Mother-to-child Transmission Research Articles

Clinical Complications of Beck's Triad in Cardiac Tamponade: Implications for Management and Patient Outcomes

Cardiac tamponade is a critical medical emergency caused by fluid accumulation in the pericardial space, resulting in heart compression. Beck's triad is a key clinical indicator for diagnosing this condition. This integrative review aimed to assess the clinical complications associated with Beck's triad in cardiac tamponade and its implications for patient management and treatment. An electronic search was conducted in the PubMed and BVS (Lilacs & Medline) databases using targeted descriptors. Studies published in the last 10 years that addressed Beck's triad's clinical complications in cardiac tamponade were included, while studies that did not meet the inclusion criteria were excluded. The review identified a range of clinical complications associated with Beck's triad, such as cardiac tamponade, pericardial effusion, hemoptysis, and cardiac arrhythmias, arising from causes including congenital heart disease, viral infections, and invasive procedures. Cardiac tamponade can also lead to systemic complications, raising the risk of thromboembolic events. Management of these complications should be individualized based on the clinical presentation and underlying cause of cardiac tamponade. Echocardiography is essential for diagnosis and ongoing monitoring, allowing accurate assessment of cardiac function and pericardial fluid volume. Timely treatment, including pericardial drainage and hemodynamic support, is critical to lowering morbidity and mortality in cardiac tamponade cases. Early recognition, accurate diagnosis, and prompt management of complications related to Beck's triad are vital for optimizing outcomes. Recognizing early signs and symptoms of severe complications is essential for timely intervention and prevention of further adverse outcomes. A multidisciplinary approach, coupled with continuous education of healthcare professionals, is crucial to implementing best practices and improving patient outcomes in cardiac tamponade.

Newborns with microcephaly in Brazil and potential vertical transmission of Oropouche virus: a case series

Oropouche fever, an orthobunyavirus disease endemic in Brazilian Amazon, has caused many febrile epidemics. In 2024, an epidemic of Oropouche fever spread in Brazil, with more than 7930 cases reported between Jan 1 and Aug 31. Infections in pregnant people have suggested the possibility of negative fetal consequences, therefore we tested newborns with microcephaly for known congenital pathogens and Oropouche virus (OROV). In this case series, we assessed historical cases of infants born with microcephaly, arthrogryposis, and other congenital malformations without a confirmed cause and their mothers for potential OROV congenital infections. The study population consisted of infants born in Brazil with samples from 2015-21 and 2024. Serum and cerebrospinal fluid (CSF) from this case series were analysed for: syphilis, toxoplasmosis, rubella, cytomegalovirus, herpes simplex, HIV, Zika, dengue, and chikungunya. Individuals that were negative for these pathogens were then tested for OROV. Pathogen testing included ELISA and haemagglutination inhibition testing for antibodies and RT-PCR for virus RNA. We tested 68 samples from 65 historical cases of congential malformations and three cases from 2024. All cases were from ten states in Brazil. Three historical cases tested positive for OROV and 62 historical cases tested negative. The three cases from 2024 all tested positive for OROV. Of the positive cases, five were female and one was male. Not all pathogens were tested for each case, and some did not have maternal samples available. One of the newborns (case 6) died aged 47 days and tissue samples were tested by real-time RT-PCR, histopathology, and immunohistochemistry assays. One other newborn died in 2016 but no post-mortem samples were available. OROV IgM was detected in five of five newborn CSF samples, and five of five newborn serum samples. Four of five maternal serum samples were positive for OROV IgM. One of four newborn CSF samples (case 6 at age 44 days) was OROV positive by real-time RT-quantitative PCR and 0 of four newborn serum samples were positive, as were 0 of three maternal serum samples. Case 6 had major tissue changes of the brain macroscopically and microscopically, including necrotic and apoptotic changes of neurons, microglia and astrocytes, vacuolisation, and tissue atrophy. OROV RNA was detected in brain, lungs, kidney, CSF, and pleural fluid; OROV antigens were found in CNS, liver, kidney, heart, and lung, mainly in neurons and microglia and also in endothelial cells, suggesting vasculitis. We detected OROV IgM in six of 68 newborns with microcephaly of unknown cause. One infant who died had OROV RNA and antigen in several tissues, including the brain. The possibility of OROV vertical transmission and potential fetal harm must be investigated with urgency. The evidence presented here does not completely confirm vertical transmission or congenital malformations due to OROV, but thorough case finding and detailed investigation of maternal or fetal OROV infection is a priority. Evandro Chagas Institute, Secretaria de Vigilância em Saúde e Ambiente, and Ministry of Health and National Institute of Science and Technology for Emerging and Reemerging Viruses.

