) infection by virus excretion in the urine showed an overall incidence of 0.4%. The incidence was about 1% for mothers between 16 and 25 years and only 0.2% for mothers between 25 and 35. No mothers over 35 years of age gave birth to congenitally infected infants. The percentage of women in the child-bearing age susceptible to CMV infection was estimated by the absence of CMV complement-fixing antibodies in cord sera and ranged from 48% to 33% with increasing age. None of the infected infants showed obvious signs of congenital CMV infection at birth. At follow-up, two infants showed slight, but transient symptoms compatible with a foetal infection; a pair of premature twins exhibited retarded physical and psychomotor development, but this could just as well be ascribed to the prematurity itself. None of the infants had detectable CMV--IgM antibodies in cord sera, but a trend towards elevated total IgM concentration in cord sera and elevated virus excretion titres appeared in the infants with symptoms. With the very low incidence and no signs of sensomotor sequelae the preliminary conclusion is that foetal CMV infection in our population by no means has a significance to deserve screening or a vaccination programme.

Cytomegalovirus isolation from a human inner ear

Cytomegalovirus (CMV) infection of the fetus has been associated with congenital deafness or hearing loss. This association has previously been based on clinical or pathological studies. We report an infant who died with the congenital CMV syndrome in which CMV was isolated from the perilymph of the inner ear providing additional evidence that this virus can infect the labyrinth.