Algorithme diagnostique de la primo-infection à cytomégalovirus (CMV) chez la femme enceinte

Abstract

Diagnosis of CMV primary infection is usually based on the detection of specific IgM antibody. However, as IgM antibody is not always correlated with primary infection, measurement of IgG avidity must be performed. The aim of our study was to evaluate the best procedure for diagnosis of CMV primary infection. In other words, is it better to first search for IgM antibody, and, if positive, then measure IgG avidity, or, first measure IgG avidity without detection of IgM antibody? CMV IgM detection and CMV IgG avidity measurement were performed on 310 IgG positive sera from pregnant women. CMV IgM antibody was detected positive for nine of 310 sera. Using CMV IgG Avidity Index (AI), dating of infection was difficult in 81/310 cases (26%), while it failed in only 3/310 cases using CMV IgM plus CMV IgG AI. The diagnosis of primary CMV infection could be based on the detection of CMV IgM antibody first and then on the measurement of CMV IgG avidity index.