Current aspects of diagnosis and treatment of cytomegalovirus infections in infants

Cytomegalovirus seronegativity rate in pregnant women and primary cytomegalovirus infection during pregnancy in rural Germany

BACKGROUND

Congenital cytomegalovirus (CMV) infection is the most common congenital infection worldwide and one of the leading causes of congenital hearing loss in newborns. The aim of this study was to determine the seroprevalence rate for cytomegalovirus in pregnant women and the rate of CMV serological testing utilised during pregnancy in a rural region in Germany.

METHODS

Retrospective data on the prevalence of CMV IgG and IgM antibodies were obtained from 3,800 women, identified in the study group of 19,511 pregnant women from outpatient settings whose samples were collected between 1 and 2014 and 30 April 2018. In addition, the serological CMV status in regards to various billing methods was further analyzed.

RESULTS

Serological CMV tests were performed in 3,800 (19.5%) out of 19,511 pregnant women. 2,081 (54.8%) of these women were CMV seronegative. Among those, seroconversion rate of 0.37-1.42% was identified. A proportion of 2,710 (14.7%) of all 18,460 women with statutory health insurance made use of the CMV testing as an individual health service.

CONCLUSIONS

The low uptake of CMV serological testing in the study population covered indicates low risk awareness among pregnant women and their healthcare professionals. Presented seronegativity rates and routine seroconversion rate, demonstrate importance to improve intervention strategy to prevent feto-maternal CMV transmission.

Congenital cytomegalovirus infection in Central Germany: an underestimated risk

PURPOSE

This is the first study to determine the cytomegalovirus (CMV) seronegativity rate for women of childbearing age in Saxony-Anhalt and to determine the prevalence of clinically relevant congenital CMV (cCMV) infection in Central Germany, because there are no valid data available.

METHODS

The retrospective study was undertaken between January 2005 and December 2015. For the first time in Germany, the following seven data sources were used to analyze the prevalence of clinically relevant cCMV infection and the rate of CMV seronegative women of childbearing age: CMV Screening in maternity unit, University Women's Hospital, Social Paediatrics Centre (SPC), Malformation Monitoring Centre (MMC), Newborn Hearing Screening (NHS), Neonatal Intensive Care Unit (NICU), and In-house Doctor Department. Key parameters were anti-CMV IgG and IgM, CMV PCR of urine, and clinically relevant symptoms caused by CMV.

RESULTS

Between 46 and 52% of women of childbearing age were CMV seronegative. The prevalence of clinically relevant cCMV infection was between 0.008 and 0.04%.

CONCLUSIONS

The CMV seronegativity rate of women of childbearing age was confirmed to be in the middle range of estimated data from other sources in Germany. Data from the NICU, SPC, NHS, and MMC show the prevalence of clinically relevant cCMV infection. The risk of all cCMV infections is underestimated. Thus, the true prevalence of clinically relevant and subclinical cCMV infections is >0.04%.

Detection of human cytomegalovirus (CMV) DNA in feces has limited value in predicting CMV enteritis in patients with intestinal graft-versus-host disease after allogeneic stem cell transplantation

BACKGROUND

Cytomegalovirus (CMV) enteritis after allogeneic hematopoietic stem cell transplantation (allo-HSCT) is difficult to diagnose. We aimed to evaluate the sensitivity and specificity of the detection of CMV DNA in feces for predicting CMV enteritis.

METHODS

HSCT patients with intestinal graft-versus-host disease (GVHD) were enrolled if they met the following criteria: (i) underwent a colonoscopy and (ii) peripheral blood and feces specimens were available for CMV DNA detection within 24 h of colonoscopy. The colonoscopy histology was used as the gold standard for diagnosing CMV enteritis.

RESULTS

Fifty-six patients underwent 58 colonoscopy examinations, and 7 were diagnosed as having CMV enteritis. Within 24 h of colonoscopy, 9 patients had detectable CMV in the feces and 19 patients had detectable CMV in the plasma, respectively. In the 7 patients with CMV enteritis, only 2 had detectable CMV in the stool, resulting in a sensitivity of 28.6%. In the 51 patients without CMV enteritis, 44 had no detectable CMV in the stool, with a specificity of 86.3%.

