anti-CMV IgM Antibodies Research Articles

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.

Association of Cytomegalovirus (CMV) Infection with Guillain- Barré Syndrome (GBS) In Tertiary Care Hospital (BSMMU) of Bangladesh

Background: Guillain-Barré syndrome (GBS) usually preceded by infections, in particular cytomegalovirus (CMV). It may occur by primary infection, reinfection or by reactivation of CMV. Objective: The aim of the present study was to evaluate the association of Guillain-Barré syndrome (GBS) with Cytomegalovirus (CMV) infection.
 Methodology: This case control study was carried out in the indoor and outpatient Department of Neurology at Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka from 1st January 2010 to 31st December 2011 for the duration of two years. All patients with GBS, who attended in neurology OPD or inpatient department at BSMMU during the study period, fulfilling the inclusion and exclusion criterias were included in this study. Age & sex matched volunteers, patients attendants, patients other than GBS who were nondiabetic, had no renal or hepatic diseases or family history of polyneuropathy were included in control group.
 Results: A total number of 78 respondents of which 39 patients were taken as cases and rest 39 were taken as controls who appeared in neurology OPD or inpatient department at BSMMU during the study period, fulfilling the inclusion and exclusion criterias were included in this study. The mean age ± SD of case and control groups were 30.82 ± 12.56 and 31.00 ± 12.77 years respectively (p=0.950). In case group the history of respiratory tract infection was present in 46.2% cases and absent in control group (p=0.001). In case group the history of gastroenteritis was present in 28.2% cases and absent in control group (p=0.001). In case group the history of fever was present in 30.8% cases and absent in control group (p=0.001). Anti-CMV IgM antibody was positive in 5.1% cases. Four fold rise of IgG in case group was present in 10.3% cases and absent in control group (p=0.040). Confirmed CMV infected GBS cases were 15.4% and absent in control group (p=0.011).
 Conclusion: The findings of this study permit to conclude that there is a significant association of Guillain-Barré syndrome (GBS) with Cytomegalovirus (CMV) infection.
 Bangladesh Journal of Neuroscience 2013; Vol. 29 (2) : 88-97

Prevalence of Cytomegalovirus DNA in Cord Blood and Voided Urine Obtained from Pregnant Women at the End of Pregnancy

Objective: This study was undertaken to determine the prevalence of congenital cytomegalovirus (CMV) infection in pregnant women at the end of pregnancy in Kuwait using cord blood and maternal urine. Subjects and Methods: Urine samples were collected prior to childbirth, and cord blood was collected immediately after delivery from 983 women. Anti-CMV IgG and IgM antibodies were determined using ELISA; CMV DNA was detected using nested PCR, and viral load was calculated using real-time PCR. CMV concentration in samples was categorized as low when the viral load ≤10³ copies/µl, intermediate when the viral load = 10³–10⁴ copies/µl, and high when the viral load >10⁴ copies/µl. The cord blood serology outcome was compared to cord blood PCR, cord blood viral load, maternal urine PCR and viral load analyses. Results: Serology showed that of the 983 cord blood samples, 89 (9%) were positive for anti-CMV IgM antibodies; PCR test showed 44 (4.5%) contained CMV DNA, and there was a high viral load in all. Maternal urine PCR showed that 9 (10.11%) women had CMV DNA, and there was a high viral load in 7 (78%). The kappa test for measures of agreement showed a reasonable agreement (0.45) between cord blood PCR and urine PCR. Conclusion: This study showed that CMV infection in the cord blood sera of pregnant women is common in Kuwait and highlights the need for more clinically based studies to follow up newborns with congenital CMV infection.

