Cytomegalovirus Infection In Pregnant Women Research Articles

Evaluation of Congenital Cytomegalovirus Infection in Pregnant Women Admitted to a University Hospital in Istanbul.

Cytomegalovirus (CMV) can cause serious complications in immunocompromised individuals and fetuses with congenital infections. These can include neurodevelopmental impairments and congenital abnormalities in newborns. This paper emphasizes the importance of concurrently evaluating ultrasonography findings and laboratory parameters in diagnosing congenital CMV infection. To examine the prenatal characteristics of CMV DNA-positive patients, we assessed serum and amniotic fluid from 141 pregnant women aged 19-45 years, each with fetal anomalies. ELISA and PCR tests, conducted in response to these amniocentesis findings, were performed at an average gestational age of 25 weeks. Serological tests revealed that all 141 women were CMV IgG-positive, and 2 (1.41%) had low-avidity CMV IgG, suggesting a recent infection. CMV DNA was detected in 17 (12.05%) amniotic fluid samples using quantitative PCR. Of these, 82% exhibited central nervous system abnormalities. Given that most infections in pregnant women are undetectable and indicators non-specific, diagnosing primary CMV in pregnant women using clinical findings alone is challenging. We contend that serological tests should not be the sole means of diagnosing congenital CMV infection during pregnancy.

Hygiene-based measures for the prevention of cytomegalovirus infection in pregnant women: a systematic review

BackgroundHuman Cytomegalovirus (HCMV) is the most frequent congenital infection worldwide causing important sequelae. However, no vaccine or antiviral treatments are currently available, thus interventions are restricted to behavioral measures. The aim of this systematic review was to assess evidence from available intervention studies using hygiene-based measures to prevent HCMV infection during pregnancy.MethodsStudies published from 1972 to 2023 were searched in Medline, PsycInfo, and Clinical Trials (PROSPERO, CRD42022344840) according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Methodological quality was assessed by two authors, using ROBE-2 and MINORS.ResultsAfter reviewing 6 selected articles, the outcome analysis suggested that implementation of hygiene-based interventions during pregnancy prevent, to some extent, the acquisition of congenital HCMV.ConclusionsHowever, these conclusions are based on limited and low-quality evidence available from few studies using this type of intervention in clinical practice. Thus, it would be necessary to perform effective and homogeneous intervention studies using hygiene-based measures, evaluated in high-quality randomized controlled trials (RCTs).

Comparison of ECL, ELISA and ELFA immunoassays

The aim of these study was the evaluation of electrochemiluminescence assay (ECL), enzyme-linked immunosorbent assay (ELISA) and enzyme-linked fluorescent assay (ELFA), for an early diagnosis of Cytomegalovirus infections in pregnant women. In medical diagnostics, it is necessary to determine the most sensitive techniques for the detection of this pathogen, due to it’s multiple fetal infections during pregnancy. The ECL technique resulted with the highest sensitivity and specificity values. However, for diagnostic purposes, the results should always be assessed in conjunction with the patient’s medical history and other clinical examinations.

Cytomegalovirus infection during pregnancy.

Cytomegalovirus (CMV) infection during pregnancy is a global silent problem. Additionally, it is the leading cause of congenital infections, non-genetic sensorineural hearing loss, and neurodevelopmental delays in infants. However, this has barely been recognized globally. This condition lacks adequate attention, which is further emphasized by the lack of awareness among healthcare workers and the general population. The impact of CMV infection is often overlooked because of the asymptomatic nature of its presentation in infected pregnant women and newborns, difficulty in diagnosis, and the perception that infants born to women with pre-existing antibodies against CMV have normal neonatal outcomes. This article highlights the latest information on the epidemiology, transmission, clinical manifestations, and development of CMV infection and its management. We reviewed the pathophysiology and clinical manifestations of CMV infection in pregnant women, diagnostic methods, including screening and prognostic markers, and updates in treatment modalities. Current advancements in research on vaccination and hyperimmunoglobulins with worldwide treatment protocols are highlighted.

Method variation of cytomegalovirus IGM assays in EQA

Cytomegalovirus (CMV) is a common virus that infects people of all ages. Correctly diagnosing a primary CMV infection in pregnant women is critical to avoid congenital anomalies. CMV IgM specificity is poor in detecting primary infections due to vial reactivation or persistence following primary infection. Algorithms using CMV IgM and IgG avidity can be useful. We sought to review the performance of CMV IgM and IgG avidity assays in the RCPAQAP CMV External Quality Assurance (EQA) Program. Data sourced from an expected IgM positive consenting donor sample was assessed using RCPAQAP software. The same sample was included in four surveys over three years. Variation in the quantitative IgM data across methods was consistently noted (e.g., Roche vs Diasorin). There were also similar differences in the qualitative interpretations between the ‘negative’ and ‘positive’ groups (21 vs 92, respectively). While 120 sites reported for IgM, only 34 of these measured IgG avidity which more than 95% reported as ‘high’. In a clinical setting, access to both results may be of benefit. While the study was limited, further investigation of discrepancies between CMV methods when interpreting results should be considered. The inclusion of IgG avidity is recommended.