CONCLUSION

We concluded that CMV detection in the feces was not a good predictor of CMV enteritis in patients with intestinal GVHD after allo-HSCT.

Cytomegalo virus as a possible risk factor for neonatal gastrointestinal surgical conditions

The present work aims to evaluate the possible causal relationship between CMV infection and gastrointestinal surgical conditions in the neonates. 33 neonate operated on because of gastrointestinal surgical conditions in Assiut University Children Hospital. Detection of CMV IgG and IgM from both mother and newborn was done. Surgical specimen was taken for pathologic examination. Positive serological tests (CMV IgM) were found only in four neonates (3 males and one female). Maternal CMV IgM were positive only in two cases. All surgical specimens showed characteristic CMV nuclear inclusion bodies.

Congenital cytomegalovirus infection

Congenital cytomegalovirus (CMV) infection is a serious health problem. The obstacles for limiting this infection are the lack of public awareness on this issue, especially owing to the asymptomatic nature of CMV infections, the inefficacy of therapy, and the unsuccessful vaccine trials to date. It is therefore important to organize the current data to estimate the results and to report that the development of a vaccine against CMV must be of the highest priority.

Therapeutic approach in managing patients with large vestibular aqueduct syndrome (LVAS)

OBJECTIVE

To discuss the clinical approach in managing patients with large vestibular aqueduct syndrome.

METHODS

Over the period from November 1997 to March 2005, 106 children have been fitted with cochlear implants in Antwerp University Hospital (UZA). The Hospital University of Maastricht (azM) had implanted 36 children since 1999 to March 2005. The present study focuses on nine children and one adult patient with large vestibular aqueduct syndrome (LVAS). The medical, report and radiology report were retrospectively analysed.

RESULTS

Eight out of nine children with LVAS had been implanted and one child was on the waiting list. One adult patient was implanted with Nucleus 24M at the age of 22 years old. Nine out of 10 patients had bilateral large vestibular aqueduct. There were no intraoperative or postoperative complications encountered.

CONCLUSION

Cochlear implantation is a safe operation for patients with LVAS.

Evaluation of a non-invasive method to detect cytomegalovirus (CMV)-DNA in stool samples of patients with inflammatory bowel disease (IBD): a pilot study

BACKGROUND

A severe flare of colitis in patients with IBD treated with immunosuppressive therapy may be complicated by an underlying CMV infection. The aim of this pilot study was to investigate the diagnostic efficacy of quantitative polymerase chain reaction (PCR) to detect CMV DNA in stool samples of IBD patients.

METHODS

Twenty-one patients with a severe flare of IBD, incompletely responding or refractory to either steroids or immunosuppressive agents, were included in the study. Nineteen patients completed the study according to the protocol undergoing an endoscopy with biopsies and collection of stool samples. Biopsy and stool samples were qualitatively and quantitatively analyzed for CMV DNA using real-time PCR.

RESULTS

Thirty-two percent (6/19) of the patients had detectable CMV DNA in colonic biopsies and in five (83%) of those patients CMV DNA was detected in the stool. Thirteen patients had negative findings for CMV DNA in biopsy and stool samples. The sensitivity, specificity, and accuracy of the PCR-based stool test for detection of CMV DNA compared to PCR-based detection of CMV in mucosal biopsies were 83, 93, and 90%, respectively.

CONCLUSIONS

The pilot study suggests a high accuracy of this non-invasive testing method to detect CMV DNA in stool samples as compared to mucosal biopsies. This approach may offer a non-endoscopic testing modality for underlying CMV infection in patients with a severe flare of IBD, which could also be applied more broadly to determine the prevalence of CMV infections in patients with IBD.

Physical and intellectual development in children with asymptomatic congenital cytomegalovirus infection: a longitudinal cohort study in Qinba mountain area, China

BACKGROUND

Although about 90% of congenital cytomegalovirus (CMV) infection is asymptomatic in newborn, some of them could show sequelae later in life. Qinba mountain area is a place with high incidence of mental retardation and a high rate of CMV intrauterine transmission in China. The correlation between asymptomatic congenital CMV infection and developmental outcomes of children in this area remain unclear.

