Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in southern Turkey

Fetal Cytomegalovirus Infection in the Absence of Maternal Cytomegalovirus-IgM Seropositivity

The aim of this study was to evaluate maternal serological status and fetal sonographic findings of Cytomegalovirus (CMV) infection. This is a retrospective study performed at Perinatology Department of Istanbul Başakşehir Çam and Sakura City Hospital. A computerized search was conducted to identify cases who underwent prenatal diagnosis of fetal CMV infection between September 2020 and December 2023. We identified nine cases with fetal CMV infection. The clinical data of the patients, gestational age at the time of diagnosis, serological, sonographic findings, and pregnancy outcomes were analyzed. A computer search of the database was made for the seroprevalance of CMV-IgM and CMV-IgG in our population. The CMV-IgM and IgG results of the 1235 patients who underwent CMV screening in the first trimester between September 2020 and December 2023 were evaluated. Fetal CMV infection was identified in nine patients. None of the 9 cases showed maternal CMV-IgM positivity. Seven of the 9 patients showed high IgG avidity index. Pregnant population had 98 % positivity for CMV-IgG. The evaluation of serologic tests for CMV is not straightforward in the second and third trimester. IgM and IgG avidity should be interpreted with caution in the second and third trimester. In the presence of ultrasound findings suggesting fetal CMV infection and CMV-IgG positivity, invasive diagnostic tests rather than serological test should be discussed with the patient, and non-primary infections should always be considered to minimize overlooked fetal cytomegalovirus infections and missed antiviral treatment opportunity.

Genetic characterization of Toxoplasma gondii strains isolated from humans living in İzmir, Türkiye

PURPOSE

Toxoplasma gondii is an obligate intracellular zoonotic parasite that can infect all warm-blooded animals, including humans. Currently, clinical findings of toxoplasmosis are being related to T. gondii strains such as Type I genotype may cause high pathogenicity and Type II genotype causes a milder clinical presentation. We have showed in our previous that Type II genotype is the most frequent strain detected in stray cats and wild birds living in natural life of İzmir. The aim of this study was to assess toxoplasmosis seroprevalence in immunocompromised patients, investigate the presence of T. gondii DNA in their blood samples, and genotype the PCR positive ones.

METHODS

The 42 buffy-coat and serum samples were collected from immunocompromised patients who were from various clinics. Thereafter, Real-Time PCR targeting RE gene of T. gondii was performed with DNA samples obtained from buffy-coat samples. Genotyping was performed by sequencing of GRA6 and GRA7 gene regions of positive DNA samples obtained from tissues of bioassay and PCR positive samples.

RESULTS

According to Real-Time PCR results, T. gondii DNA was detected in 23.8% (10/42) samples. Among these 10 samples, two samples were determined as T. gondii Type II genotype. Anti-Toxoplasma IgG antibodies were detected in 28.57% (12/42) samples.

CONCLUSIONS

Overall, the detection of Type II genotype in humans in İzmir province suggested that T. gondii infection in humans, stray cats, and wild animals may be associated to each other in terms of transmission.

Seroprevalence of Toxoplasma gondii infections in Syrian pregnant refugee women in Turkey

OBJECTIVE

Congenital infections in refugee women have been very rarely studied. The purpose of this study is to investigate the Toxoplasma gondii (T. gondii) seroprevalence in Syrian pregnant refugee women living in Turkey and to discuss the differences with Turkish pregnant women.

STUDY DESIGN

This is a retrospective cohort study including 752 pregnant refugee women and is based on the nine-year data of a reference public hospital in Ankara.

RESULTS

In the study group, T. gondii immunoglobulin G (IgG) and immunoglobulin M (IgM) seropositivity rates were 47 % and 0.4 %, respectively. Compared with a recent study conducted in the same center on Turkish native pregnant women, there was a significant difference in IgG seropositivity and no significant difference in IgM seropositivity.

CONCLUSION

Due to the seroprevalence difference between the indigenous and refugee groups, the Syrian refugee women has to be specifically considered in the prevention of congenital toxoplasmosis infections in Turkey.

Seroprevalences of antibodies against ToRCH infectious pathogens in women of childbearing age residing in Brazil, Mexico, Germany, Poland, Turkey and China

Determination of antibodies against ToRCH antigens at the beginning of pregnancy allows assessment of both the maternal immune status and the risks to an adverse pregnancy outcome. Age-standardised seroprevalences were determined in sera from 1009 women of childbearing age residing in Mexico, Brazil, Germany, Poland, Turkey or China using a multiparametric immunoblot containing antigen substrates for antibodies against Toxoplasma gondii, rubella virus, cytomegalovirus (CMV), herpes simplex viruses (HSV-1, HSV-2), Bordetella pertussis, Chlamydia trachomatis, parvovirus B19, Treponema pallidum and varicella zoster virus (VZV). Seroprevalences for antibodies against HSV-1 were >90% in samples from Brazil and Turkey, whereas the other four countries showed lower mean age-adjusted seroprevalences (range: 62.5-87.9%). Samples from Brazilian women showed elevated seroprevalences of antibodies against HSV-2 (40.1%), C. trachomatis (46.8%) and B. pertussis (56.6%) compared to the other five countries. Seroprevalences of anti-T. gondii antibodies (0.5%) and anti-parvovirus B19 antibodies (7.5%) were low in samples from Chinese women, compared to the other five countries. Samples from German women revealed a low age-standardised seroprevalence of anti-CMV antibodies (28.8%) compared to the other five countries. These global differences in immune status of women in childbearing age advocate country-specific prophylaxis strategies to avoid infection with ToRCH pathogens.

