1
|
Ozdemir E, Sarac Sivrikoz T, Sarsar K, Tureli D, Onel M, Demirci M, Yapar G, Yurtseven E, Has R, Agacfidan A, Kirkoyun Uysal H. Evaluation of Congenital Cytomegalovirus Infection in Pregnant Women Admitted to a University Hospital in Istanbul. Viruses 2024; 16:414. [PMID: 38543779 PMCID: PMC10975387 DOI: 10.3390/v16030414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Revised: 02/28/2024] [Accepted: 03/06/2024] [Indexed: 05/23/2024] Open
Abstract
Cytomegalovirus (CMV) can cause serious complications in immunocompromised individuals and fetuses with congenital infections. These can include neurodevelopmental impairments and congenital abnormalities in newborns. This paper emphasizes the importance of concurrently evaluating ultrasonography findings and laboratory parameters in diagnosing congenital CMV infection. To examine the prenatal characteristics of CMV DNA-positive patients, we assessed serum and amniotic fluid from 141 pregnant women aged 19-45 years, each with fetal anomalies. ELISA and PCR tests, conducted in response to these amniocentesis findings, were performed at an average gestational age of 25 weeks. Serological tests revealed that all 141 women were CMV IgG-positive, and 2 (1.41%) had low-avidity CMV IgG, suggesting a recent infection. CMV DNA was detected in 17 (12.05%) amniotic fluid samples using quantitative PCR. Of these, 82% exhibited central nervous system abnormalities. Given that most infections in pregnant women are undetectable and indicators non-specific, diagnosing primary CMV in pregnant women using clinical findings alone is challenging. We contend that serological tests should not be the sole means of diagnosing congenital CMV infection during pregnancy.
Collapse
Affiliation(s)
- Evrim Ozdemir
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (E.O.); (K.S.); (M.O.); (G.Y.); (A.A.)
- Institute of Health Sciences, Istanbul University, Istanbul 34126, Turkey
| | - Tugba Sarac Sivrikoz
- Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (T.S.S.); (D.T.); (R.H.)
| | - Kutay Sarsar
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (E.O.); (K.S.); (M.O.); (G.Y.); (A.A.)
| | - Dilruba Tureli
- Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (T.S.S.); (D.T.); (R.H.)
| | - Mustafa Onel
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (E.O.); (K.S.); (M.O.); (G.Y.); (A.A.)
| | - Mehmet Demirci
- Department of Medical Microbiology, Faculty of Medicine, Kirklareli University, Kirklareli 39100, Turkey;
| | - Gizem Yapar
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (E.O.); (K.S.); (M.O.); (G.Y.); (A.A.)
| | - Eray Yurtseven
- Department of Biostatistics, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey;
| | - Recep Has
- Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (T.S.S.); (D.T.); (R.H.)
| | - Ali Agacfidan
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (E.O.); (K.S.); (M.O.); (G.Y.); (A.A.)
| | - Hayriye Kirkoyun Uysal
- Department of Medical Microbiology, Istanbul Faculty of Medicine, Istanbul University, Istanbul 34093, Turkey; (E.O.); (K.S.); (M.O.); (G.Y.); (A.A.)
| |
Collapse
|
2
|
Zlatkin R, Bilavsky E, Pardo J, Salman L, Bardin R, Hadar E, Shmueli A. The association between maternal cytomegalovirus urinary excretion and congenital infection rate. BMC Pregnancy Childbirth 2021; 21:741. [PMID: 34724918 PMCID: PMC8559400 DOI: 10.1186/s12884-021-04194-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 10/06/2021] [Indexed: 11/10/2022] Open
Abstract
Background In utero Cytomegalovirus (CMV) vertical transmission occurs predominantly during primary maternal infection. There are no known non-invasive methods for diagnosis of fetal infection before delivery, however some risk factors have been suggested. We aimed to evaluate the association between maternal CMV urinary excretion and congenital CMV infection. Methods A retrospective cohort study of all women who were diagnosed with primary CMV infection during pregnancy in a single university affiliated tertiary medical center, between 2012 and 2016. We examined congenital CMV infection and disease rates among infants born to women with and without CMV urinary excretion. Results Overall, 126 women were included, 77 in the positive urinary excretion group, and 49 in the negative urinary excretion group. There was no difference in maternal symptoms between the groups. We found no difference in congenital CMV infection and disease rates between infants born to women with and without urinary excretion of CMV (congenital infection rate 37.1% vs. 24.4%, p = 0.209, congenital disease rate of 18.2% vs. 22.4%, p = 0.648). Women with positive urinary CMV excretion had lower IgG avidity values (36.7% vs 54.6%, p = 0.007), with no additional difference in serology pattern. Compared to asymptomatic women, those with CMV related symptoms did not have significantly higher rates of urinary excretion of CMV (70% vs. 60.5%, p = 0.38) or congenital infection rates (40.7% vs. 31.2%, p = 0.48). Conclusion Among infants of women with primary CMV infection in pregnancy, we did not find an association between urinary excretion of CMV and congenital CMV infection.
