Sequence analyses of variable cytomegalovirus genes for distinction between breast milk- and transfusion-transmitted infections in very-low-birth-weight infants

Breast milk-transmitted acquired cytomegalovirus infection in an extremely low birth weight infant

We encountered an extremely low birth weight infant with breast milk-transmitted cytomegalovirus (CMV) infection. To determine the transmission route, we conducted direct sequence analysis of two variable CMV genes, UL139, and UL146. When utilizing breast milk, the possibility of acquired CMV infection should be considered and tested for prompt diagnosis and treatment.

Prospective cohort study for postnatal cytomegalovirus infection in preterm infants

AIM

Cytomegalovirus (CMV) is a virus that can cause congenital and postnatal infections. Postnatal CMV is mainly transmitted via breast milk and blood transfusions. Frozen-thawed breast milk is used to prevent postnatal CMV infection. A prospective cohort study was conducted to determine the infection rate, risk, and clinical findings of postnatal CMV infection.

METHODS

This prospective cohort study included infants born at 32 weeks or earlier than the gestational age (GA). Participants were prospectively screened for infection in the urine by performing urine CMV DNA tests twice, that is, once within the first 3 weeks of life and again after 35 weeks postmenstrual age (PMA). Postnatal CMV infection was defined as a case of CMV negative tests within 3 weeks of birth and CMV positive tests after 35 weeks PMA. CMV-negative blood products were used for transfusions in all cases.

RESULTS

A total of 139 patients were subjected to two urine CMV DNA tests. The prevalence of postnatal CMV infection was 5.0%. One patient died of sepsis-like syndrome. The risk factors of postnatal CMV infection were younger GA and older age of the mother. The characteristic clinical findings of postnatal CMV infection were pneumonia.

CONCLUSIONS

Frozen-thawed breast milk feeding is not fully effective in preventing postnatal CMV infection. The prevention of postnatal CMV infection is important to further improve the survival rate of preterm infants. Development of guidelines on breast milk feeding for the prevention of postnatal CMV infection is necessary in Japan.

CMV screening of group-specific orders-good stewardship of the blood supply

BACKGROUND

In addition to antigen-negative red blood cells (RBC), Immunohematology Reference Laboratories (IRL) must provide RBCs that are cytomegalovirus (CMV) seronegative. Due to high percentage of CMV seropositive individuals, it is challenging to find CMV and antigen-negative RBC. The IRL selects predominantly group O donors tested for CMV, and these RBC are sometimes needed to fill orders for nongroup O patients. This study evaluated units sent that were out of group to fulfill CMV-seronegative requests.

STUDY DESIGN AND METHODS

Requests for CMV-seronegative and antigen-negative RBCs were divided into Period 1 (January 1, 2019-February 29, 2020) before intervention and Period 2 (March 1, 2020-May 31, 2020) post intervention. ABO Rh units requested were compared to ABO Rh units provided.

RESULTS

Period 1: 537 CMV-seronegative RBC units were provided. 99/188(52.66%) B-positive requests were fulfilled using O RBCs. 58/504 (11.51%) of D-negative units were sent to D-positive patients. Period 2: 119 CMV-seronegative RBC units were provided. 18/51 (35.29%) B positive requests were fulfilled using O RBCs. Only 7/113 (6.19%) D-negative units were sent to D-positive patients.

DISCUSSION

For 239/656 (36.43%) CMV-seronegative antigen orders requested for B-positive patients, more than half of these orders were filled with O RBCs. To decrease group O usage for nongroup O patients, the IRL practice has changed to increase CMV testing for group B donors. Since the change in algorithm, there was a 17.37% decrease group O usage for group B patients.

Cytomegalovirus infection in kidney transplant patients: Prevalence, risk factors, and impact on outcome - A local multicentre experience

BACKGROUND

CMV infection prevalence in kidney transplant recipients (KTR) is reported to be high in the literature, reaching rates of over 80%.

OBJECTIVES

The primary endpoints were the evaluation of the prevalence, the risks factors, and the effects of CMV infection on graft function and survival, as well as patient survival at three years after kidney transplantation.

MATERIAL AND METHODS

We retrospectively reviewed the medical records of 288 kidney transplant patients operated in three Lebanese transplant centers between 1998 and 2017 with three years of follow-up. The patients were divided into two groups: those free of any CMV infection (271 patients (94%); Group I) and those who suffered from CMV infection (17 patients (6%); Group II).