Evaluation of Toxoplasma, Rubella, and Cytomegalovirus serological results in women of childbearing age

OBJECTIVE This study aimed to determine the rates of IgG and IgM antibodies against cytomegalovirus, rubella, and Toxoplasma gondii (all of which may cause congenital infections) in women of childbearing age who were admitted to Bolu Abant İzzet Baysal University Training and Research Hospital. METHODS Between January 2015 and December 2017, Toxoplasma gondii, rubella, and cytomegalovirus IgM and IgG antibody levels were studied using the ELISA method (Architect i2000SR, Abbott, Germany) in patients aged 15 to 45 who attended the obstetrics and gynecology outpatient clinics. Toxoplasma gondii and cytomegalovirus IgG avidity levels were analyzed retrospectively. RESULTS A total of 13.470 tests were conducted in the laboratory. Seropositivity percentages of IgM antibodies were found to be 1.3%, 0.5%, and 1.6% for Toxoplasma (n = 3607), rubella (n = 3931), and cytomegalovirus (n = 3795), respectively. The seropositivity percentages of IgG antibodies were 22%, 94.2%, and 98.2% for Toxoplasma (n = 702), rubella (n = 693), and cytomegalovirus (n = 679), respectively. Primary infection (acute, recently acquired) was found in 7 (35%) patients with low Toxoplasma IgG avidity. One (3%) patient with low cytomegalovirus IgG avidity had a primary infection. CONCLUSION Toxoplasma gondii seronegativity was found to be high in the region. Therefore, screening women of childbearing age may be important for the prevention of congenital infections caused by Toxoplasma gondii.

Thirty years of CMV seroprevalence-a longitudinal analysis in a German university hospital

Human cytomegalovirus (CMV) is a significant cause of morbidity and mortality in patient groups at risk. We have previously shown that the anti-CMV IgG seroprevalence in an urban region of Germany has changed over the last decades. Overall, a decline from 63.7 to 57.25% had been observed between 1988–1997 and 1998–2008 (p < 0,001). Here, we continuously follow the trends to the most recent decade 2009 to 2018. In a retrospective analysis, we determined the seroprevalence of CMV IgG antibodies in our patient cohort, stratified by gender and selected groups at risk (e.g., patients with HIV infection; women of childbearing age). The overall prevalence of anti-CMV IgG non-significantly declined further from 57.25% in 1998–2008 to 56.48% in 2009–2018 (p = 0.881). Looking at gender differences, overall CMV seroprevalence in males declined to 52.82% (from 55.54% in 1998–2008; p = 0.0254), while it non-significantly increased in females to 59.80%. The high seroprevalence in patients with a known HIV infection further increased from 87.46% in 1998–2008 to 92.93% in the current period (p = 0.9999). In women of childbearing age, no significant changes over the last three decades could be observed. The CMV seroprevalence in oncological patients was determined to be 60.64%. Overall, the former significant decline of CMV seroprevalence between the decades 1988–1997 and 1998–2008 in this urban region of Germany slowed down to a non-significant decrease of 0.77% (1998–2008 vs. 2009–2018). This might be an indicator that CMV seroprevalence has reached a plateau.

A review of toxoplasmosis in humans and animals in Turkey

Infections by the protozoan parasite Toxoplasma gondii are widely prevalent in humans and animals in Turkey but little is known of the burden of their clinical toxoplasmosis. Many early papers on toxoplasmosis in Turkey were published in Turkish and often not available widely. Here, we review prevalence, clinical spectrum, epidemiology and diagnosis of T. gondii in humans and animals in Turkey. This knowledge should be useful to biologists, public health workers, veterinarians and physicians. Although one-third of the human population in Turkey is seropositive, the rate of congenital toxoplasmosis is unknown and no information is available in children 12 years old or younger. One large outbreak of acute toxoplasmosis has been reported in 14–18-year old school children in Turkey. An alarming rate (36%) of T. gondii tissue cysts were reported in tissues of sheep and water buffalo meats destined for human consumption; these reports require verification. Genetically, T. gondii strains from domestic cats and wild birds in Turkey were generally classical type II and III, like those prevalent in Europe. A separate genotype, Type 1 Africa, was isolated from two congenitally infected children and a domestic cat in Turkey.

B S, H.S A, Kabbashi AS. Cytokines Level (Il8 and Il17) in Pregnant Women with Toxoplasmosis in Khartoum State

Toxoplasmosis is one of the most important zoonotic diseases worldwide caused by Toxoplasma gondii that leads to abortion or hydrocephalus during pregnancy. It’s a comparative cross-sectional one designed to assess immunoglobulins and cytokines in pregnant women. A total of 300 venous blood samples were collected from each pregnant woman and centrifuged to obtain serum. Patient’s information was recorded in a questionnaire previously designed for the purpose of analysis. In addition, 40 uninfected women were enrolled in the study as control group to assess the level of IL8 and IL17 cytokines. The overall seropositive rate of Toxoplasma gondii infection was 22.6%. Within the positive cases of study population, only 16 and 13 showed positive results of IL8, IL17 respectively. The results showed highly significant increase in the mean serum level of IL8 (210.25pg/ml) and IL17 (203.15 pg/ml) when compared to the control group who showed 68.9 pg/ml and 54.8 pg/ml respectively. The serum level of proinflammatory cytokines investigated in this study seems to be increased in patients with serological evidence of Toxoplasma gondii infection. Our study concludes that IL-17 and IL-8 involved in the induction of inflammation and toxoplasmosis disease.