OBJECTIVES

To investigate the impact of asymptomatic congenital CMV infection on physical and intellectual development of children during the first 6 years of life in Qinba mountain area.

STUDY DESIGN

Longitudinal cohort study. Forty-nine of all the 54 children with asymptomatic congenital CMV infection were followed prospectively in a study for surveying physical growth and intellectual developments.

RESULTS

Either in neonatal or in infant period, no significant difference was noted between the asymptomatic congenital CMV infection children and the controls in average weight, height and head circumference (both p>0.05). The intellectual development was disproportion in asymptomatic congenital infected children. Compared with the control group, both global development quotient (DQ) and full-scale intelligence quotient (IQ) scores of asymptomatically infected children were worse (t=2.19, p=0.031; t=2.48, p=0.015), especially on language DQ scores (t=3.25, p=0.002) and verbal IQ scores (t=3.88, p=0.000). However, the incidence rates of mental retardation (DQ/IQ<70) were similar in two groups (chi(2)=1.03, p>0.05).

CONCLUSIONS

Although asymptomatic congenital CMV infection did not have significant influence on the neonatal physical development or incidence of mental retardation later in life, it is obviously an important factor correlating with long-time cognitive outcomes, especially on the development of language. It is necessary to survey CMV congenital infection and monitor the early intellectual development of children with asymptomatic congenital CMV infection in this area.

Protracted course of lymphocytic choriomeningitis virus WE infection in early life: induction but limited expansion of CD8+ effector T cells and absence of memory CD8+ T cells

Viral infections in human infants frequently follow a protracted course, with higher viral loads and delayed viral clearance compared to viral infections in older children. To identify the mechanisms responsible for this protracted pattern of infection, we developed an infant infection murine model using the well-characterized lymphocytic choriomeningitis virus (LCMV) WE strain in 2-week-old BALB/c mice. In contrast to adult mice, in which viral clearance occurred as expected 8 days after infection, LCMV titers persisted for several weeks after infection of infant mice. LCMV-specific effector CD8(+) T cells were elicited in infant mice and fully functional on day 7 but rapidly waned and could not be recovered from day 12 onwards. We show here that this results from the failure of LCMV-specific CD8(+) T cells to expand and the absence of protective LCMV-specific memory CD8(+) T cells. Under these early life conditions, viral control and clearance are eventually achieved only through LCMV-specific B cells that contribute to protect infant mice from early death or chronic infection.

Epidemiology of Epstein-Barr virus, cytomegalovirus, and Kaposi's sarcoma-associated herpesvirus infections in peripheral blood leukocytes revealed by a multiplex PCR assay

A multiplex polymerase chain reaction (PCR) has been developed for the simultaneous detection of Epstein-Barr virus (EBV), cytomegalovirus (CMV), and Kaposi's sarcoma-associated herpesvirus (KSHV) in a clinical sample. Primers of multiplex PCR were designed to amplify specific regions of the EBV EBNA1, CMV IE2, and KSHV LANA genes. This multiplex PCR assay was found to have detection sensitivities of 1-10 copies of purified viral DNA cloned into the plasmid. To assess diagnostic and pre-clinical applications with this method, we utilized KSHV-positive primary effusion lymphoma (PEL) cells, EBV-positive Burkitt's lymphoma cells, CMV-infected fibroblast cells, and clinically prepared peripheral blood leukocytes (PBLs) that had been infected with viruses. We found that this multiplex PCR assay has high sensitivity and specificity for simultaneous detection of EBV, CMV, and KSHV genomes in a single amplification from a clinical material. Using this multiplex PCR assay, we investigated the prevalence of EBV, CMV, and KSHV in PBL samples from normal Japanese randomly selected. KSHV, EBV, and CMV genomes were detected in samples from 2 (0.2%), 377 (39.5%), and 27 (2.8%) of the 953 blood donors, respectively. Interestingly, both EBV and CMV genomes were detected in samples from all KSHV-positive donors.