Neonatal ascites, leading to the diagnosis of congenital dengue with plasma leakage.

Although Cambodia is a dengue-endemic country, mother-to-child transmission of dengue virus has yet to be documented. We report a rare case for congenital dengue diagnosed by RT-PCR in a 4-day-old neonate with ascites. The neonate was initially treated for suspected perinatal infection. The management was supportive.

Bolstering Access to HIV-Related Health care in Zimbabwe Among Young Mothers Living With HIV: Lessons Learned on HIV Health Promotion From Zvandiri's Young Mentor Mother Program.

HIV disproportionately affects adolescent girls and young women living in Southern Africa. Rates of perinatal HIV transmission are high in this population, emphasizing the need for targeted health promotion and public health programming to improve the health of young mothers living with HIV. Zvandiri, a non-profit organization in Zimbabwe, created the Young Mentor Mother (YMM) program in response to this issue. This health promotion program uses peer-led service delivery conducted by trained young mothers living with HIV, called YMMs. We conducted semi-structured virtual interviews (N = 29) among Zvandiri staff and YMMs to identify benefits and challenges, and to inform future program scaling. We applied thematic analyses to the transcriptions. Participant narratives revealed several themes, including three key benefits from the YMM program: (1) peer support, (2) holistic care, and (3) women's empowerment. Participants also shared barriers to the success of the program, reflecting two overarching dimensions: (1) barriers related to scaling up the YMM program and (2) challenges related to addressing socio-structural factors. Barriers to scale-up included limited funds and resources, and food insecurity. Socio-structural challenges included HIV-related stigma, cultural and geographic differences, and intimate partner violence (IPV). These challenges align with the social-ecological model, whereby structural factors (lack of funding, food insecurity), community factors (HIV-related stigma, socio-cultural differences in accepting HIV care), and interpersonal factors (IPV) affect the implementation and scale-up of the program. We recommend future adopters of the YMM program to tailor the model for their community, prioritize peer supporter's well-being, foster women's empowerment, and adopt a holistic care approach.

Serological and Molecular Detection of Cytomegalovirus in Aborted Women in Diyala Province, Iraq

Background: Cytomegalovirus (CMV) is a common virus that can infect individuals of all ages. In pregnant women, CMV infection can lead to complications such as congenital CMV infection, which can cause miscarriage, stillbirth, or significant fetal abnormalities. Objective: To evaluate the prevalence of CMV infection in women with and without a history of miscarriage in Diyala Province, Iraq. Methods: A total of 120 women were recruited and divided into three groups: 40 pregnant women with a history of miscarriage, 40 non-pregnant women with a history of miscarriage, and 40 healthy women without a history of miscarriage (control group). Blood samples were collected from each participant and analyzed for the presence of CMV-specific IgG and IgM antibodies using enzyme-linked immunosorbent assay (ELISA). Some positive results were retested to detect the MIE gene region IE-2 (UL122) by real-time PCR and the IE1 (UL123) gene by conventional PCR. Demographic data of study groups were recorded, and statistical analysis was performed using SPSS Version 29. Results: The serological analysis revealed the following prevalence of CMV IgG antibodies: 100% in both pregnant and non-pregnant women with a history of miscarriage, and 95% in the control group of healthy women without a history of miscarriage. For CMV IgM antibodies, the prevalence was 47.5% in pregnant women with a history of miscarriage, 40% in non-pregnant women with a history of miscarriage, and 7.5% in the control group of healthy women without a history of miscarriage. The PCR results showed that 9 of the samples were positive for both the UL122 and UL123 genes. Conclusion: The study indicates a high prevalence of CMV infection among women with a history of miscarriage in Diyala Province, Iraq. Routine screening for CMV in pregnant women, especially those with a history of miscarriage, is recommended to reduce potential risks and improve pregnancy outcomes.