Seroprevalence of Toxoplasma gondii and its associated risk factors among women of reproductive age in Saudi Arabia: a systematic review and meta-analysis

Toxoplasma gondii (T. gondii), which infects many warm-blooded animals including humans, causes toxoplasmosis, a globally widespread condition. To date, no research has explored the overall T. gondii infection seroprevalence among women in Saudi Arabia, nor have the risk factors associated with the infection been examined in the Saudi Arabian context. The present systematic review and meta-analysis therefore aimed to investigate toxoplasmosis seroprevalence based on previous study samples of Saudi women of reproductive age, and to establish the potentially risk factors in this national context. PubMed, Science Direct, and Scopus were searched for studies on T. gondii seroprevalence among women in mainland Saudi Arabia published between January 2000 and December 2017. Seroprevalence with 95% CI was presented for each study, and point estimates and their 95% CIs of pooled seroprevalence were then calculated. Twenty papers were eligible for inclusion, with samples totaling 13,597 females of childbearing age (ie, between 15 and 49 years) covering various regions of Saudi Arabia. The pooled estimation for T. gondii prevalence using a random-effect model was calculated as 27.8% (95% CI =20.6%–36.3%). A significant association was observed between age and T. gondii seroprevalence. This review represents the first comprehensive and systematic evaluation of T. gondii infection seroprevalence among Saudi Arabian women, and reports a high prevalence of Toxoplasma infection. Further research is required to support the development of more cost-effective preventive strategies.

Activation of toxoplasma retinochoroiditis during pregnancy and evaluation of ocular findings in newborns

The purpose of this study was to evaluate patients with activation of toxoplasma retinochoroiditis during pregnancy and ocular findings in newborns. A total of 17 pregnant patients who were clinically and serologically diagnosed with ocular toxoplasmosis were retrospectively reviewed. After birth, ocular findings for all infants were recorded. The mean age of the patients was 29.08 ± 5.71 years. In all cases, activation was present in only one eye. In 13 cases, anterior uveitis was associated with posterior uveitis. Visual acuity in all cases prior to treatment was 0.3 ± 0.21 and increased to 0.55 ± 0.29 after treatment. The mean gestational age of the patients was 19.76 ± 8.71 weeks at the time of hospital admission. No case of toxoplasmic ocular involvement was identified in the infants on postnatal examination. In the case of toxoplasma retinochoroiditis during pregnancy, appropriate treatment and follow-up is very important to protect the newborns and to prevent impaired vision in mothers.

Systematic Review of Measles and Rubella Serology Studies

Serological tests provide information about individual immunity from historical infection or immunization. Cross-sectional serological studies provide data about the age- and sex-specific immunity levels for individuals in the studied population, and these data can provide a point of comparison for the results of transmission models. In the context of developing an integrated model for measles and rubella transmission, we reviewed the existing measles and rubella literature to identify the results of national serological studies that provided cross-sectional estimates of population immunity at the time of data collection. We systematically searched PubMed, the Science Citation Index, and references we identified from relevant articles published in English. We extracted serological data for comparison to transmission model outputs. For rubella, serological studies of women of child-bearing age provide information about the potential risks of infants born with congenital rubella syndrome. Serological studies also document the loss of maternal antibodies, which occurs at different rates for the different viruses and according to the nature of the induced immunity (i.e., infection or vaccine). The serological evidence remains limited for some areas, with studies from developed countries representing a disproportionate part of the evidence. The collection and review of serological evidence can help program managers identify immunity gaps in the population, which may help them better understand the characteristics of individuals within their populations who may participate in transmission and manage risks.

Distribution of Cytomegalovirus Genotypes among Neonates Born to Infected Mothers in Islamabad, Pakistan

Background

Congenital cytomegalovirus (cCMV) infection contributes to considerable long-term sequelae in neonates and children all over the world. The association between viral genotypes and severity of clinical cytomegalovirus (CMV) infection is yet to be defined. The objective of this study was to find the impact of active CMV infection during pregnancy and the clinical significance of genotypes in neonates with congenital cytomegalovirus infections in Pakistan.

Methods

A total of 409 blood samples from pregnant women seeking health care services at the two antenatal hospitals of Islamabad during January to December 2012 were tested by ELISA and nested-PCR. Pregnant women with active infection (detected as IgM positive, PCR positive or positive on both assays) were followed until delivery, to detect the outcome of overt cCMV infection in neonates. Genetic characterization of CMV strains was performed by sequence analysis of envelope glycoproteins: gB, gN and gH to detect the contributing CMV genotypes.