Cytomegalovirus gB genotype and clinical features in Chinese infants with congenital infections

OBJECTIVE

To investigate cytomegalovirus (CMV) glycoprotein B (gB) genotypes and clinical features in Chinese infants with congenital infections.

METHODS

Urine samples were obtained from 79 infants with human CMV infection confirmed by quantitative fluorescence polymerase chain reaction (PCR). A fragment of the gB gene was amplified by nested PCR. CMV gB genotyping was carried out by restriction fragment length polymorphism, and 24 samples of the amplified DNA fragments were verified by DNA sequencing.

RESULTS

The levels of CMV DNA in symptomatic and asymptomatic infants were 2.95 x 10(5) and 4.5 x 10(3) copies/ml, respectively, with a significant difference (p < 0.001). In all these cases, the most prevalent genotype was gB1 (50.63%), followed by gB3 (21.52%), gB2 (17.72%), and coinfection (10.13%); gB4 was not found. Moreover, gB1 was more prevalent in infants with liver damage (22/32) than in other symptomatic infants without liver damage (8/22, p = 0.019) or asymptomatic infants (10/25, p = 0.030). The homology of CMV gB in the 24 strains amplified as compared with the sequences of prototype strains in GenBank ranged from 97.06 to 99.64%.

CONCLUSIONS

The restriction fragment length polymorphism analysis of CMV gB genotypes was definite and reliable. The gB1 genotype is the most prevalent in Chinese infants with congenital CMV disease, especially in those with liver damage, followed by genotypes gB3, gB2, and gB4.

Multiplex PCR-based DNA array for simultaneous detection of three human herpesviruses, EVB, CMV and KSHV

Human lymphotropic herpesviruses, Epstein-Barr virus (EBV), cytomegalovirus (CMV) and Kaposi's sarcoma-associated herpesvirus (KSHV) are responsible for a wide variety of human diseases. Due to an increase in diseased states associated with immunosuppression, more instances of co-morbid infections with these herpesviruses have resulted in viral reactivations that have caused numerous fatalities. Therefore, the development of rapid and accurate method to detect these viruses in immunocompromised patients is vital for immediate treatment with antiviral prophylactic drugs. In this study, we developed a new multiplex PCR method coupled to DNA array hybridization, which can simultaneously detect all three human herpesviruses in one single cell sample. Multiplex PCR primers were designed to amplify specific regions of the EBV (EBER1), CMV (IE) and KSHV (LANA) viral genomes. Pre-clinical application of this method revealed that this approach is capable of detecting as few as 1 copy of the viral genomes for KSHV and CMV and 100 copies of the genome for EBV. Furthermore, this highly sensitive test showed no cross-reactivity among the three viruses and is capable of detecting both KSHV and EBV viral genomes simultaneously in the lymphoblastoid cells that have been double infected with both viruses. Thus, this array-based approach serves as a rapid and reliable diagnostic tool for clinical applications.

Chronological changes of incidence and prognosis of children with asymptomatic congenital cytomegalovirus infection in Sapporo, Japan

BACKGROUND

Chronological changes of the incidence of congenital cytomegalovirus (CMV) infection and the longitudinal prognosis in children with asymptomatic congenital infection were investigated.

METHODS

Congenital CMV infection, as demonstrated by isolation of the virus within the first week of life, was diagnosed in infants born in Sapporo, Japan, during the 26-year period between 1977 and 2002.

RESULTS

Congenital infection was diagnosed in 37 (0.31%) of 11,938 infants. Thirty-two infants were (86.5%) asymptomatic and 5 (13.5%) were symptomatic at birth.

CONCLUSIONS

Although a decrease in the total incidence of congenital CMV infection has been seen in recent years, screening of congenital infection at birth seems to be necessary to detect late-onset neurodevelopmental sequelae.

