Immune complexes in congenital and natal cytomegalovirus infections of man

The occurrence of circulating immune complexes was investigated in 31 patients with cytomegalovirus infection (29 infected in utero and 2 with natal infection) and 34 uninfected controls. Anti-complementary activity above 1:20 occurred in 34% (29/86) of the sera tested from the infected group in contrast to 7.5% (3/40) in the controls (P < 0.005). When assayed by means of a lymphoblastoid cell line (Raji cell test), the reactivity in these groups was 45 (39/86) and 2.7% (1/36), respectively (P < 0.001). Correlation of results between these two complement-dependent assays occurred in 75% of samples collected from the infected group. Frequency of reactivity was higher in severe intrauterine infection and during the 1st yr of life paralleling the patterns of viral excretion and humoral immune responses. Physicochemical characterization demonstrated that reactive substances in sera were acid-dissociable and, in one sample tested, contained 7S IgG antibodies with cytomegalovirus (CMV) specificity. Circulating immune complexes were heavier (18-22S) in sick, as opposed to subclinically CMV-infected patients, in whom intermediate size complexes (12-16S) were found. In three of four symptomatic patients whose demise was due to severe congenital infection, granular deposits of immunoglobulins and C3 were detected in a pattern typical of immune complexes along the glomerular basal membrane of the glomeruli. Whether or not circulation and deposition of heavier immune complexes contributed to the adverse clinical outcome is unresolved. Because of the high incidence of both congenital and natal CMV infections, definition of the pathogenetic potentials of both heavy and intermediate size immune complexes is required to design more effective therapeutic measures.

[Evolution of cytomegalovirus antibodies of maternal origin and acquired, throughout the first year of life (author's transl)]

Cytomegalovirus antibodies have been determined by indirect hemagglutination technique in sera taken during the first year of life in two infant groups : Bantu infants in Mozambique, French infants in Alsace. IgM specific antibodies have been detected in serum fractions obtained by density gradients. The evolutions of maternal antibodies and of antibodies resulting from a primary CMV infection have been documented. The analysis of the results confirmed that the mother is the main source of infection and that contamination occurs at the time of birth.

Perinatal cytomegalovirus infection in man

In a prospective study of 148 children from urbanized southern Finland 3 were found to be congenitally and 48 perinatally infected with cytomegalovirus (CMV), while 6 developed "late" infection during the first year of life. During pregnancy and the first year after delivery 23 of the mothers had no CMV antibodies; none of the children of these seronegative mothers developed any type of CMV infection. Fresh blood exchange transfusions did not increase the risk of CMV infection. The data support the hypothesis that the mother is the source of perinatal CMV infection. Children with a low birthweight not due to prematurity, and first children seem to run a greater risk of acquiring perinatal CMV infection. If the child is breast fed up to the age of 2 months the risk seems to be increased. Perinatal CMV infection gave rise to no symptoms or signs and had no effect on growth or on motor and psychosocial development during the first year of life.

Cytomegalovirus endolabyrinthitis

A premature male infant, who died 22 days after birth with hyaline membrane disease, was found to have had cytomegalic inclusion disease at autopsy. Histopathologic examination of the temporal bones showed cytomegalovirus (CMV) infection of the entire endolabyrinth without involvement of the neural and sensory structures. These findings support the thesis that late gestational or perinatal fetal CMV infection results in an endolymphatic labyrinthitis. We hypothesize that blood-borne virus passes from the stria vascularis into the endolymphatic spaces and infects the nonneurosensory epithelium. This pattern of infection differs from the perilabyrinthitis of human varicellazoster and experimentally produced mouse CMV.