Viral markers in patients with hemophagocytosis: A prospective study in a tertiary care hospital

Hemophagocytic syndrome (HPS) is a rare clinicopathological condition characterized by the activation of macrophages with prominent hemophagocytosis in bone marrow and other reticulo-endothelial systems. HPS can be familial or secondary to infections including viruses. To study the viral markers in patients with HPS. Serum samples of patients with HPS and control group were screened for anti EBV VCA IgM, and IgG, anti-Parvo B19 IgM, and anti-CMV IgM antibodies using commercially available ELISA kits and CMV and ParvoB19 DNA by polymerase chain reaction (PCR). The present prospective study reports the profile of viral markers in HPS cases from north India. Among the 14 HPS cases 43% (6/14) were positive for at least one viral marker tested, of which EBV was found to be the most prevalent (3/6: 50%) followed by parvovirus B19(2/6: 33%) and cytomegalovirus (1/6: 17%). Mortality was noted in 33% of virus associated HPS patients. Our study highlights the higher association of Epstein-Barr virus (EBV) with HPS as compared to other viruses along with higher rate of mortality in both parvovirus B 19 and EBV associated HPS.

Perinatal cytomegalovirus hepatitis in Saudi infants: A case series

Background/Aim:Cytomegalovirus (CMV) is the most common congenital viral infection, occurring in 0.4%–2.3% of all live births. The clinical manifestations of CMV are multiorgan involvement. Currently, the numbers of studies of hepatic CMV infection in immunocompetent infants are insufficient and little information exists in the medical literature about the hepatic manifestations and complications of CMV.Patients and Methods:Nine infants diagnosed with hepatic CMV infection were included in the study. The diagnosis was based on the presence of IgM anti-CMV antibodies titer in serum and detection of CMV-DNA in blood. The authors identified clinical characteristics, biochemical characteristics, immunologic markers, and the outcome of hepatic CMV with or without treatment.Results:Jaundice was the most common clinical feature of CMV infection in infancy (100%). Hepatic abnormalities in the form of cholestasis (defined as a serum conjugated bilirubin concentration greater than 17.1 μmol/L or greater than 20% of the total serum bilirubin) were found in all patients (100%), hepatitis (77%), hypoalbuminemia (55%), elevated alkaline phosphatase, and gamma-glutamyltransferase (77%). Other findings showed hepatosplenomegaly (44%), thrombocytopenia (22%) and low birth weight (11%) The treatment of hepatic CMV infection was indicated in 66% and was not indicated in 33%. Both of them had resolved cholestasis and hepatitis.Conclusion:Jaundice and cholestasis were the most common clinical features of hepatic CMV infections. Hepatic CMV infection in young infants is often a self-limited illness that does not require antiviral therapy. Most of the patients with hepatic CMV infection had a favorable outcome.

Antiretroviral therapy alone resulted in successful resolution of large idiopathic esophageal ulcers in a patient with acute retroviral syndrome

Antiretroviral therapy alone resulted in successful resolution of large idiopathic esophageal ulcers in a patient with acute retroviral syndrome

An immunocompetent adult patient with hepatitis and guillain-barré syndrome after cytomegalovirus infection

ObjectivesIt is to describe an immunocompetent adult patient with hepatitis and Guillain-Barré syndrome (GBS) after Cytomegalovirus (CMV) infection. In the initial course of the diagnosis and treatment, CMV infection was ignored.Case reportA 19-year-old Chinese girl complained of fatigue with pain and numbness of the limbs, with abnormal liver function. She was diagnosed as a case of GBS based on history, clinical findings and auxiliary examinations. On day 13 of admission, her liver function was still abnormal. So CMV was recommended to examine. CMV hepatitis was diagnosed on positive serum anti-CMV IgG and IgM antibodies. The case was improved only with intravenous immunoglobulin therapy, without the use of antiviral therapy.ConclusionsThis case showed an immunocompetent adult patient with hepatitis and GBS induced by CMV. The physicians should take into account multi-system involvement of severe CMV infection.