Results

The seroprevalence of anti-CMV IgG and IgM was 97.5% (399 out of 409) and 12.7% (52 out of 409), respectively, while 20% (82/409) pregnant women were found positive for CMV DNA by PCR. Logistic regression analysis showed a significant association of active infection with parity [OR = 2.56, 95% CI = 1.82–2.62, p = 0.04], febrile illness [OR = 1.84, 95% CI = 1.76–3.65, p = 0.01] and jaundice [OR = 22.5, 95% CI = 4.53–85.02, p = 0.002]. We were able to isolate virus in 41 out of 70 neonates; 36.6% (15 out of 41) of them were symptomatic at birth while 63.4% (26 out of 41) were asymptomatic. The most prominent clinical feature observed in symptomatic neonates was hepatosplenomegaly (26.6%; 4 out of 15). All three genotypes gB, gN and gH were found with the highest frequency of gB1 genotype, found in 75% infants with hepatic damage. Phylogenetic analysis of Pakistani strains showed 96%-100% homology to their prototype strains.

Conclusions

Active CMV infection during pregnancy is a major cause of congenital CMV infection with comparable distribution of all three genotypes: gB, gN and gH in symptomatic and asymptomatic neonates. Our findings emphasize to conduct a comprehensive large scale survey and introduction of country wide routine screening at maternity clinics for early diagnosis of CMV to reduce its associated devastating outcomes.

Seroprevalence of toxoplasmosis in diabetic pregnant women in southwestern of Iran

To investigate anti-Toxoplasma gondii IgG and IgM antibodies in diabetic pregnant women in Ahvaz, southwest of Iran this experiment was performed. In current study the sera of 110 diabetic pregnant women as well as 110 non diabetic pregnant women referred to the hospitals affiliated with the Ahvaz Jundishapur University of Medical Sciences were assessed for anti-T. gondii IgG and IgM antibodies by ELISA and IFA methods. The ELISA assessments showed that 47 (42.7 %) and 3 (2.7 %) of diabetic women were positive for IgG and IgM antibodies, respectively. However, in the control group, 24 individuals (21.81 %) were positive for IgG antibody but no detection for IgM antibody. According to IFA method, 46 (41.8 %) and 3 (2.7 %) of diabetic women were positive for IgG and IgM antibodies, respectively, while in control group, 21 individuals (19.09 %) were positive for IgG antibody. In this method, IgM antibody was negative for all samples of control group (0 %). In both methods, the values obtained in the case group were significantly higher than those in the control group (p < 0.05). Prevalence of anti-Toxoplasma IgG and IgM antibodies in diabetic pregnant women was higher than that in non-diabetic pregnant women. It seems that screening tests for seeking patients and teaching the transmission routes should be considered as prenatal cares for diabetic women.

TORCH seroprevalence among patients attending Obstetric Care Clinic of Haydarpasa Training and Research Hospital affiliated to Association of Istanbul Northern Anatolia Public Hospitals

OBJECTIVE

Toxoplasma gondii, Rubella, Cytomegalovirus and Herpes simplex viruses are microorganisms that cause congenital infections and they are called briefly as TORCH. There is an ongoing argument for the screening of reproductive age women due to the high cost of tests. For a test to be used in screening, prevalence of disease in this population should be known. The aim of this study was to investigate TORCH seroprevalence among women attending a teaching hospital in Istanbul.

METHODS

A total of 1101 patients attending outpatient clinic of Obstetric Care Clinic of Haydarpasa Training and Research Hospital affiliated to Association of Istanbul Northern Anatolia Public Hospitals between September 2013 to January 2015 and their laboratory data were evaluated retrospectively. We investigated Ig G and M seropositivity rates against TORCH.

RESULTS

The age of the patients ranged between 17-47 years with a mean age of 30.3±5.8 years. Pregnant population had 99.5% anti-CMV Ig G (+), 94.2% anti-Rubella Ig G (+), 31% anti-Toxoplasma Ig G (+). Seroprevalence for Anti IgM was 0.5% for CMV, 0.2% for rubella.

CONCLUSION

The screening for Toxoplasma gondii may be suggested since the prevalence is not high in our population. The screening of CMV is not meaningful, due to high seroprevalence. Although seroprevalence of rubella is also high, it may be suggested for preconception vaccination especially in women above 20 years of age born prior to National Vaccination Programme.

Seroprevalence of Toxoplasma gondii, rubella and Cytomegalovirus among pregnant females in north-western Turkey

OBJECTIVE

To examine the sera-prevalence rates of Toxoplasma gondii, rubella and Cytomegalovirus (CMV) among pregnant women in different age groups in the context of a comparison with nationwide and international data previously reported.

METHODS

Females of reproductive age attending to our hospital between 1 January 2012 and 1 January 2014 were included in this study. Antibodies against T gondii;~, rubella and CMV were assayed using chemiluminescence immunoassay methods. The test results.were evaluated retrospectively.

RESULTS

Of the participants, 2.5 and 43.9% were seropositive for Toxoplasma lgM and lgG, respectively. The corresponding figures for rubella and CMV were 1.5 and 93.8%, and 2 and 91.5%, respectively.

CONCLUSION

The high rates of immunity against rubella and CMV infections among pregnant females in our region call into question the routine screening of pregnant females for these two diseases. On the other hand, the high rate of seronegativity for T gondii warrants such a routine practice.