Viral attributes and host factors in carcinogenesis: herpesviruses

This paper describes two different experiments of nature: 1) the persistence of unusual virus strains of Epstein-Barr virus (EBV) (which proved oncogenic in vitro) and cytomegalovirus (CMV) in lymphoid cells following congenital or early acquired infection; 2) the occurence of multiple cases of Burkitt's lymphoma and nasopharyngeal carcinoma in one family. All the members of this family were EBV viral capsid antigen (VCA) and nuclear antigen (EBNA) antibody positive. The two patients with nasopharyngeal carcinoma had high titers of EBV-VCA, EA, and EBNA antibodies. The only member of this family having EBV early antigen (EA antibodies in addition to the patients with tumors was the mother. Borderline IgA deficiency was documented in 3 members of this family. These findings illustrate the importance of host factors (intracellular resistance to transformation and secondarily, immunological surveillance) in the outcome of the host-virus challenge whether cancer or infectious disease is the outcome. Extensive studies of these cases may provide the best insight into the mysteries of viral oncogenesis.

Specific impairment of cell-mediated immunity in mothers of infants with congenital infection due to cytomegalovirus

Specific lymphocyte-mediated cytotoxicity to cytomegalovirus (CMV) in eight infants (six to 27 months old) with congenital CMV infection and in the mothers of six of these infants was evaluated with use of a 51chromium (51Cr)-release microassay. The control population consisted of 25 normal newborns, children, and adults. The titers of indirect hemagglutinating (IHA) antibody to CMV in the infected infants ranged from 1:16 to 1:1,024. All of these infants had detectable specific immune release of 51Cr that ranged from 3.3% to 48.9% (mean +/-SE, 21.0%+/-5.6%). The mothers of these infants demonstrated significantly elevated titers of IHA antibody to CMV (geometric mean titer, 1:410) as compared with a mean titer of 1:22 in controls (t = 5.71; P less than 0.001) but showed significantly depressed specific immune release (9.2% +/- 3.2%) compared with that of normal seropositive controls (24.8% +/- 2.8%; t = 3.31; P less than 0.001). In addition, two adult nulliparous women with persistent CMV viruria were also found to have depressed specific immune release to CMV (10.8% and 16.2%). These data suggest that a specific impairment in cell-mediated immunity to CMV occurs in mothers of infants with congenital CMV infection and in some persons who persistently excrete CMV.

Human cytomegalovirus. A review of developments between 1970 and 1976. I. Clinical developments

Cytomegalovirus (CMV), like other members of the herpesviruses, is widely distributed in human populations where the frequency of seropositive individuals is influenced by such factors as age, sex and socio-economic conditions. While this virus causes such diseases as mononucleosis, it is also implicated in autoimmune phenomena and plays an adverse role renal and bone marrow transplantation. Perhaps the most menacing aspect of CMV is the role which it play in congenital malformations resulting from in utero or neo-natal infection. Indeed, this virus is one of the few which can be transmitted vertically. The above mentioned clinical aspects of CMV are discussed here in light of recent clinically studies. The second part of this review will be devoted to the great mass of information recently acquired through experimentation.

Rapid detection of human cytomegalovirus and herpesvirus hominis IgM antibody by the immunoperoxidase technique

Immunoglobulin M (IgM) to human cytomegalovirus (CMV) and herpesvirus hominis (HVH, types 1 and 2) has been searched for in a group of patients with congenital and recent CMV and HVH infections and also in a group of patients with remote CMV and recurrent HVH infections, using the immunoperoxidase antibody technique (IPA) as compared to a technique using sucrose density gradient differential centrifugation. Both techniques detected the same positive samples. High IgM antibody titers (1:32-1:512) were observed in all cases of primary CMV and HVH infection, whereas low titers (1:8-1:16) were found in congenital infections. The IPA technique is sensitive, specific and useful for rapid diagnosis of recent and congenital CMV and HVH infections.