Seroprevalence and serum profile of cytomegalovirus infection among patients with hematologic disorders in Bahia State, Brazil

Human cytomegalovirus (CMV) is a ubiquitous herpesvirus with from 30% to 100% of the general population exhibiting prior exposure by serology. This cross-sectional study evaluated the serological profile of anti-CMV antibodies and two acute-phase reaction proteins in Haematologic Disorder Patients (HDPs) from Bahia State, Brazil. Immuno-chemiluminescence assays were performed to detect anti-CMV IgM and IgG antibodies. Serological levels of High Sensitivity C-Reactive Protein (CRPH) and Alpha-1-Acid Glycoprotein (AAG) were measured using immunonephelometry. A total of 470 HDPs were enrolled, 238 (50.6%) males and 232 (49.4%) females. The overall seroprevalence of CMV was 89.4%, directly proportional to age and to the amount of blood units transfused. There was no difference between seroprevalence rates according to gender (P = 0.12). Four HDPs (0.9%) were seropositives for anti-CMV IgM, only one could be characterized as recent acute infection. The most CMV seropositive HDPs had anti-CMV IgG in low titers. There was a tendency for females to have higher anti-CMV IgG titers than men (P < 0.05). CRPH levels were different among HDPs CMV negative and positive groups (P < 0.001). There was no difference in the AAG levels between groups (P = 0.15). The high CMV seroprevalence found underscores the importance of using strategies to provide "CMV safe" blood to HDPs who are at high risk of developing severe CMV infection. CRPH can be used as a biomarker associated with CMV seropositivity; however, more efforts are needed to better characterize the clinical profile of active CMV infection in this group of patients.

Seroprevalence of cytomegalovirus infection among healthy blood donors in Bahia State, Brazil

We aimed at analyzing the seroprevalence of cytomegalovirus infection (CMV) and to assess particular aspects of the related immunological profile among blood donors in the State of Bahia, Brazil. Immunoassays were performed to detect anti-CMV IgG and IgM antibodies and the anti-CMV IgG avidity was evaluated. The methodology used was Enzyme Linked Immuno Sorbent Assay (ELISA) with results being confirmed by chemiluminescence. Reactivity to CMV was compared between genders and age groups. Among the 636 healthy blood donors tested, 428 (67.3%) were men and 208 (32.7%) were women. The overall seroprevalence of CMV was 87.9%; seroprevalence was statistically higher in women (94.7%) than in men (84.6% - p<0.05). No sample was positive for anti-CMV IgM antibodies. About 4.6% of the sample tested showed high titers of anti-CMV IgG; in these cases an IgG avidity assay was performed that showed: low avidity (31%), moderate avidity (21%), and high avidity (48%). The high CMV seroprevalence underscores the importance of using strategies such as leukoreduction and transfusion with CMV-seronegative blood in patients who are at high risk of developing severe CMV infection. The high titers of anti-CMV IgG antibodies and its IgG avidity profile suggest the possibility of viral reactivation or re-infection.

Cytomegalovirus Immunity in Pregnancy in South of Iran

Problem statement: Fetal loss and abortion are responsible for significant emotional distress for couples desiring children. There are many documents which support the role of some certain asymptomatic infections such as Cytomegalovirus (CMV) in spontaneous abortion. This study was aimed to evaluate the prevalence of seropositivity for CMV IgG and IgM in women with abortion and compare it with normal women with no previous history of abortion. Approach: This case-control study was carried out in Shariatee hospital of Hormozgan University of medical sciences, during 2003-2004. A number of 250 women with definite diagnosis of previous abortion and 200 matched women with normal full term delivery and negative history of miscarriage as controls were studied as case and control groups. Serum samples were obtained from participants and a demographic questionnaire was also filled for each of them. All serum samples were then tested using ELISA method for detection of anti-CMV IgM and IgG Antibodies. Data was analyzed, using SPSS software (chi square and t-test). Results: The average age was 25.6±7.6 years in case group and 25.3±6.5 years in control group. The number and percentage for CMV-IgG was 235(94%) and 150(75%) in case and control groups, respectively (p-value = 0.0001). In case group 13(5.2%) women were positive for CMV-IgM, while no positive sample was detected in control group (p-value = 0.0001). Conclusion: This study showed higher prevalence of seropositivity for CMV in women with spontaneous abortion comparing to women with normal full term delivery and suggest that cytomegalovirus plays a significant role in abortion.