[Viral pneumonia in immunocompetent patients]

Les infections virales respiratoires communautaires sont fréquentes et le plus souvent bénignes. Beaucoup d'agents différents comme les virus influenza, ou para-influenza, le virus respiratoire syncitial, les rhinovirus, coronavirus, adénovirus et les herpès virus peuvent être isolés chez les patients immunocompétents. Parmi ces virus, le cytomégalovirus (CMV) peut être responsable de pneumonie nosocomiale en réanimation. Le diagnostic des infections virales est difficile car les signes cliniques sont non spécifiques et l'isolement du virus responsable difficile. Cependant, une symptomatologie clinique associant fièvre, myalgies, céphalées, pharyngite est fréquente dans les infections à Inflenza qui peuvent aboutir à des tableaux sévères. Enfin, le virus plus récent responsable d'infection respiratoire est un virus nouvellement découvert de la famille des coronavirus, le SRAS-CoV qui a été responsable d'une épidémie d'infections respiratoires sévères. Les pneumonies virales sont fréquentes mais probablement non diagnostiquées chez les patients immunocompétents. Cependant le diagnostic est nécessaire car pour la plupart des pathogènes il existe un traitement efficace. Le diagnostic repose sur l'histologie mais de nouvelles techniques comme la PCR doivent devenir d'utilisation courante pour améliorer le rendement diagnostique.

Ganciclovir therapy in cytomegalovirus (CMV) infection in immunocompetent pediatric patients

OBJECTIVES

To evaluate the outcome of immunocompetent pediatric patients who had positive cytomegalovirus (CMV) antigenemia and received ganciclovir.

METHODS

A retrospective review was done of patients who had a CMV infection based on positive antigenemia. Medical charts were reviewed for the following information: age, sex, underlying disease, symptoms and signs, laboratory results, complementary diagnostic procedures, duration and dose of ganciclovir therapy, concomitant medications, complications, and outcome.

RESULTS

Sixty-four patients with positive CMV antigenemia were identified; 15 patients were excluded from the study because of their underlying diseases. Of the remaining 49 patients, 26 (53%) were female; the median age was 11.5 months (range 0.3-132 months). Sixty-one percent (30/49) of these patients received ganciclovir (5-10 mg/kg/day) for a median of 14 days (range 7-42 days). Clinical findings included: fever, anemia, hepatomegaly, failure to thrive, elevated liver enzymes, splenomegaly, seizures, and thrombocytopenia. Sixty-three percent (19/30) of the treated patients had negative antigenemia at the end of therapy. CMV antigenemia remained positive in six (20%) patients. Nine patients received a second course of ganciclovir.

CONCLUSIONS

Ganciclovir was effective in 80% of patients, as determined by negative antigenemia at the end of therapy.

Human cytomegalovirus infection during pregnancy and detection of specific T cells by intracellular cytokine staining

OBJECTIVE

The flow cytometric assay was evaluated as a tool for real-time monitoring of human cytomegalovirus (HCMV)-specific cellular immunity in pregnant women.

METHODS

We screened for HCMV infection in pregnant women in Sapporo, Japan, during the year 2000, by serologic assays, virus isolation from urine, and PCR to detect DNA in cervical swabs. The frequencies of HCMV-specific CD4+ T cells in pregnant women with serum anti-HCMV IgG antibody were detected by intracellular cytokine (ICC), interferon-gamma (IFN-gamma) and tumor necrosis factor-alpha (TNF-alpha) staining.

RESULTS

The levels of intracellular cytokines in pregnant women with serum anti-HCMV IgG antibody were significantly higher than those in women without anti-HCMV IgG antibody (P = 0.011 for IFN-gamma and P = 0.023 for TNF-alpha) but lower than those in non-pregnant women with serum anti-HCMV IgG antibody. Frequencies of HCMV-specific CD4+ T cells were higher in infants with symptomatic congenital infection than in infants with asymptomatic perinatal infection.

CONCLUSIONS

This ICC assay may reflect immunologic activity against HCMV infection in pregnant women with immunosuppressive conditions.