Risk groups of HIV infection among the population of the Omsk region

The peculiarities of the course of the epidemic process of HIV infection, including the formation of certain risk groups by gender, age and social status, are relevant, as they allow the development of specific preventive measures. The aim is to identify risk groups for HIV infection among the population of the Omsk region in 1996–2023. Data from the main statistical reporting forms, the Federal Register of Persons Infected with the Human Immunodeficiency Virus, and the results of epidemiological investigations were used for the analysis. The analysis made it possible to establish the main trends in the development of the epidemic process of HIV infection in the Omsk region. The general trend of decreasing morbidity has been revealed, which coincides with that in the Russian Federation, primarily due to the large volume of preventive measures carried out. Changes in the characteristics of the risk groups of infection have been established — the contingents of injecting drug users and men who have sex with men, prevailing at an early stage of the epidemic, have been replaced by persons who became sexually infected from individuals of the opposite sex. At the same time, the proportion of infected women approached that of men. This entailed the risk of perinatal transmission of HIV infection. The introduction of mandatory screening for HIV infection markers in pregnant women and the implementation of antiretroviral prophylaxis has reduced the number of cases of perinatal infection of newborns to a minimum. An increase in the share of the rural population in the total structure of newly diagnosed people with HIV infection may indicate both lower awareness of this problem and shortcomings in the provision of medical care, its lower accessibility compared to the urban population. The prevalence in the structure of HIV-infected people who are not engaged in work indicates that the most socially unprotected contingents are involved in the epidemic process, as a rule, they are not ready to take care of their own health and the health of others, often leading an antisocial lifestyle. Thus, HIV infection in the Omsk region remains one of the priority epidemiological problems requiring the formation of an integrated approach to its solution. The conducted research made it possible to identify the main risk groups for HIV infection, in relation to which targeted preventive strategies should be applied.

Perinatal Transmission of Dengue in a Neonate: A Case Report

Vertical transmission of dengue is rare. However, the rapid rise of dengue infection is a risk in pregnancy which can lead to preterm delivery, low birth weight, stillbirth, miscarriage, neonatal morbidity and mortality. Here, we present a case of perinatal transmission of dengue in a term neonate who presented with fever on second day of life and desaturation without respiratory distress. Laboratory findings showed thrombocytopenia, dengue Ag NS1/IgM positive and treatment was started. There was positive maternal history of dengue 10 days prior to delivery. Hence, early investigations with prompt interventions was done leading to uneventful recovery.

EFFECTS OF HUMAN CYTOMEGALOVIRUS ON SOME HEMATOLOGICAL PARAMETERS AND LIVER FUNCTION IN PREGNANT WOMEN, YEMEN

Human Cytomegalovirus (HCMV) infection is a common congenital infection that affects approximately 0.7%–1% of all live births worldwide. Approximately 11% of newborns who are infected show symptoms at birth, and of these, between 30% and 40% are at a risk of experiencing long-term neurological complications. This study aimed to evaluate the effect of HCMV on hematological parameters and liver function in pregnant women in Hajjah governorate, Yemen. This study is a cross-section study that conducted in the Hajjah governorate of Yemen during a period of March to June 2023. A total of 108 blood specimens were collected from participants; 78 from patients group and 30 health group. Hematological parameters, such as total red blood cell count (RBC), hemoglobin (HB), platelet count (PLT), and white blood cells (WBC), as well as liver function tests, such as total protein, albumin, alkaline phosphatase (ALP), serum glutamic oxaloacetic transaminase (SGOT), serum glutamate pyruvate transaminase (SGPT), total bilirubin, and direct bilirubin, were measured. Majority of participant patients aged between 16–21 years 27 (34.7%), studied at secondary schools (46.2%), in their second trimester 51 (65.4%), those with multigravida 54 (69.2%), and those with no history of congenital diseases 60 (76.9%). Compared with the control group, the mean WBC levels were significantly lower in HCMV patients (P < 0.05), whereas PLT levels were higher among HCMV patients (P < 0.05). Additionally, the mean levels of total bilirubin, direct bilirubin, SGOT, ALP, and albumin were significantly lower in patients with HCMV than in HC (P < 0.05). Furthermore, there were no significant differences between the patient and healthy groups in terms of HB, RBC counts, SGPT, and total protein (P > 0.05). It can be concluded that HCMV infection had a statistically significant effect on WBC, PLT, total bilirubin, direct bilirubin, SGOT, ALP, and albumin levels in pregnant women. Consequently, further studies are needed to define the role of HCMV in liver disorders.