RESULTS

Baseline demographics of the two groups were similar, including recipient and donor gender and age, cause of renal disease, recipient body mass index, pre-transplant fasting blood sugar and dialysis duration, HLA matching between donor and recipient, degree of sensitization in the recipient, type of CMV prophylaxis, maintenance immunosuppression and immunological characteristics. The prevalence of CMV infection is 5.9% among KTR. There were significant differences between the two groups concerning the type of induction therapy and the duration of anti-CMV prophylaxis. The rate of infected patients and infectious episodes were significantly higher in Group II. At 3-years, graft function and survival, patient survival, and the rate of new-onset diabetes were similar between the two groups.

CONCLUSION

The present study is the first to explore the incidence and risk factors of CMV in kidney transplant patients in Lebanon. Comprehensive nationwide studies are therefore necessary to determine the epidemiology and risk factors of CMV infection after kidney transplantation in Lebanon.

High prevalence of breastmilk-acquired cytomegalovirus infection in jaundiced infants

Background

Our objective was to evaluate the prevalence and different diagnostic methods of breastmilk (BM)‐acquired cytomegalovirus (CMV) infection in a pathologically jaundiced cohort.

Methods

A total of 400 infants confirmed with pathological jaundice at The People's Hospital of Qingyang City were screened for BM‐acquired CMV infection between February 2018 and February 2019. A total of 300 infants were finally enrolled in our study. CMV infection was confirmed by detecting both CMV‐DNA in various samples using FQ‐PCR and CMV‐IgM with chemiluminescence. Clinical and other laboratory data were collected from these infants during their hospitalization or regular visits.

Results

Ninety‐eight (32.67%) subjects were confirmed to be BM CMV‐DNA–positive, and 18 (18.37%) were diagnosed with a BM‐acquired CMV infection. All 18 (100%) infants with a BM‐acquired CMV infection were CMV‐DNA–positive in urine, while 5 (27.78%) cases and 11 (61.11%) cases were confirmed in plasma and peripheral blood mononuclear cells (PBMCs), respectively. Only 6 (33.33%) infants were CMV‐IgM–positive. Birthweight, direct bilirubin, aspartate aminotransferase, and the viral load in BM of the BM‐acquired CMV group were higher than those in the non‐infected group (P < .05). Low birthweight and viral load in BM were risk factors for BM‐acquired CMV infection. Detecting CMV‐DNA in urine samples exhibited better performance than the other methods for screening BM‐acquired CMV infections.

Conclusions

Our study found a high prevalence of BM‐acquired CMV infection in jaundiced infants, and detecting CMV‐DNA in a urine sample was the most sensitive method for disease screening.

Microwave treatment of breast milk for prevention of cytomegalovirus infection

BACKGROUND

Breast milk (BM) is the best nutrition for very preterm infants (VPI), except when provided by human cytomegalovirus (HCMV)-seropositive mothers. Given that VPI are at high risk of developing a sepsis-like syndrome or cholestasis, methods for prevention of HCMV infection via BM have been investigated. Although Holder pasteurization (HP) is the gold standard, HP needs special instruments. Microwave (MW) is available anywhere, therefore, we performed this study to determine whether MW can be used for HCMV prevention.

METHODS

Human cytomegalovirus Towne strain was added to formula, followed by heating procedure using HP or MW (at 500 W for 20, 30, 40, or 60 s). HFL-III cells were seeded in culture dishes. Aliquots of HCMV-milk samples after heating were inoculated onto susceptible cell monolayers. The number of plaques was counted to determine the viral titer. The determination of HCMV-DNA copies was also performed.

RESULTS

Addition of HCMV for a viral load of 5.0 × 10³ plaque-forming units (p.f.u.)/mL achieved 772 p.f.u./mL at baseline, with a decrease to 257 p.f.u./mL after MW radiation for 20 s. No plaque was detected after HP or MW for 30, 40, and 60 s. The temperature of the breast milk reached 60°C after MW radiation for 40 s. The number of HCMV-DNA copies did not change with MW.

CONCLUSIONS

Microwave at 500 W for 40 s can be used as a prevention strategy for HCMV transmission. Further research including the loss of bioactive properties in BM is required prior to clinical application.