Collapse
Affiliation(s)
- Rita Zlatkin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Efraim Bilavsky
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Schneider Children's Medical Center, Petach Tikva, Israel
| | - Joseph Pardo
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Tikva, Israel
| | - Lina Salman
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Tikva, Israel
| | - Ron Bardin
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Tikva, Israel
| | - Eran Hadar
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Tikva, Israel
| | - Anat Shmueli
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. .,Department of Obstetrics and Gynecology, Helen Schneider Hospital for Women, Rabin Medical Center, 49100, Tikva, Israel.
| |
Collapse
|
3
|
Adachi K, Xu J, Ank B, Watts DH, Mofenson LM, Pilotto JH, Joao E, Santos B, Fonseca R, Kreitchmann R, Pinto J, Mussi-Pinhata MM, Gray G, Theron G, Morgado MG, Bryson YJ, Veloso VG, Klausner JD, Moye J, Nielsen-Saines K. Cytomegalovirus Urinary Shedding in HIV-infected Pregnant Women and Congenital Cytomegalovirus Infection. Clin Infect Dis 2017; 65:405-413. [PMID: 28369278 PMCID: PMC5850431 DOI: 10.1093/cid/cix222] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 03/16/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Cytomegalovirus (CMV) urinary shedding in pregnant women infected with human immunodeficiency virus (HIV) was evaluated to determine whether it poses an increased risk for congenital CMV infection (cCMV). METHODS A subset of mother-infant pairs enrolled in the perinatal NICHD HPTN 040 study (distinguished by no antiretroviral use before labor) was evaluated. Maternal and infant urines were tested by qualitative real-time polymerase chain reaction (RT-PCR) for CMV DNA with quantitative RT-PCR performed on positive specimens. RESULTS Urine specimens were available for 260 women with 85.4% from the Americas and 14.6% from South Africa. Twenty-four women (9.2%) had detectable CMV viruria by qualitative PCR. Maternal CMV viruria was not associated with mean CD4 cell counts or HIV viral load but was associated with younger maternal age (P = .02). Overall, 10 of 260 infants (3.8%) had cCMV. Women with detectable peripartum CMV viruria were more likely to have infants with cCMV than those without: 20.8% (5/24) versus 2.1% (5/236), (P = .0001). Women with CMV viruria had significantly higher rates of HIV perinatal transmission (29.2% vs. 8.1%, P = .002). They were 5 times (adjusted odds ratio [aOR] = 5.6, 95% confidence interval [CI] 1.9-16.8) and nearly 30 times (aOR, 29.7; 95% CI, 5.4-164.2) more likely to transmit HIV and CMV to their infants, respectively. Maternal gonorrhea (aOR, 19.5; 95% CI, 2.5-151.3) and higher maternal HIV log10 viral load (OR, 2.8; 95% CI, 1.3-6.3) were also significant risk factors for cCMV. CONCLUSION In this cohort of HIV-infected pregnant women not on antiretrovirals, urinary CMV shedding was a significant risk factor for CMV and HIV transmission to infants. CLINICAL TRIALS REGISTRATION NUMBER NCT00099359.