Early Postnatal Neuroinflammation Produces Key Features of Diffuse Brain White Matter Injury in Rats.

Perinatal infection is a major risk factor for diffuse white matter injury (dWMI), which remains the most common form of neurological disability among very preterm infants. The disease primarily targets oligodendrocytes (OL) lineage cells in the white matter but also involves injury and/or dysmaturation of neurons of the gray matter. This study aimed to investigate whether neuroinflammation preferentially affects the cellular compositions of the white matter or gray matter. Neuroinflammation was initiated by intracerebral administration of lipopolysaccharide (LPS) to rat pups at postnatal (P) day 5, and neurobiological and behavioral outcomes were assessed between P6 and P21. LPS challenge rapidly activates microglia and astrocytes, which is associated with the inhibition of OL and neuron differentiation leading to myelination deficits. Specifically, neuroinflammation reduces the immature OLs but not progenitors and causes acute axonal injury (β-amyloid precursor protein immunopositivity) and impaired dendritic maturation (reduced MAP2+ neural fiber density) in the cortical area at P7. Neuroinflammation also reduces the expression of doublecortin in the hippocampus, suggesting compromise in neurogenesis. Utilizing a battery of behavioral assessments, we found that LPS-exposed animals exhibited deficits in sensorimotor, neuromuscular, and cognitive domains. Our overall results indicate that neuroinflammation alone in the early postnatal period can produce cardinal neuropathological features of dWMI.

T cell responses and clinical symptoms among infants with congenital cytomegalovirus infection.

BACKGROUNDCongenital cytomegalovirus (cCMV) infection can cause developmental impairment and sensorineural hearing loss (SNHL). To determine the relationship between immune responses to cCMV infection and neurologic sequelae, T cell responses were compared for their connection to clinical symptoms at birth and neurodevelopmental outcomes.METHODSThirty cCMV-infected and 15 uninfected infants were enrolled in a single-center prospective observational case-control study. T cell pp65-specific cytokine responses; CD57, CD28, and PD-1 expression; and memory subsets were compared.RESULTSInfected neonates (73% symptomatic at birth) lacked pp65-specific cytokine-secreting T cells, with elevated frequencies of CD57+, CD28-, and PD-1+CD8+ T cells and effector memory subsets. Though frequencies overlapped between cCMV symptom groups, asymptomatic infants had higher frequencies of CD57+PD-1+CD8+ T cells. Neonates with subsequent developmental delay lacked detectable CMV-specific T cell responses, with patterns resembling those of uninfected infants. Two children with progressive SNHL had high frequencies of PD-1+CD8+ T cells over the first year compared with children without progressive SNHL.CONCLUSIONSimilar to published reports, neonatal viral antigen-specific cytokine-secreting T cell responses were not detected, but overall patterns indicate that globally differentiated memory CD8+ T cell populations were induced by cCMV infection, with higher frequencies of terminally differentiated PD-1+CD8+ T cells potentially associated with asymptomatic infection. In this cohort, a lack of in utero T cell differentiation was associated with developmental delay, and high frequencies of PD-1+CD8+ T cells persisted only in children with progressive SNHL. Further work is needed to define the specificity of these T cells and their mechanistic connection to these outcomes.FUNDINGThis study was funded through an intramural research award at Nationwide Children's Hospital, the Pediatric Infectious Disease Society Fellowship Award funded by Stanley and Susan Plotkin and Sanofi Pasteur, the Abigail Wexner Research Institute at Nationwide Children's Hospital, and the Pichichero Family Foundation Vaccines for Children Initiative Research Award from the Pediatric Infectious Diseases Society Foundation.

Bone Accrual Trajectories in Children and Adolescents with Perinatal HIV Infection.