Analysis of chemokines and soluble adhesion molecules in cytomegalovirus-positive renal transplant recipients

The relationship among cytomegalovirus (CMV) infection and the serum level of chemokines and soluble adhesion molecules is not well studied. This study aimed to assess chemokines and soluble adhesion molecules in CMV-positive Saudi renal transplant recipients. The study was conducted in a tertiary hospital in Eastern Saudi Arabia over a 12-month period. All kidney transplant recipients who regularly attended the nephrology clinics were included (n = 150). Randomly selected age- and sex-matched individuals served as a control group (n = 158). CMV antibodies (IgG and IgM), chemokines and soluble adhesion molecules were measured using standard enzyme-linked immunosorbent assay (ELISA). CMV viral DNA was detected using real time polymerase chain reaction (PCR). Of the 150 patients studied, 149 (n = 150) had detectable levels of Anti-CMV IgG antibodies (99.3%). In the control group, 113 (n = 158), blood donors had anti-CMV IgG antibodies (71.5%). Forty-one (n = 150) kidney transplant recipients were positive for anti-CMV IgM antibodies (27.3%), whereas only one (n = 158) blood donor had detectable anti-CMV IgM antibodies. All IgM positive samples contained CMV viral DNA. MCP-1, IL-8, ICAM-1, and VCAM-1 levels were measured using ELISA. Of those, only MCP-1 and IL-8 were detectable. Eighteen kidney transplant recipients were positive for MCP-1 (12%). All MCP-1 patients were also anti-CMV IgM positive, while 5 patients had detectable levels of IL-8 (3.3%). All these patients were CMV IgM-positive. The increase in chemokine levels during CMV infection may reflect a possible role for these molecules in the immunopathogenesis of CMV infection in this study population.

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

Prenatal screening for antibodies to Toxoplasma gondii (T. gondii), rubella virus and cytomegalovirus (CMV) infectious agents is an important tool in this process. The aim of this study was to determine the seroprevalence of these infections through antenatal screening in Kocaeli region. 1972 samples of sera were tested for antibodies to TORCH agents known to cause serious congenital infections: T. gondii, rubella, CMV. Anti-Toxoplasma, anti-rubella and anti-CMV IgM and IgG antibodies were assayed by ELISA method using Abbott kits (Axsym, Abbott, USA) according to the manufacturer's instructions. Of 1972 pregnant women, seropositivity for anti-toxoplasma IgG antibody was found in 952 (48.3%), while 8 (0.4%) of the subjects tested were positive for the anti-Toxoplasma IgM antibody only, and 31 (1.6%) of the subjects tested were positive for anti-Toxoplasma IgG+IgM antibodies together. The seropositivities for anti-rubella IgG, IgM and IgG+IgM together were found in 1896 (96.1%), 4 (0.2%) and 35 (1.8%) of the pregnant women, respectively. The seropositivities for anti-CMV IgG, IgM and IgG+IgM together were found in 1900 (96.4%), 13 (0.7%) and 37 (1.9%) of the pregnant women, respectively. Widespread population screening may contribute to the prevention of congenital infections due to TORCH agents. Because of the high seropositivity of T. gondii, rubella and CMV in pregnant women, preventive measures should be taken.

Incidence and Risk of Cytomegalovirus Infection during Pregnancy in an Urban Area of Northern Italy

The fetal consequences of CMV infection make it one of the most serious infections contracted during pregnancy, but the scientific community is divided over the proposed implementation of preventive screening for anti-CMV antibodies. The aim of this study was to assess the incidence and risk of infection during pregnancy in 2817 women who underwent anti-CMV IgG and IgM antibody screening during the period 2005–2007. The prevalence of anti-CMV IgG antibodies was 68.3% (95% CI: 66.6–70.0); the seroconversion rate in the 892 seronegative women was 0.32%; the results of IgG avidity testing revealed an cumulative incidence of 1.4% (95% CI: 0.97–1.83), density incidence of 0.8% (as cases/pregnant woman-trimester) (95% CI: 0.47–1.13), and a risk of infection of 0.5% (95% CI: 0.24–0.76). The screening identified 13 cases of primary infection (84.6% of which occurred in the first trimester of pregnancy). The possibility to identify these cases and consequently to plan appropriate interventions, supports the use of screening during pregnancy, especially in the first trimester when the risk of infection is greater.