Collapse
Affiliation(s)
- Kristina Adachi
- David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California
| | | | - Bonnie Ank
- David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California
| | - D Heather Watts
- Office of the Global AIDS Coordinator, US Department of State, Washington, DC
| | - Lynne M Mofenson
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | | | - Esau Joao
- Hospital Federal dos Servidores do Estado, Rio de Janeiro
| | | | | | - Regis Kreitchmann
- Irmandade da Santa Casa de Misericordia de Porto Alegre, Rio Grande do Sul
| | - Jorge Pinto
- Federal University of Minas Gerais, Belo Horizonte, Minas Gerais
| | | | - Glenda Gray
- SAMRC and Perinatal HIV Research Unit, University of Witwatersrand
| | - Gerhard Theron
- Department of Obstetrics and Gynecology, Stellenbosch University/Tygerberg Hospital, Cape Town, South Africa
| | | | - Yvonne J Bryson
- David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California
| | | | - Jeffrey D Klausner
- David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California
- Fielding School of Public Health, UCLA, Los Angeles, California
| | - Jack Moye
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland
| | - Karin Nielsen-Saines
- David Geffen University of California, Los Angeles School of Medicine, Los Angeles, California
| |
Collapse
|
4
|
Traore L, Tao I, Bisseye C, Diarra B, Compaore TR, Nebie Y, Assih M, Ouedraogo A, Zohoncon T, Djigma F, Ouermi D, Barro N, Sanou M, Ouedraogo RT, Simpore J. Molecular diagnostic of cytomegalovirus, Epstein Barr virus and Herpes virus 6 infections among blood donors by multiplex real-time PCR in Ouagadougou, Burkina Faso. Pan Afr Med J 2016; 24:298. [PMID: 28154653 PMCID: PMC5267872 DOI: 10.11604/pamj.2016.24.298.6578] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2015] [Accepted: 07/15/2016] [Indexed: 12/21/2022] Open
Abstract
Introduction In most developing countries, Cytomegalovirus (CMV), Epstein Barr virus (EBV) and Herpes virus 6 (HHV-6) are not diagnosed in blood donors. The aim of this study is to determine the prevalence of these viruses in blood donors from the city of Ouagadougou, Burkina Faso. Methods The study included 198 blood donors of the Regional Blood Transfusion Centre of Ouagadougou. Multiplex real time PCR was used to diagnose the three viruses. Statistical analysis was performed with the software EpiInfo version 6 and SPSS version 17. P values ≤ 0.05 were considered significant. Results Of 198 samples tested, 18 (9.1%) were positive to at least one of the three viruses. In fact, 10 (5.1%) were positive for EBV, 10 (5.1%) positive for CMV and 12 (6.1%) positive for HHV-6. Viral infections were higher in women than in men, EBV (8,6% versus 4.3%), CMV (8.6% versus 3.7%) and HHV-6 (11.4% versus 4.9%). EBV / CMV / HHV-6 co-infection was found in 3.5% (7/198) of blood donors. Conclusion The prevalence recorded in this study is low compared to those found in previous studies from the sub-region among blood donors. The molecular diagnostic test used in our study could explain the differences with previous studies.
Collapse
Affiliation(s)
- Lassina Traore
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Issoufou Tao
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Cyrille Bisseye
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso; Laboratory of Molecular and Cellular Biology, University of Sciences and Techniques of Masuku, P 943 Franceville, Gabon
| | - Birama Diarra
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Tegwindé Rebeca Compaore
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Yacouba Nebie
- Molecular Biology, Epidemiology and Monitoring of Communicable of Bacteria and Viruses Through Food, UFR / SVT, University of Ouagadougou, Burkina Faso
| | - Maleki Assih
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Alice Ouedraogo
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Theodora Zohoncon
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Florencia Djigma
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Djénéba Ouermi
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| | - Nicolas Barro
- Molecular Biology, Epidemiology and Monitoring of Communicable of Bacteria and Viruses Through Food, UFR / SVT, University of Ouagadougou, Burkina Faso
| | - Mahamoudou Sanou
- Molecular Biology, Epidemiology and Monitoring of Communicable of Bacteria and Viruses Through Food, UFR / SVT, University of Ouagadougou, Burkina Faso
| | - Rasmata Traore Ouedraogo
- Molecular Biology, Epidemiology and Monitoring of Communicable of Bacteria and Viruses Through Food, UFR / SVT, University of Ouagadougou, Burkina Faso
| | - Jacques Simpore
- Biomolecular Research Center Pietro Annigoni Labiogene, UFR / SVT, University of Ouagadougou BP 364 Ouagadougou, Burkina Faso
| |
Collapse
|