Seroprevalence of Toxoplasma, Rubella, and Cytomegalovirus among pregnant women in Van

OBJECTIVE

To determine the seroprevalence of anti-Toxoplasma, anti-Rubella, and anti-Cytomegalovirus (CMV) antibodies among pregnant women receiving prenatal care at Van Training and Research Hospital.

MATERIALS AND METHODS

In developing countries, various infectious agents encountered in the gestational period are important because they influence both maternal and fetal health. Among these, Toxoplasma gondii, Rubella and CMV are quite prevalent. In the present study, anti-Toxoplasma, anti-Rubella and anti-CMV antibodies were analyzed in the serum samples obtained from women receiving prenatal care at Van Training and Research Hospital between June 2012 and July 2013, and positive serum samples were retrospectively evaluated. Anti-Toxoplasma, anti-Rubella and anti-CMV antibodies were analyzed using ELISA with Cobas 4000 e411 (Roche, Germany) and Architect i2000SR (Abbott Diagnostics, Germany) analyzers.

RESULTS

Over the course of the study period, the results of a total of 9809 patients were investigated in terms of anti-Toxoplasma, anti-Rubella, and anti-CMV antibodies. Anti-Toxoplasma, anti-Rubella, and anti-CMV IgM and IgG antibody positivity rates were 1.1%, 0.5% and 2.6%, and 37.6%, 86.5% and 100%, respectively.

CONCLUSION

Anti-Toxoplasma IgG antibody positivity rates determined in the present study were lower as compared with the results of the other studies reported from Turkey. However, CMV IgM and IgG antibody positivity rates were be higher as compared with those reported in the literature.

High seropositivity of IgG and IgM antibodies against cytomegalovirus (CMV) among HIV-1 seropositive patients in Ilorin, Nigeria

BACKGROUND

Human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) is a major public health problem in sub-saharan Africa. Cytomegalovirus (CMV) has been reported to enhance HIV replication and accelerate the progression of HIV infection to AIDS.

OBJECTIVE

This study reports on the high seropositivity of immunoglobulin (Ig) G and M antibodies against CMV and the risk factors for CMV infection among HIV/AIDS patients in Ilorin, Nigeria.

METHOD

A total of 180 consented HIV-1 seropositive patients (age-range 16-56 years; 108 females and 72 males) were consecutively recruited. Socio-demographic/behavioral data and 5 ml blood samples were collected from each patient. Plasma of each sample was assayed for anti-CMV IgG/IgM using a CMV IgG and IgM Enzyme Linked ImmunoSorbent Assay (ELISA) kit.

RESULTS

Twenty (11.1%) of the 180 HIV-1 seropositive subjects were positive for anti-CMV IgM antibody while 169(93.9%) were positive for anti-CMV IgG antibody. Age, marital status, number of sexual partners, CD4 cells counts and previous history of blood transfusion were the main correlates of CMV seropositivity among these patients. However, occupation, sex, highly active antiretroviral therapy (HAART) were not statistically associated with CMV seropositivity in this study.

CONCLUSION

This study has shown that greater percentages of HIV-1 seropositive patients had active CMV infection. It has further shown that CMV is hyperendemic in HIV-1 seropositive patients in Ilorin, Nigeria.

Cytomegalovirus disease in patients with glomerular diseases treated by immunosuppressive treatment

PURPOSE

Cytomegalovirus (CMV) infection is an important complication in organ and bone marrow recipients as well as patients infected with HIV. Although screening and prophylaxis have been defined in these patients, there are few data about the frequency of CMV disease in glomerular diseases treated by immunosuppression.

METHODS

We recruited 133 patients with glomerular diseases treated by immunosuppression between 2006 and 2013. Patients who had any symptoms suggestive of CMV disease were screened for viral DNA. Immunosuppressive treatments were as follows: Group 1, steroid only; Group 2, steroid with cyclophosphamide (CP); Group 3, steroid with cyclosporine A; and Group 4, steroid with mycophenolate mofetil or azathioprine.

RESULTS

Patients developing CMV and non-CMV disease were compared for age, sex, renal pathology, hypertension, diabetes, baseline creatinine, and estimated glomerular filtration rate, and immunosuppressive regimen. At follow-up, 55 patients were tested for CMV disease during immunosuppressive treatment. Twenty-six patients had CMV DNA positivity of 1,112-205,500 copies/mL. Patients with CMV disease were all seen within the first 5 months of immunosuppressive treatment, and the disease was observed most commonly (14 patients, 53 %) in the first 2 months of treatment. Multiple regression analysis revealed that high baseline creatinine levels, older age, and use of steroids with CP were independent risk factors for development of CMV disease.

CONCLUSIONS

CMV disease is not an uncommon complication in patients with glomerular diseases treated by immunosuppression. Further prospective studies and prophylaxis should be addressed in future studies, including particular groups of patients.