Acute Cytomegalovirus Infection Is a Risk Factor in Refractory and Complicated Inflammatory Bowel Disease

The role of cytomegalovirus (CMV) infection in patients with inflammatory bowel disease (IBD) is controversial. Although CMV has been specifically associated with refractory disease, the strength and nature of this association have been a subject of debate. The aim of this study was to evaluate the prevalence and outcome of acute cytomegalovirus infection in patients with severe refractory and complicated inflammatory bowel disease. Seventy-two patients with active IBD (both ulcerative colitis [UC] and Crohn's diseases [CD]) were included in this study. Thorough history taking and physical examination of all patients was made with special emphasis on symptoms and signs of CMV disease. Colonoscopic assessment was made for the extent and activity of IBD and collection of specimen. Prevalence of CMV infection was estimated by serology; anti-CMV IgM and IgG antibodies, and pathologic studies of colonic biopsies used conventional haematoxylin and eosin (H & E) and immunohistochemistry (IHC) with monoclonal antibodies. Complete blood count and liver function tests were done for all patients. Among 72 patients with active inflammatory bowel disease, 23 (31.9%) were resistant to intravenous steroids. CMV was detected in eight (six with UC and two with CD) of the 23 (34.8%) steroid-resistant patients and in only one (3.2%) patient in the remaining 31 patients under steroid treatment and was not detected in 18 IBD patients not using steroids. Among nine CMV-positive IBD patients, six (66.6%) were female and six had fever; cervical lymphadenopathy was found in five patients and splenomegaly in two, compared to no patients in the CMV-negative group (P = 0.01 and 0.03, respectively). Leucopenia and thrombocytopenia were predominantly seen in the CMV-positive versus CMV-negative patients (2.1+/-0.3 vs. 5.9+/-3.4 and 98+/-34 vs. 165+/-101, respectively). Pancolitis was found in five of nine CMV-positive IBD patients whereas in only two patients out of 63 in the CMV-negative group (P = 0.005). Acute CMV infection in patients with IBD is not rare and is often underestimated. CMV infection in patients with refractory or complicated IBD should be ruled out before aggressive immunosuppressive therapy. High clinical index of suspicion for the association of CMV infection with IBD should be directed towards female IBD patients presenting with fever, lymphadenopathy, splenomegaly, leucopenia, and mild hepatitis. CMV IHC is significantly more sensitive than routine H & E stain and should be considered as part of the routine evaluation of IBD patients with severe exacerbation or steroid-refractory disease before proceeding with other medical or surgical therapy that may not be necessary once the CMV is treated.

High cytomegalovirus IgG avidity is a reliable indicator of past infection in patients with positive IgM detected during the first trimester of pregnancy

To evaluate the accuracy of high cytomegalovirus (CMV) specific IgG avidity in excluding recent infection in patients with anti-CMV IgM antibodies detected during the first trimester, using amniotic fluid obtained by standard amniocentesis. Records of all patients with a positive anti-CMV IgM with IgG avidity >65% detected during pregnancy were reviewed. Amniocentesis for CMV assessment was offered to all patients. The presence of the virus in amniotic fluid was determined by polymerase chain reaction (PCR) and shell vial testing. Seventy-nine patients with a positive CMV IgM-high IgG avidity combination were identified. The serological tests were performed during the first trimester in 65 (82.3%) patients, of which 28 consented and underwent amniocentesis. All amniotic fluid samples were negative for CMV-PCR and CMV shell vial testing. IgG avidity above 65% is a good indicator of past infection, and thus excludes CMV in the amniotic fluid. In such circumstances, invasive prenatal diagnosis may eventually not be required. This optimistic conclusion, however, needs to be confirmed by large scale studies.

