Cytomegalovirus infection anong infants admitted to a paediatric department

Review of cytomegalovirus shedding in bodily fluids and relevance to congenital cytomegalovirus infection

Congenital cytomegalovirus (CMV) infections are a leading cause of sensorineural hearing loss (SNHL) and neurological impairment. Congenital transmission of CMV can occur with maternal primary infection, reactivation, or reinfection during pregnancy. We reviewed studies of CMV shedding in bodily fluids (defined as CMV detected by culture or CMV DNA detected by polymerase chain reaction). Following diagnosis at birth, children with congenital CMV infection exhibited the highest prevalences of CMV shedding (median = 80%, number of sample population prevalences [N] = 6) and duration of shedding, with a steep decline by age five. Healthy children attending day care shed more frequently (median = 23%, N = 24) than healthy children not attending day care (median = 12%, N = 11). Peak shedding prevalences in children occurred at 1-2 years of age, confirming that young children are the key transmission risk for pregnant women. CMV shedding among children was more prevalent in urine specimens than in oral secretions (median prevalence difference = 11.5%, N = 12). Adults with risk factors such as STD clinic attendance had higher shedding prevalences (median = 22%, N = 20) than adults without risk factors (median = 7%, N = 44). In adults with risk factors, CMV was shed more frequently in urine; in adults without risk factors genital shedding was most common. The prevalence of CMV shedding in nine sample populations of pregnant women increased with advancing gestation. In seven sample populations of children with congenital CMV infection, higher viral load at birth was consistently associated with an elevated risk of SNHL. Higher CMV viral load at birth also consistently correlated with the presence of symptoms of congenital CMV at birth. Published 2011. This article is a US Government work and is in the public domain in the USA.

Respiratory tract infections in cytomegalovirus-excreting and nonexcreting infants

BACKGROUND

There is evidence of an immunosuppressive effect of cytomegalovirus (CMV), and CMV has been claimed to be a copathogen in respiratory tract infections (RTI). We therefore studied the significance of CMV viral load in infants with RTI, compared the frequency of infection with respiratory viruses and followed the course of RTI in CMV-excreting vs. nonexcreting infants.

METHODS

We examined 201 infants consecutively admitted to the Department of Pediatrics for RTI. At admission nasopharyngeal aspirates, throat swabs and urine were examined for CMV, and nasopharyngeal aspirates were examined for respiratory viruses.

RESULTS

In these patients 23.3% had CMV in the urine, 15.3% had CMV in the throat and 10.9% had CMV in the nasopharynx; 26.2% excreted CMV in at least one site. No relationship was found between CMV viral load and clinical symptoms. Infection with respiratory viruses was as common in infants excreting CMV as in nonexcreting infants. Symptoms and the course of infection were not different in the two groups except that CMV-excreting infants had a significantly higher frequency of rhonchi at admission (P = 0.007) and a tendency for longer duration of cough (P = 0.06).

CONCLUSION

CMV viral load was not related to clinical symptoms. The frequency of infection with common respiratory viruses in infants was independent of CMV excretion. The course of infection was not more complicated in infants excreting CMV; however, a higher frequency of rhonchi was demonstrated in patients with CMV.

Improvement of serological diagnosis of neonatal cytomegalovirus infection by simultaneously testing for specific immunoglobulins E and M by antibody-capture enzyme-linked immunosorbent assay

This study describes the results of testing 92 serum samples, including 10 umbilical cord serum samples, from 38 cytomegalovirus (CMV)-infected neonates for CMV-specific immunoglobulins E (IgE) and M by antibody-capture enzyme-linked immunosorbent assays with enzyme-labeled CMV antigen. All infants excreted CMV in the urine. It was demonstrated that the CMV IgE test was more sensitive than the CMV IgM test in diagnosing CMV infection in neonates by serology. Thus, the sensitivity for the IgE test was 82%, whereas for the IgM test it was only 66%. Furthermore, the CMV-specific IgE response, expressed as absorbance, was higher than the specific IgM response in 91% of the 76 sera which contained antibodies of either one or both immunoglobulin classes. Forty-six control sera, including 18 umbilical cord sera, from 46 neonates from whom CMV was not isolated were also tested. Most sera were negative. Three infants, however, had CMV antibodies of one or both classes, indicating infection. The level of total serum IgE was controlled in 24 of the sera from the CMV-infected neonates, but in none of the cases was the level elevated. No correlation was found between the reactivity of the antibodies in the two immunoglobulin classes and the level of CMV in urine.