Low bone mineral density (BMD) has been reported in children and adolescents living with perinatally-acquired HIV (PHIV). Little is known about their bone accrual through puberty compared to an uninfected healthy cohort. To compare bone accrual in PHIV and healthy children. PHIV children aged 7-16 years had dual energy X-ray absorptiometry (DXA) at entry, 2 years, and then at least 2 years later. Bone accrual was compared to healthy children from the Bone Mineral Density in Childhood Study (BMDCS). United States academic clinical research centers. 172 PHIV; 1321 BMDCS. We calculated height-adjusted whole-body and spine BMD and bone mineral content (BMC) Z-scores in PHIV using BMDCS reference curves. We fit piecewise weighted linear mixed effects models with change points at 11 and 15 years, adjusted for age, sex, race, height Z-score, and Tanner stage, to compare BMD and BMC Z-scores across actual age by cohort.Main Outcome Measure: BMD/BMC Z-scores. Height-adjusted whole-body BMD and BMC Z-scores in PHIV were lower across age compared to BMDCS children. Spine BMD Z-score across age was higher in PHIV after height adjustment. Whole-body and spine bone area tended to be lower in PHIV. PHIV had slower accrual in whole-body and spine bone area before 14 years. After 15 years, bone area accruals were similar, as were height-adjusted spine BMC Z-scores, across age. PHIV had persistent deficits in all measures except height-adjusted spine BMD and BMC Z-scores. Data are needed on PHIV followed to adulthood.

Hepatitis B

Hepatitis B is a viral infection caused by the Hepatitis B virus (HBV), primarily affecting the liver and leading to both acute and chronic disease. With over 250 million individuals suffering from chronic Hepatitis B, it poses a significant global health challenge, being a leading cause of liver cirrhosis, liver failure, and hepatocellular carcinoma. This study aims to elucidate the transmission pathways, treatment options, and necessary public health strategies for Hepatitis B. We analyze the modes of transmission, which include contact with infectious body fluids—primarily through perinatal transmission, unprotected sexual contact, and sharing contaminated needles. Despite the availability of an effective vaccine since the 1980s, Hepatitis B remains endemic in many parts of Asia and Africa due to limited immunization coverage. The pathogenesis of HBV involves complex interactions between the virus and the host immune system, potentially leading to liver inflammation and fibrosis. Clinical presentations vary widely, ranging from asymptomatic infections to severe liver disease. Current treatment options for chronic Hepatitis B include antiviral medications such as tenofovir and entecavir, which suppress viral replication but do not cure the infection. Recent advancements in therapeutic strategies, including novel antivirals and immune modulators, show promise for more effective management and potential cures in the future. Comprehensive public health strategies—such as vaccination, screening, and education—are crucial for controlling the spread of HBV and reducing the global burden of Hepatitis B-related complications.

Safety of Intrauterine Transfusion Performed Beyond 34 weeks of Gestation

ABSTRACTObjectiveTo describe (1) procedure‐related complications, and (2) gestational age (GA) at delivery in patients who received their final intrauterine transfusion (IUT) at ≥ 34 weeks 0 days versus at < 34 weeks 0 days.MethodsThis was a retrospective study of pregnancies treated with IUT. Procedure‐related complications were defined as any of the following within 48 h of IUT: (1) rupture of membranes or preterm delivery, (2) intrauterine infection, (3) fetal death, (4) fetal compromise resulting in emergency cesarean, or (5) neonatal death. Patient and procedural characteristics were described among patients with final IUT at ≥ 34 weeks 0 days and at < 34 weeks 0 days.ResultsWe studied 94 pregnancies with 237 IUTs; 35 (37.2%) had their last IUT at ≥ 34 weeks 0 days and 59 (62.8%) had their last IUT at < 34 weeks 0 days. Three procedure‐related complications occurred (1.3% of procedures, 3.2% of pregnancies). All resulted in emergency cesarean section; 1 case performed at < 34 weeks 0 days resulted in neonatal death. The remaining 2 occurred during IUT at ≥ 34 weeks 0 days. Pregnancies with the last IUT at ≥ 34 weeks 0 days delivered at a median GA of 37.1 weeks.ConclusionsComplications were rare. IUT performed at ≥ 34 weeks 0 days appeared safe.

Characterization of Two Novel HIV-1 CRF01_AE/CRF07_BC Recombinant Forms Among Men Who Have Sex with Men and Mother-to-Child Transmission Cases in Baoding City, China.

CRF01_AE and CRF07_BC are predominant circulating HIV-1 subtypes in China. In this study, we report two novel HIV-1 CRF01_AE/CRF07_BC recombinant forms isolated from one man who has sex with men (MSM) (BDD027) and one mother-to-child transmission (MTCT) case (BDL123) in Baoding City, Hebei Province, China. The recombination breakpoint analysis showed that the recombination pattern of the near-full-length genome of BDD027 consisted of two CRF07_BC fragments inserted into a CRF01_AE backbone, while the recombination pattern of the near-full-length genome of BDL123 consisted of one CRF01_AE fragment inserted into a CRF07_BC backbone. This study demonstrates the importance of strengthening the monitoring of HIV-1 molecular epidemiological characteristics and emphasizes the urgent need to reduce the HIV-1 epidemic among MSM and MTCT populations in China.