Combination of native and recombinant cytomegalovirus antigens in a new ELISA for detection of CMV-specific antibodies

Background Serological detection of cytomegalovirus (CMV)-specific antibodies varies greatly due to antigen composition and the lack of antigen standardization. Objectives To develop and evaluate a new ELISA with native and/or recombinant cytomegalovirus antigens for the detection of anti-CMV IgG and IgM antibodies. Results The diagnostic performance of three anti-CMV ELISAs coated with different CMV antigen preparations, (i) native CMV antigen, (ii) a mixture of recombinant CMV peptides pp150, pp28, gB2 and pp52 and (iii) a combination of native CMV antigens and recombinant CMV IE1 antigen applied in the new Genzyme Virotech CMV ELISA, were compared. All tested sera were derived from patients or healthy blood donors and were predefined with the Dade Behring Enzygnost ® CMV ELISA as well as by CMV PCR analysis. Additionally, official well-characterized serum panels were also tested. The new Genzyme Virotech CMV ELISA IgG/IgM test applying a combination of native antigens and recombinant IE1 antigen was evaluated and the performance was compared to the Dade Behring Enzygnost ® CMV ELISA. The sensitivities were 98.9% (IgG) and 98.2% (IgM), the specificities were 98.8% (IgG) and 98.9% (IgM) for the Genzyme Virotech CMV ELISA. Furthermore all sera of the BBI mixed titer performance panel as well as the BBI seroconversion panel were identified 100% correctly with the new Genzyme Virotech ELISA. Conclusions These data suggest that the new Genzyme Virotech CMV ELISA has higher sensitivity and specificity than ELISAs based on native antigens or recombinant peptides only. Specific combinations of native and recombinant antigens increase the serological detection of CMV infections and may add to further standardization of CMV serology.

Pesquisa de anticorpos IgG e IgM para citomegalovírus em parturientes e recém-natos do município de Presidente Prudente e região, Estado de São Paulo

Primary infection by Cytomegalovirus (CMV) is usually followed by a persistent and/or recurrent infection. In most cases the infection is sub-clinical, but it can eventually be acute. This paper aims to evaluate by ELISA the frequency of IgG and IgM anti-CMV antibodies in 86 samples of parturient women and their newborns living in Presidente Prudente, SP, and vicinities. The samples were collected at Dr.Domingos Ceravolo University Hospital. Three parturient women (3.5%) were negative for anti-CMV antibodies, and 83(96.5%) were positive for IgG only. About the newborns, 83(96.5%) were positive for IgG only, 2(2.3%) where positive for both antibodies, and 1(1,2%) was negative for both antibodies. Results showed a high frequency of IgG anti-CMV antibodies in parturient women and their newborns. Moreover, we detected a relative high frequency of CMV congenitally infected newborns in this population, which might have an important impact on the amount of children with neurological and other diseases due to the virus infection

Acute otitis media associated with cytomegalovirus infection in infants and children

Acute otitis media (AOM) is one of the most common complications of viral respiratory tract infections in children, but the role of each virus is still to be elucidated. We analyzed AOM associated with infection by cytomegalovirus (CMV), which is known as one of the major causes of viral respiratory tract infection. Four hundred and ninety-five children (292 boys and 203 girls) diagnosed as having AOM in 2002 were studied. All of the children were under 6 years old, with the average age being 1.31+/-1.36 years. Bacterial and viral culture of both nasopharyngeal secretions (NPS) and middle ear fluid (MEF) was performed in all 495 children. The levels of glutamyl pyruvic transaminase (GPT) and the serum IgM antibody for CMV were measured. CMV infection was defined on the basis of isolation of this virus by culture and/or positive anti-CMV IgM antibody. NPS and MEF specimens of the subjects diagnosed as having CMV infection were tested for the virus by nested PCR. Twelve of the 495 children were found to have CMV infection. They included 6 boys and 6 girls aged from 3 to 25 months, with the average age being 11+/-7 months. Among 10 children in whom CMV infection was diagnosed by viral culture, CMV was isolated from NPS alone in nine cases and from both NPS and MEF in one case. Nested PCR was performed in all 12 subjects diagnosed as having CMV infection, and all NPS samples were positive, as were 8 MEF samples. We obtained serum samples from 205 children under 2 years of age, including 9 with CMV infection. The mean serum GPT level of 124 children in whom no viruses were detected was 20.7+/-14.4 IU/L. While, the serum GPT levels of 9 children with CMV infection ranged from 10 to 280 IU/L with the average titer being 78.4+/-81.9 IU/L, and the GPT levels of the children with CMV infection were significantly higher than those of the children in whom no viruses were detected (p<0.05). Our results suggested that CMV is a causative pathogen of AOM, and that CMV infection should be suspected in patients with AOM and liver dysfunction.