Impact of socioeconomic risk factors on the seroprevalence of cytomegalovirus infections in a cohort of pregnant Polish women between 2010 and 2011

The purpose of this investigation was to perform an evaluation of the prevalence and socioeconomic risk factors for human cytomegalovirus (HCMV) infections in a cohort of Polish pregnant women between 2010 and 2011. HCMV-specific IgG and IgM antibody levels were assayed with enzyme-linked immunosorbent assay (ELISA) tests in serum samples collected from 1,250 pregnant women attending outpatient obstetric clinics and hospitalized at two hospitals in Lodz. The seroprevalence of anti-HCMV IgG and IgM antibodies was 62.4 and 2.2 %, respectively, and differed significantly between age-stratified groups (p ≤ 0.05). The highest IgG prevalence was observed in women above 36 years of age (76.2 %) and IgM in adolescent women aged 16–20 years (6.0 %). Of the various socioeconomic factors, age above 36 years, basic and professional education, and offspring were significantly associated with HCMV IgG prevalence rates (PRs; 1.89, 1.80, and 1.56, respectively). Financial status, occupational risk related to contact with children, and transfusions were not related to the prevalence of IgG antibodies. The IgM prevalence was not associated with any of the analyzed risk factors. A slightly higher prevalence was observed in women who were transfused in the past, but the relationship was not significant. The current data have revealed a decrease in HCMV IgG seroprevalence in our region during recent years (62.4 vs. 76.7 %). Basic and professional education, as well as bringing up offspring, were determined as significant risk factors for HCMV infections in Polish pregnant women [risk ratio (RR) 1.20 and 1.17, respectively], suggesting that the primary and secondary prophylaxis of cytomegaly is necessary during pregnancy, even if screening is not mandatory.

The role of maternal screening in diagnosing congenital cytomegalovirus infections in highly immune populations

BACKGROUND

Congenital cytomegalovirus (CMV) infection is the most important infectious cause of central nervous system disease and hearing loss in children.

AIMS

In this study, we aimed to investigate the role of maternal screening in early diagnosis of congenital infection in highly immune populations.

METHODS

A total of 163 women were included in the study; 103 of the subjects were pregnant and were at full term. The other 60 women were not pregnant, and all were healthy.

RESULTS

CMV IgG seropositivity among the pregnant and control groups was found to be 98.1% (101/103) and 98.3% (59/60), respectively, and high IgG avidity was found in all women who had IgG positivity. We did not find any primary CMV infection in the two groups. The recurrent infection rate was found to be 5.82% in the pregnant group and 3.33% in the control group. There were no significant differences between the pregnant and control women in terms of CMV excretion in urine samples (4.85 vs. 3.33%, respectively; P = 1.000) or CMV-DNA presence in serum samples (1.94 vs. 0.0%, respectively; P = 0.532). The presence of symptomatic infection was not observed in any of the 104 babies born from the 103 pregnancies.

CONCLUSIONS

According to our results, a maternal screening-based approach would be useful for only a very small group that is at risk of primary infection. Considering the cost of the scan, a routine maternal-based screening program is unadvisable in developing societies, but it is necessary for studies of different cohort groups and infectious diseases.

Diagnosis of congenital cytomegalovirus antigenemia by immunohistochemical detection of immediate early antigen

Cytomegalovirus (CMV) can be a cause of fetal morbidity and mortality among approximately 1% of pregnancies. With an aim to detect CMV antigenemia among 51 pregnant women with/without clinically diagnosed abnormalities and intrauterine growth retardation (IUGR) maternal and fetal samples either prenatal (n:22) or postpartum (n:29) were obtained between 17-42 weeks of gestation to analyze anti-CMV IgG, IgM antibodies and cytoplasmic or nuclear CMV antigens. Cytoplasmic and nuclear CMV antigenemia was detected among 19.6% and 11.8% of maternal samples. These values were 29.4% and 17.6% for fetal samples. Among both maternal and fetal samples, there was a 100% correlation when IgG and IgM were negative. The correlation for IgG and IgM positivity was not present among maternal samples since cytoplasmic (37.5%) and nuclear (25%) antigens could not be demonstrated in spite of immunity. Cytoplasmic and nuclear CMV antigens were detected within fetal samples from subjects presenting maternal immunoglobulin positivity, clinical abnormality and clinically normal findings (50, 32, 16.7% and 50, 16, 5.6%) respectively. In conclusion, immunocytochemical detection of CMV antigenemia improves CMV infection diagnosis which may be associated with clinical abnormalities/IUGR.

Seroprevalence of toxoplasmosis and rubella in pregnant women attending antenatal private clinic at Ouagadougou, Burkina Faso

OBJECTIVE

To evaluate the prevalence of toxoplasmosis and rubella among pregnant women at Ouagadougou in Burkina Faso.

METHODS

All patient sera were tested for rubella and toxoplasmosis anti-IgG using commercial ELISA kits (Platelia™ Rubella IgG and Platelia™ Toxo IgG). The presence of anti-rubella and anti-toxoplasmosis IgM in serum samples was tested using commercial ELISA kits Platelia Rubella IgM and Platelia Toxo IgM.

RESULTS

Among all the pregnant women tested for toxoplasmosis and rubella, their prevalence were 20.3% and 77.0%, respectively. Pregnant women in the age group of 18-25 years showed the highest frequency of anti-toxoplasmosis (34.5%) and anti-rubella IgG (84.6%). The prevalence of anti-toxoplasma and anti-rubella IgG decreased between 2006 and 2008 from 32.7% to 12.1% and 84.6% to 65.0%, respectively. There was no significant association between age and the mean titer of anti-toxoplasmosis IgG among pregnant women.

CONCLUSIONS

The diagnosis of toxoplasmosis and rubella is necessary in pregnant women in Burkina Faso because of the low immunization coverage rate of rubella and the high level of exposure to these two infections which can be harmful to the newborn if contracted by women before the third trimester of pregnancy.