School failure and deafness after "silent" congenital cytomegalovirus infection

We found IgM antibody directed against cytomegalovirus in the umbilical-cord blood of 53 of 8644 newborns. Forty-four of the 53 had psychometric and pediatric evaluations at 3.5 to 7.0 years of age. The group's mean IQ was 102.5+/-22.4 (+/-S.D.), whereas in matched controls it was 111.7 (PC 0.025). Bilateral hearing loss was present in five of 40 children with antibody against cytomegalovirus and in one of 44 matched controls without antibody (P less than 0.1). Three of the antibody-positive children, however, had profound deafness, an abnormality that occurs once in approximately 1000 children. The predicted school failure rate, based on IQ, behavioral, neurologic and auditory test data, was 2.7 times that of matched socioeconomic controls and eight times that of randomly selected controls. We conclude that clinically inapparent congenital cytomegalovirus infection can adversely affect central-nervous-system development.

Optic nerve manifestations of human congenital cytomegalovirus infection

A Latin American male and a white female infant who had a cytomegalovirus infection on the first day of life had unilateral optic nerve hypoplasia. A white male infant who had cytomegalovirus isolated at 5 weeks of age had a unilateral partial coloboma of the optic nerve. A 4-month-old black infant with cytomegalovirus infection diagnosed at 2 days of age had a unilateral complete coloboma of the optic nerve associated with microphthalmia. Optic nerve involvement was an important manifestation of this disease.

[Congenital cytomegalovirus infection after maternal renal transplantation (author's transl)]

A 34-year-old female gave birth to a 32 to 35 week-old girl one year after she had undergone renal transplantation. The child was dwarfed and microcephalic and also had congenital platelet deficiency and purpura. In addition it was anaemic and suffered from severe neonatal icterus. An initial hypogammaglobulinaemia disappeared except for low IgA levels. The immunoglobulin deficiency is probably correlated with the virologically and serologically proven cytomegalovirus infection. The incidence of this disease seems to be high in children of mothers with renal transplantations.

Immunoperoxidase technique for detection of antibodies to human cytomegalovirus

The indirect immunoperoxidase antibody technique (IPA) has been applied to determine immunoglobulin (Ig)G to humans cytomegalovirus (CMV) antibodies in 114 blood donor sera, four cases of congenital cytomegalic inclusion disease, and four cases of acquired CMV infection. The results have been compared with those obtained with the CMV complement fixation (CF) test and indirect fluorescent antibody technique (IFA) for broad spectrum CMV antibody (sigmaAb) detection. IgG antibody has been detected by both CF and IPA. In healthy adult people IPA titers are usually higher than CF titers. In addition, IFA sigmaAb titers are generally higher than CF titers. Some sera negative by CF and IPA are positive at low dilutions by IFA sigmaAb antibody determination, due to the detection of small amounts of IgA or noncomplement-fixing IgG. Nonspecific results seem unlikely, since only nuclear inclusion fluorescence was interpreted as specific, as demonstrated by blocking tests. In acute CMV infection, the IFA sigmaAb and IPA IgG titers are essentially the same, except during the first weeks of infection, when IFA titers are higher and IgM is detectable. No cross-reactivity with other herpes group viruses, herpes simplex and varicella-zoster, was observed. Although some problems of nonspecific staining of cytoplasmic inclusions are shared by both methods, the IPA technique seems to possess the same degree of sensitivity and specificity as the IFA technique, but interpretation is easier and various procedural steps can be delayed without the technical problems associated with fluorescence microscopy.

Viral infections

Although rubella is the only virus which can be regarded in the strict sense of the term a teratogen, there is no convincing evidence that other viruses can cause fetal damage of varying severity. The risk to the fetus appears to depend on the nature of the infectious agent, the maternal immune status and the gestational age when infection takes place. The possibility that subclinical maternal infections may cause damage must not be overlooked. As some of the viruses referred to can cause damage after the period of organogenesis, the use of the term 'teratogenic efect' in relation to viral infections is considered to be inappropriate.

Hemiatrophy and hemiparesis in a patient with congenital cytomegalovirus infection

A 3-year-old girl with congenital cytomegalovirus (CMV) infection has been followed up since birth. Hemiatrophy and hemiparesis occurred at 9 months of age. These unusual sequels of congenital CMV infection should encourage physicians to do longitudinal studies on infants with congenital CMV infection, as well as to examine children with hemiatrophy and hemiparesis for CMV infection.