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

Primary infections caused by Toxoplasma gondii, rubella and cytomegalovirus (CMV) can lead to serious complications in pregnant women. The aim of this study was to determine the seroprevalence of Toxoplasma, rubella and CMV infections through antenatal screening. In this study, the consecutive records of 1652 pregnant women examined between the period March 2004 to January 2006 were included. The results of the antenatal screening for Toxoplasma, rubella and CMV during the first trimester of pregnancy were evaluated. Anti-Toxoplasma, anti-rubella and anti-CMV IgG and IgM antibodies were assayed using an enzyme linked immunosorbent assay method. Of the 1652 pregnant women tested, anti-Toxoplasma IgG antibody was found in 860 (52.1%) of the cases, while 9 (0.54%) of the subjects tested positive for anti-Toxoplasma IgM. Anti-rubella IgG and IgM antibodies were reactive in 1570 (95.0%), and in 9 (0.54%) of the tested women, respectively. Moreover, 1568 (94.9%) of them were found to be positive for anti-CMV IgG, while 7 (0.4%) tested positive for anti-CMV IgM. Consequently, because of the high seropositivity of T. gondii, rubella and CMV in the pregnant women, the country's health authorities should be alerted, and preventive measures should be taken.

Reactivation of human herpesvirus (HHV) family members other than HHV-6 in drug-induced hypersensitivity syndrome

Drug-induced hypersensitivity syndrome (DIHS) is characterized by a severe multiorgan hypersensitivity reaction that usually appears after a 3-6-week exposure to certain drugs, including anticonvulsants. There are some reports showing that serum IgG levels often decrease at the early stage of DIHS. Reactivation of human herpesvirus (HHV)-6 has been reported in patients with DIHS, and some other DIHS patients showed reactivation of cytomegalovirus (CMV) or Epstein-Barr virus (EBV). To determine whether reactivation of HHV-6, HHV-7, CMV and/or EBV occurs in patients with DIHS. Titres of IgG and IgM antibodies to HHV-6 and HHV-7 were determined using an indirect immunofluorescence antibody assay on admission and at various times after admission. Anti-CMV IgG and IgM antibody titres and anti-EBV capsid antigen IgG, IgA, IgM, and EBV nuclear antigen and EBV early antigen IgG titres were determined by enzyme immunoassay. Polymerase chain reaction (PCR) procedures for HHV-6, HHV-7, CMV and EBV DNAs were performed using serum samples. IgG antibody titres to HHV-6, HHV-7, CMV and EBV were increased after the onset in seven, six, seven and two of seven patients, respectively. IgG antibody titres to HHV-6 and HHV-7 were elevated simultaneously 21-38 days after the onset. IgG antibody titres to CMV and EBV were elevated 10-21 days after the elevation of HHV-6 and HHV-7 antibody titres. PCR showed that HHV-6, HHV-7, CMV and EBV DNAs became positive in six, five, seven and two of seven patients, respectively. HHV-6 and HHV-7 DNAs were detected 21-35 days after the onset, and CMV DNA was detected 10-21 days after detection of HHV-6 and HHV-7 DNAs. The present study suggests that in addition to HHV-6 reactivation, reactivation of HHV-7, CMV and/or EBV may also occur following drug eruption in some patients with DIHS.