Efficacy and safety of 2-drug regime dolutegravir/lamivudine in pregnancy and breastfeeding- clinical implications and perspectives.

To assess the efficacy and safety of a two-drug regimen (2DR) with dolutegravir (DTG) and lamivudine (3TC) in maintaining viral suppression during pregnancy and breastfeeding, and to evaluate its potential as an alternative to the recommended three-drug regimen (3DR) in preventing mother-to-child transmission (MTCT) of HIV. We present a case of a 34-year-old pregnant woman who, after discontinuing 3DR due to side effects and poor adherence, was switched to DTG/3TC at gestational week 23. Maternal viral load (VL) and infant HIV status were monitored throughout pregnancy and a ten-month breastfeeding period. Data on pharmacokinetic changes in pregnancy and the risks associated with 2DR were reviewed. The patient's VL remained suppressed (<20 copies/mL) from gestational week 23 until the end of the breastfeeding period. A healthy HIV-negative baby was born at 39 weeks, and the child remained HIV-negative after ten months of breastfeeding. The 2DR was well-tolerated, improved adherence, and reduced fetal drug exposure. Despite limited experience with 2DR in pregnancy, no viral rebound occurred, and no adverse effects were observed. Although 3DR remains the preferred therapy during pregnancy and breastfeeding, this case indicates that DTG/3TC may be an effective alternative for patients experiencing intolerance or poor adherence to 3DR. Further studies are needed to explore the impact of pharmacokinetic changes in pregnancy on 2DR efficacy and to confirm its safety and role in preventing MTCT.

Congenital CMV infection - what we know about the symptoms, treatment and prevention? - Review of literature

Introduction: Cytomegalovirus (CMV) is a double-strand DNA virus, member of the viral family known as Herpesviridae which is wide-spread. CMV infection is the most common congenital infection worldwide. Disease is mostly asymptomatic for healthy people, therefore is detected late, when the children start presenting symptoms. Unfortunately the congenital CMV infection leads to the serious health problems for infants. Detection of the virus is typically done through quantitative PCR assays. Infection especially affects nervous system and can present infant’s deafness. Earlier it was equivalent with the children being deaf till the end of life, but nowadays thanks to the development of laryngological methods (ex. cochlear implantation) patients have chance to grow up correctly. Material and methods: A literature search was conducted using Google Scholar, PubMed, and Web of Science databases. We searched articles by entering key words in the appropriate configuration: “CMV”, “Congenital CMV infection”, “valganciclovir”, “infant’s deafness”. Scientific articles published between 1991–2023 were analyzed from all over the world and guidelines of Polish Society of Epidemiology and Infectious Diseases.Conclusions: Currently we haven’t got prevention towards congenital CMV, only the treatment for infants: valganciclovir. It stops development of severe symptoms. There are available analysis, where using valganciclovir during pregnancy reduces the possibility or soften the course of the congenital CMV infection , but it’s not the obligatory guidelines. In many countries researchers want to conduct screening test for CMV IgG among the pregnant women.

Cystic leukoencephalopathy in congenital cytomegalovirus infection.

Cystic leukoencephalopathy in congenital cytomegalovirus infection.

Changes of CD8+CD28- Tregs and Gamma-Delta-T-cells in a Neonate with Intrauterine Cytomegalovirus Infection: A Case Report