Cytomegalovirus infections: occupational risk for health professionals

Health care personnel are becoming increasingly aware of potential hazards associated with caring for patients with contagious diseases. The cytomegalovirus is of special concern, because infection with this virus in a pregnant female employee could be associated with significant neurologic injury in her fetus. Nosocomial transmission from patient to health care worker has not been documented. A review of cytomegalovirus excretion in hospitalized patients and prospective evaluations of primary infection in hospital personnel do not support frequent occurrence of cytomegalovirus infection despite ample opportunity for exposure. Adherence to proper isolation techniques should be adequate to prevent nosocomial transmission of the cytomegalovirus.

Prevalence of antibodies to human cytomegalovirus in urban, kibbutz, and Bedouin children in southern Israel

Prevalence of antibody to human cytomegalovirus (CMV) was determined in a sample of 860 healthy children aged 1-13 years in Beer Sheva, in the Negev region of Israel. Three groups of children were tested: (1) urban Jewish children of low, middle, and high socioeconomic levels; (2) 8 rural communes (kibbutz) in which children live in close contact with each other from the 6th week of life under good hygienic conditions and a high standard of living; (3) Bedouin, seminomadic Arabs living in relatively poor hygienic conditions in the desert. Kibbutz children showed a significantly higher rate of CMV seropositivity by the second year of life than urban Jewish and Bedouin children (76% versus 44% and 54% respectively) with a gradual increase to 94% in the 10-13-year age group. Among children living in urban populations a significantly higher prevalence of CMV seropositivity was associated with crowding, but not with other socioeconomic indicators (place of residence, country of origin, or education level of parents). A marked rise of CMV seropositivity with age was found in urban Jewish children in the 2-5-year age group during which time they attend nurseries (44% to 67%) and in the Bedouin children in the 6-9-year age group (59% to 86%) when they first attend school. The data suggest that close contact is of major importance in CMV infection in childhood. The clinical implications of early acquisition and high prevalence of CMV antibodies in the kibbutz setting are discussed.

Seroepidemiology of cytomegalovirus infections during the first years of life in urban communities

Using indirect haemagglutination assay, combined with a collection of blood samples on blotting cards, seroepidemiological surveys of cytomegalovirus infections during early infancy have been done in different populations (French and immigrant) in urban areas. The comparison of CMV antibody status of mothers and their children at 10 months and at 2 years of age enables possible factors of viral transmission to be defined. During the first year of life, seropositive mothers were the only source of infection and they remained the main source during the second year. Socioeconomic class and educational level are determinant factors in the incidence of viral transmission.

Congenital and acquired cytomegalovirus infections. Virological and clinical studies on a Swedish infant population

The study included two clinical materials. First, the frequency of cytomegalovirus and its clinical significance were studied among 661 Swedish children under one year of age admitted to a paediatric hospital. Before the age of one week 4/326 (1%) children excreted virus. At one month the frequency had risen to 6/52 (12%) and after this age the frequency was constant around 20--25%. Sixty per cent of infants born to immigrants were infected after one month of age. One of the four congenitally infected children had symptoms at birth followed by neurological sequelae. The majority of the infections acquired at birth or in early infancy seemed to be subclinical and without sequelae. Second, a retrospective investigation of 18 695 children born during a six-year period was performed. Two cases of virologically confirmed congenital cytomegalic inclusion disease was found. Regarding seven microcephalic patients in the retrospective study congenital CMV-infection could be excluded in four cases. In the remaining three cases the data did not permit any conclusions regarding the etiology.