Frequency of human cytomegalovirus-specific T cells during pregnancy determined by intracellular cytokine staining

The characteristics of cytomegalovirus (CMV)-specific T-cell immunity was investigated in pregnant women with primary, latent, or reactivated CMV infection, and in a comparative group of non-pregnant women. Forty-six pregnant and 8 non-pregnant women were examined based on the presence of serum antibody activity against CMV and viral excretion in urine. The frequency of CMV-specific CD4(+) T cells in peripheral blood lymphocytes was determined by staining for intracellular cytokines, interferon (IFN)-gamma, and tumor necrosis factor (TNF)-alpha. There was no change in the frequencies of CMV-specific CD4(+) T cells in CMV-seropositive normal non-pregnant and pregnant women at any gestation. However, the frequency of CMV-specific CD4(+) T cells in pregnant women associated with CMV reactivation or reinfection was significantly higher than in CMV-seropositive normal pregnant and non-pregnant women. There were no CMV transmissions to the infants of all these women. These CMV-specific T cells responses in pregnant women may contribute some to block the intrauterine CMV infection in their infants.

Immunological evaluation and clinical aspects of children with congenital cytomegalovirus infection

To determine the ability of immunological response to human cytomegalovirus (CMV), the flow cytometric assay was evaluated as a tool for real-time monitoring of specific cellular immunity in children with congenital CMV infection. Longitudinal cohort study of 2 children with asymptomatic and 2 with symptomatic congenital CMV infection evaluated at birth and followed up with serial age-appropriate neurodevelopmental testing. Frequencies of CMV-specific CD4 (+) T cell in these children were detected by intracellular cytokines (ICC), interferon (IFN)-gamma and tumor necrosis factor (TNF)-alpha, staining. Findings detected by CT and MRI were the most sensitive predictor for neurodevelopmental prognosis. Frequencies of CMV-specific CD4(+) T cells detected by ICC, both IFN-gamma and TNF-alpha, were higher in 2 children with symptomatic congenital CMV infection than those in 2 children with asymptomatic congenital infection. Frequencies of CMV-specific CD4(+) T cells in 2 children with symptomatic congenital infection were significantly higher than those in 6 healthy children of 1 to 5-years of age with serum anti-CMV IgG antibody without serum anti-CMV IgM antibody and viral excretion in to urine (p < 0.01). The ICC assay reflects immunological activity against CMV infection in children with asymptomatic or symptomatic congenial infection. Categorizing findings obtained by the ICC assay may helps to determine the prognosis of children with congenital CMV infection.

Diagnosis and treatment approaches of CMV infections in adult patients

BACKGROUND

Cytomegalovirus (CMV) infections are very common in the general population. Clinical CMV disease, particularly CMV pneumonitis, greatly impacts the morbidity and mortality of immunosuppressed patients.

OBJECTIVE

To present an overview of the basic aspects of the biology, epidemiology, and clinical features of CMV in relation to the available diagnostic and therapeutic approaches in adult patients.

METHODS

Review of the medical literature on cytomegalovirus infection and disease in adult hosts, with a focus on approaches to diagnosis and treatment of CMV respiratory disease in immunosuppressed hosts.

CONCLUSIONS

Cytomegalovirus infections are likely to remain a significant cause of morbidity and mortality among immunosuppressed patients. Important aspects of the biological events underlying the transition from infection to clinical disease remain unclear. Despite that, considerable progress has been made in the design of improved diagnostic techniques and the development of antiviral agents. Preventive and particularly preemptive therapeutic approaches demand further technical improvements in diagnostic testing. At present, the emphasis in the search for improved diagnostic testing rests on the development of quantitative methods for early detection of the increased viral replicative activity that presumably precedes the onset of CMV disease in infected individuals.

Congenital and perinatal infections with cytomegalovirus

Congenital cytomegalovirus (CMV) infections remain the leading viral cause of congenital malformations in the developed world. Despite advances in our knowledge, the epidemiology and natural history of congenital CMV infection are still poorly understood, particularly in Australia. Congenital CMV causes illness ranging from no clinical disease (asymptomatic, but infected) through to prematurity, encephalitis, deafness and haematological disorders and death. Perinatal CMV acquisition usually results in less severe illness including asymptomatic infection, acute infection with hepatitis, fever, and pneumonitis. CMV infects only humans, and in vitro and in vivo models for intrauterine infection are required in order to test new treatments, and better describe the pathogenesis of congenital CMV. Using new knowledge of the epidemiology and natural history of CMV, treatment regimens during late pregnancy are currently undergoing clinical trial although no definitive recommendations are available.