Cytomegalovirus (CMV) seroprevalence in pregnant women, bone marrow donors and adolescents in Germany, 1996-2010

In Germany, studies on the IgG seroprevalence in pregnancy and in women of childbearing age are rare. Therefore, we retrospectively evaluated the CMV IgG seropositive rate in 40,324 pregnant women as well as in 31,093 female and male bone marrow donors over 15 consecutive years (1996-2010). Furthermore, the result of a study conducted in 1999 investigating 1,305 healthy adolescents with known ethnicity was included. The overall CMV IgG seroprevalence in pregnant women (15-50 years) was 42.3%. Age-dependent analysis revealed a significantly higher seropositive rate (55.6%) in young women (15-25 years) than in those aged 26-40 years (37-42%) and in women older than 40 years (48.3%). Over the study period of 15 years, the rate of seroprevalence in pregnant women declined significantly (χ(2) test < 0.01) from 44.3% in the first interval period (1996-2000), to 42.8% (2001-2005) and to 40.9% (2006-2010). The most influencing factor on CMV seropositivity appeared to be the socioeconomic status (SES), which we characterized by type of health insurance: Seroprevalence in women with low, middle and upper SES was 91.8, 46.9 and 33.7%, respectively. Female bone marrow donors of childbearing age (15-45 years) showed a significantly higher seropositive rate of 36.5% than age-matched male donors (28.6%). In adolescents aged 13-16 years, no gender-specific differences were recognized. Concerning ethnicity, youngsters with German descent had a significantly lower seroprevalence (29.9%) than those with non-German descent (67.4%).

Epidemiology and aetiology of maternal bacterial and viral infections in low- and middle-income countries

BACKGROUND

Maternal morbidity and mortality in low- and middle-income countries has remained exceedingly high. However, information on bacterial and viral maternal infections, which are important contributors to poor pregnancy outcomes, is sparse and poorly characterised. This review aims to describe the epidemiology and aetiology of bacterial and viral maternal infections in low- and middle-income countries.

METHODS

A systematic search of published literature was conducted and data on aetiology and epidemiology of maternal infections was extracted from relevant studies for analysis. Searches were conducted in parallel by two reviewers (using OVID) in the following databases: Medline (1950 to 2010), EMBASE (1980 to 2010) and Global Health (1973 to 2010).

RESULTS

Data from 158 relevant studies was used to characterise the epidemiology of the 10 most extensively reported maternal infections with the following median prevalence rates: Treponema pallidum (2.6%), Neisseria gonorrhoeae (1.5%), Chlamydia trachomatis (5.8%), Group B Streptococcus (8.6%), bacterial vaginosis (20.9%), hepatitis B virus (4.3%), hepatitis C virus (1.4%), Cytomegalovirus (95.7% past infection), Rubella (8.9% susceptible) and Herpes simplex (20.7%). Large variations in the prevalence of these infections between countries and regions were noted.

CONCLUSION

This review confirms the suspected high prevalence of maternal bacterial and viral infections and identifies particular diseases and regions requiring urgent attention in public health policy planning, setting research priorities and donor funding towards reducing maternal morbidity and mortality in low- and middle-income countries.

Identification of potential serodiagnostic and subunit vaccine antigens by antibody profiling of toxoplasmosis cases in Turkey

Toxoplasmosis, caused by infection of the protozoan parasite Toxoplasma gondii, is associated with mild disease in healthy individuals, whereas individuals with depressed immunity may develop encephalitis, neurologic disorders, and other organ diseases. Women who develop acute toxoplasmosis during pregnancy are at risk of transmitting the infection to the fetus, which may lead to fetal damage. A diagnosis is usually confirmed by measuring IgG, or IgM where it is important to determine the onset of infection. A negative IgM result essentially excludes acute infection, whereas a positive IgM test is largely uninterpretable because IgM can persist for up to 18 months after infection. To identify antigens for improved diagnosis of acute infection, we probed protein microarrays displaying the polypeptide products of 1357 Toxoplasma exons with well-characterized sera from Turkey. The sera were classified according to conventional assays into (1) seronegative individuals with no history of T. gondii infection; (2) acute infections defined by clinical symptoms, high IgM titers, and low avidity IgG; (3) chronic/convalescent cases with high avidity IgG but persisting IgM; (iv) true chronic infections, defined by high avidity IgG and no IgM. We have identified 38 IgG target antigens and 108 IgM target antigens that can discriminate infected patients from healthy controls, one or more of which could form the basis of a 'tier-1' test to determine current or previous exposure. Of these, three IgG antigens and five IgM antigens have the potential to discriminate chronic/IgM persisting or true chronics from recent acutely infected patients (a 'tier-2' test). Our analysis of the antigens revealed several enriched features relative to the whole proteome, which include transmembrane domains, signal peptides, or predicted localization at the outer membrane. This is the first protein microarray survey of the antibody response to T. gondii, and will help in the development of improved serodiagnostics and vaccines.

Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns: 2007-2008

BACKGROUND

Human cytomegalovirus (HCMV) has established itself as the most significant cause of congenital infection in the developed world. The objective of this research was prenatal identification of pregnant women at risk for developing active infection due to HCMV as well as to diagnose congenitally infected newborns.