BackgroundCongenital cytomegalovirus (cCMV) infection can lead to a range of adverse outcomes. The majority of cCMV neonates with clinical symptoms are infected postnatally; however, established cases of intrauterine infection are uncommon, resulting in a paucity of reports on clinical findings and lymphocytes expression in CMV-infected neonates.Case presentationWe followed a neonate with cCMV infection from the onset of hospitalization to several months of follow-up. This infant was intrauterine CMV-positive in the amniotic fluid of the mother at 21 weeks’ gestation and received intravenous ganciclovir infusion and sequential oral valganciclovir after birth. The typical clinical signs manifested in the nervous system, liver, and peripheral blood and were documented during the hospitalizaion period and up to the follow-up visit. Flow cytometry was employed to examine the expression of T cells, their subsets, and the associated cytokines in peripheral blood samples at various time points. The flow data for the cCMV neonate were compared with those of the controls at each time point. Following treatment, clinical symptoms improved and the infant became CMV negative. However, developmental delays occurred later in life. The proportion of CD8+CD28− Tregs in the peripheral blood of the neonate with congenital CMV infection was higher than that in the controls at the three time points. The expression levels of perforin and granzyme B secreted by γδ T cells (Vδ1 and Vδ2 T cells), increased during the course of hospitalization until follow-up and were higher than those in the controls at the three time points.ConclusionsDespite the alleviation of clinical symptoms, developmental delay in later life remains inevitable in this intrauterine cCMV neonate. CD8+CD28− Tregs and Vδ1 and Vδ2 T cells secreting perforin and granzyme B may be involved in congenital CMV infection, although this hypothesis requires validation in a larger study. This report may contribute to our understanding of the effect of current treatment and the immune status of intrauterine cCMV-infected neonates.

Maternal Cytomegalovirus (CMV) Serology: The Diagnostic Limitations of CMV IgM and IgG Avidity in Detecting Congenital CMV Infection.

Congenital cytomegalovirus (cCMV) is a common congenital viral infection. Testing for cCMV usually begins with assessing maternal CMV serology, specifically IgM and IgG antibodies. A negative maternal CMV IgM suggests a low risk of recent maternal CMV infection, thereby suggesting a low risk of cCMV in the fetus. Consequently, cCMV is often ruled out when maternal CMV IgM is negative. In our perinatal autopsy and placental pathology database, we identified 5 cases of cCMV despite negative maternal CMV IgM results in the second trimester. In all 5 cases, fetal abnormalities were first detected by ultrasound in the second trimester, prompting maternal CMV testing. Since second trimester maternal CMV IgM was negative in all cases, cCMV was considered unlikely, thus precluding further prenatal CMV testing in 4 of these cases. The diagnosis of cCMV was subsequently made through placental and/or autopsy examinations. Following this diagnosis, retrospective CMV serology and IgG avidity testing was performed on stored frozen first-trimester maternal blood samples in 3 cases. Among these, the first-trimester samples in 2 cases were IgG+, IgM+, and exhibited low IgG avidity, suggesting a primary maternal CMV infection around the time of conception. In the third case, both first and second-trimester maternal blood samples were IgG+, IgM-, and showed high IgG avidity, suggesting a non-primary maternal CMV infection (i.e., reactivation or reinfection of CMV). A negative maternal CMV IgM in the second trimester cannot exclude cCMV infection. While CMV IgG avidity testing and analysis of stored frozen first-trimester maternal blood samples provide valuable insights, they have limitations. CMV PCR performed on amniotic fluid is a useful prenatal diagnostic tool. For cases of unexplained fetal abnormalities or death, autopsy and placental examination are recommended.

Clinical Characteristics and Outcomes of Intrauterine Blood Transfusion (IUT) for Infectious Etiologies.

Congenital viral infection may result in fetal anemia and thrombocytopenia. While intrauterine blood transfusions (IUTs) are more commonly performed for Rh alloimmunization, reports using IUT for infection have varying success. Our primary objective was to characterize the outcomes of patients undergoing IUT for infectious etiologies at our center compared with Rh disease. This was a case series of patients undergoing IUT from 2012-2023. Infectious etiologies were identified by maternal serologies and confirmed by amniotic fluid polymerase chain reactions (PCR). Clinical outcomes were obtained from electronic medical records. During the study period, 70 patients underwent IUT, 34% (24/70) for Rh alloimmunization and 17% (12/70) for infection. Those with infectious etiologies were more likely to be diagnosed at earlier gestational ages (22 vs. 25weeks, p=0.04), with hydrops (75 vs. 33%, p=0.03), and thrombocytopenia (27±33×103 vs. 163±112×103, p<0.01). Perinatal death was significantly greater in cases of CMV (4/5, 80%) compared to parvovirus (1/7, 14%) or Rh alloimmunization (5/24, 21%) (p=0.02). Anemias and thrombocytopenias related to fetal infection may be indications for IUT. Compared with Rh alloimmunization, IUT in fetal infections was performed significantly earlier, and hydrops were more common at the time of IUT. In the case of CMV, greater rates of IUFD (80%) were observed. Patients should be counseled on the various outcomes by indication.