Cytomegalovirus infection in infants with autoimmune lymphoproliferative syndrome (ALPS)

Fas-mediated apoptosis may be one of the effector pathways leading to the elimination of virus-infected cells. Cytomegalovirus (CMV) infection in two brothers with Fas deficiency associated with autoimmunity and benign lymphoproliferation (ALPS) provided a unique opportunity to study the clinical course of CMV infection in children with defective apoptosis. The clinical courses of two brothers with autosomal dominant ALPS who were infected with CMV in the neonatal period are described. CMV was detected from throat and urine culture from the brothers. ALPS was confirmed by in vitro anti-CD95 MoAb-induced T lymphocyte apoptosis assay and subsequent sequencing and identification of mutations in the Fas gene. A de novo mutation in the Fas gene, leading to a truncated cytoplasmic Fas product, was associated with autosomal dominant ALPS in a mother and her two sons. Both boys had evidence of CMV infection acquired early in infancy which cleared by the age of 2-3 years. There were no neurodevelopmental sequelae. The natural history of CMV infection in two infants with ALPS was similar to that described in normal children.

Relationship between seropositivity of husbands and primary cytomegalovirus infection during pregnancy

The role of the sexual transmission of human cytomegalovirus (CMV) as a cause of congenital infection was investigated. Serum samples were collected from 756 pregnant women at 10 to 12 weeks of gestation and at 32 to 36 weeks of gestation. Serum samples were also obtained from the husbands of women who seroconverted and women who were seronegative during pregnancy. Commercially available enzyme immunoassay kits were used to detect serum IgG, IgM, and IgA antibodies against CMV. CMV from neonatal urinary specimens was isolated according to a standard tissue culture technique, using MRC-5 cells. At 10 to 12 weeks of gestation, 634 of the 756 pregnant women (83.9%) had IgG antibody to CMV. At 32 to 36 weeks of gestation, 642 of the 756 women (84.9%) had IgG antibody to CMV. A meaningful rise of serum IgG-antibody titer (seroconversion) occurred in 8 women (1.1%). CMV was isolated from the urine of an infant born to a seroconverted woman within a week after birth. The prevalence of IgG antibody to CMV was significantly higher in the husbands of women who seroconverted during pregnancy than in the husbands of the women who were seronegative during pregnancy (P < 0.01). Understanding the epidemiology of CMV is a key element in the development of strategies for the prevention of infection. The transmission of CMV by sexual contact may be important in the pathogenesis of congenital infection. Entirely new approaches to the prevention and treatment of congenital CMV infection are necessary, including antiviral interventions and the development of a vaccine strategy.

Quantitative analysis of cytomegalovirus load using a real-time PCR assay

A novel real-time PCR assay system was developed to quantify the cytomegalovirus (CMV) genome load. The real-time PCR assay could detect from 6 to over 10(6) copies of CMV-DNA with a wide linear range. The virus load of immunocompromised patients with symptomatic CMV infections was quantified and compared to that of asymptomatic ones. In symptomatic patients, all 17 peripheral blood leukocytes were positive for CMV DNA, and its mean value was 10(3.3) copies/10(6) cells. On the other hand, only 9 of 38 samples (24%) were positive in the asymptomatic patients, and its mean titer was lower (10(2.0) copies/10(6) cells) than that of the symptomatic group (P = 0.002). In plasma, the virus genome was detected in 13 out of 17 samples from symptomatic patients (76%), and its mean value was 10(4.0) copies/ml. In contrast, for the asymptomatic group, only one out of 36 samples were positive (3%). Finally, this system was used to monitor two patients with CMV infections serially. The CMV DNA copy number changed with their clinical symptoms and anti-CMV therapy, and virtually paralleled the result of the pp65 antigenemia assay in both cases. In one patient with the cord blood transplantation, however, the CMV DNA became positive faster than the antigenemia assay. These results indicate that this assay is sensitive and useful for estimating the CMV genome load not only in peripheral blood leukocytes but also in plasma. It can be very helpful for diagnosing CMV-related diseases and monitoring the virus load in patients with CMV infections.