METHODS

A diagnostic algorithm based on specific immunoglobulin G (IgG), IgM, and, IgG avidity was used to screen serum from 1131 pregnant women enrolled prospectively from 3 municipalities from Havana City, Cuba during 2007-2008. Qualitative multiplex nested PCR and quantitative real time-based PCR testing for HCMV DNA were performed on urine and saliva specimens from women detected with active infection and from their newborns.

RESULTS

Most women were seropositive to HCMV (92.7%), with 2.38% (27 women) having active infection. Primary infection was detected in 20 pregnant women (1.77%) while 7 patients (0.62%) had active nonprimary infection. HCMV DNA was detected in specimens from 9 of the 27 pregnant women by both PCR methods. HCMV congenital infection was diagnosed in 12 (1.06%) of the 26 live children born from 25 mothers with active infection, for a vertical transmission rate of 46.2%. Two fetal deaths were reported from 2 women with active infection; furthermore 2 newborns were symptomatic at birth and 2 showed sequelae during the follow-up done until 6 months age.

CONCLUSIONS

Mothers with active infection during the pregnancy and with HCMV excretion had significant risks, RR = 1.16 and RR = 1.35, respectively, to have congenitally infected children.

Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection

Cytomegalovirus establishes a lifelong latent infection following primary infection that can periodically reactivate with shedding of infectious virus. Primary infection, reactivation and reinfection during pregnancy can all lead to in utero transmission to the developing fetus. Congenital CMV infections are a major cause of permanent hearing loss and neurological impairment. In this literature review, we found that CMV infection was relatively common among women of reproductive age, with seroprevalence ranging from 45 to 100%. CMV seroprevalence tended to be highest in South America, Africa and Asia and lowest in Western Europe and United States. Within the United States, CMV seroprevalence showed substantial geographic variation as well, differing by as much as 30 percentage points between states, though differences might be explained by variation in the types of populations sampled. Worldwide, seroprevalence among non-whites tended to be 20-30 percentage points higher than that of whites (summary prevalence ratio (PR) = 1.59, 95% confidence interval (CI) = 1.57-1.61). Females generally had higher seroprevalences than males, although in most studies the differences were small (summary PR = 1.13, 95% CI = 1.11-1.14). Persons of lower socioeconomic status were more likely to be CMV seropositive (summary PR = 1.33, 95% CI = 1.32-1.35). Despite high seroprevalences in some populations, a substantial percentage of women of reproductive age are CMV seronegative and thus at risk of primary CMV infection during pregnancy. Future vaccine or educational campaigns to prevent primary infection in pregnant women may need to be tailored to suit the needs of different populations.

Seroprevalence of TORCH infections in women of childbearing age in Croatia

During 2005-2009, a seroepidemiological study was carried out in Croatia to define the population susceptible to common TORCH agents among pregnant and non-pregnant women of childbearing age. The IgG seroprevalence was 29.1% forT. gondii, 94.6% for rubella, 75.3% for cytomegalovirus (CMV), 78.7% for herpes simplex virus type 1 (HSV-1), and 6.8% for HSV-2. Acute toxoplasmosis and CMV infection (positive IgM antibodies with low IgG avidity) were documented in 0.25% and 0.09% women, respectively. IgM prevalence was 1.2% for both HSV-1 and HSV-2. None of the participants showed acute rubella infection. Seropositivity to T. gondii and HSV-2 varied significantly between age groups (p = 0.001 and p = 0.036, respectively). Women residing in rural regions showed a significantly higher seroprevalence rate for T. gondii, CMV, and HSV-1 than urban women (T. gondii: 44.0% vs. 25.4%, p < 0.001; CMV: 85.0% vs. 73.1%, p = 0.018; HSV-1: 86.0% vs. 76.4%, p = 0.041).

Toxoplasmosis snapshots: global status of Toxoplasma gondii seroprevalence and implications for pregnancy and congenital toxoplasmosis

Toxoplasma gondii's importance for humans refers mainly to primary infection during pregnancy, resulting in abortion/stillbirth or congenital toxoplasmosis. The authors sought to evaluate the current global status of T. gondii seroprevalence and its correlations with risk factors, environmental and socioeconomic parameters. Literature published during the last decade on toxoplasmosis seroprevalence, in women who were pregnant or of childbearing age, was retrieved. A total of 99 studies were eligible; a further 36 studies offered seroprevalence data from regions/countries for which no data on pregnancy/childbearing age were available. Foci of high prevalence exist in Latin America, parts of Eastern/Central Europe, the Middle East, parts of south-east Asia and Africa. Regional seroprevalence variations relate to individual subpopulations' religious and socioeconomic practices. A trend towards lower seroprevalence is observed in many European countries and the United States of America (USA). There is no obvious climate-related gradient, excluding North and Latin America. Immigration has affected local prevalence in certain countries. We further sought to recognise specific risk factors related to seropositivity; however, such risk factors are not reported systematically. Population awareness may affect recognition of said risks. Global toxoplasmosis seroprevalence is continuingly evolving, subject to regional socioeconomic parameters and population habits. Awareness of these seroprevalence trends, particularly in the case of women of childbearing age, may allow proper public health policies to be enforced, targeting in particular seronegative women of childbearing age in high seroprevalence areas.