Cytomegalovirus infection in pregnant women - threats, diagnosis and treatment

Cytomegalovirus is one of the most widespread DNA viruses, with 90% of women of childbearing age in Poland infected with it. Infection poses a risk to the mother as well as the fetus, as the virus can cross the placenta and damage the fetus. The purpose of this paper is to review scientific publications from 2017-2022, which describe the course of cytomegalovirus infection in pregnant women, the risks to the mother and fetus associated with the infection, methods of diagnosing the infection in the pregnant woman and the fetus, as well as treatment of cytomegalovirus infection and directions for vaccine research.
 The most common complications of congenital cytomegalovirus infection include hearing loss, mental developmental delays and miscarriage. The infection can be detected in the pregnant woman by immunological testing, while polymerase chain reaction is used in the fetus and newborn. Early detection of infection in a pregnant woman allows the implementation of treatment which includes ganciclovir, valganciclovir, acyclovir and valacyclovir. A vaccine against cytomegalovirus has not been developed. Particularly important in the prevention of infection is to conduct educational activities regarding the routes of transmission of the virus and the consequences of congenital infection for the fetus.
 Cytomegalovirus infections among pregnant women. It is important to monitor fetal development and possibly diagnose for congenital CMV infection in case of abnormalities, and the best diagnostic method is polymerase chain reaction testing. For the treatment of congenital CMV infection, acyclovir and valacyclovir are preferred, and therapy should be implemented for specific indications. Attention should be paid to educating women about infections caused by cytomegalovirus.

Pitfalls in the Serological Evaluation of Maternal Cytomegalovirus Infection as a Potential Cause of Fetal and Neonatal Involvements: A Narrative Literature Review.

Cytomegalovirus (CMV) is the most common cause of intrauterine infection and serological assays are the primary tools for assessing CMV infections during pregnancy. CMV-specific immunoglobulin M (IgM) antibodies have been used as a diagnostic marker for primary CMV infection in pregnant women, although CMV-IgM has been detected in non-primary CMV infections. IgG avidity testing may aid the distinguishing of primary from non-primary CMV infection; however, there is no standardized assay for detecting this difference. Moreover, when maternal serology shows positive CMV-IgG with negative CMV-IgM findings, vertical transmission probability following primary CMV infection is often excluded. However, symptomatic congenital CMV infections in the context of negative findings for maternal CMV-IgM have been reported recently. The absence of CMV-IgM is recognized in both primary and non-primary CMV infections. Furthermore, maternal non-primary CMV infections during pregnancy may yield a greater proportion of symptomatic congenital CMV infections than previously thought. If universal prenatal screening is performed, ultrasonography for abnormal fetal findings should be conducted regardless of CMV-IgM antibody status. If not universally screened, CMV antibody screening should be performed whenever routine fetal ultrasound reveals abnormal findings. For suspected fetal CMV infection, amniotic fluid or postnatal infant urine CMV-DNA testing is required.

Maternal Facial Nerve Palsy and a Perinatal Infection.

Maternal Facial Nerve Palsy and a Perinatal Infection.

Cytomegalovirus infections in pregnant women as a risk of congenital deafness in a child.

IntroductionOne per cent of live births are affected by cytomegalovirus infection, but 90% of neonates with perinatal infection do not show symptoms of disease. Symptomatic cytomegalovirus (CMV) is present in 5–10% of children. Typical clinical signs of congenital cytomegalovirus infection are microcephalia, mental retardation, progressive major amblyacousia, and neuromuscular infection. Hypoacusis is present in 30–60% of children with congenital symptomatic CMV – in most cases it is bilateral and applies to high-frequency hearing loss.Material and methodsA group of 70 children had serological and genetic screening of viral DNA using the polymerase chain reaction method in urine and blood. In this group, 52 children were diagnosed with congenital CMV, and 10 children were diagnosed with acquired CMV. Audiological examinations including pure-tone audiometry, auditory brainstem response, transiently evoked otoacoustic emission, and immittance audiometry were performed.ResultsBilateral sensorineural hearing loss was in 9 children associated with mental and physical retardation, brain malformation, and microcephalia. Unilateral hearing loss was observed in 3 children. In 40 cases, we did not observe hearing loss, although the level of bilirubin was high, as well as splenomegaly, hepatomegaly, and facial nerve paralysis.ConclusionsCongenital cytomegalovirus infection often caused hearing loss. Children with congenital and acquired CMV should be under the permanent care of an audiologist. The growing problem of CMV infections and their late diagnosis suggests the need to prepare screening tests and increase the education of gynaecologists, neonatologists, paediatricians, and general practice doctors about CMV problems.

The role of lipid peroxidation products in the development of iron deficiency anemia in cytomegalovirus infection in pregnant women of the first trimester

Aim. To establish the role of lipid peroxidation (LPO) products in the development of iron deficiency anemia in pregnant women of the first trimester during exacerbation of cytomegalovirus infection. Materials and methods . A prospective case-control study included 60 women in the first trimester of pregnancy (8-12 weeks), of which 35 were cytomegalovirus-positive with mild iron deficiency anemia (main group) and 25 - cytomegalovirus-seronegative (control group). Antibodies of IgM and IgG to CMV, low avid IgG (avidity index), and serum ferritin concentration were determined by enzyme-linked immunosorbent assay. In order to assess the intensity of LPO processes in blood serum spectrophoto-metric method was used to measure the levels of molecular products of oxidation: diene conjugates and active products of thiobarbituric acid. The concentration of arachidonic acid in blood serum was analyzed by means of the method of capillary gas-liquid chromatography. The concentration of total hemoglobin in red blood cells was measured by photometry. The study of iron metabolism included: evaluation of serum iron by spectrophotometric method, the total iron binding capacity of serum using commercial kits of the company “Lachema” (Czech Republic), transferrin saturation coefficient by means of calculation method. Results . Activation of LPO processes was noted in women of the main group, as evidenced by an increase in the concentration of diene conjugates by 1.54 times (p<0.001), active products of thiobarbituric acid by 2.4 times (p<0.001) and arachidonic acid by 1.3 times (p<0.001) compared with similar indicators of the control group. It has been found that hemoglobin levels were reduced by 1.2 times (p<0.001), serum iron and ferritin, respectively, by 1.4 (p<0.001) and 2 times (p<0.001), in the setting of an increase in the total iron binding capacity of serum while reducing the coefficient of iron saturation with transferrin. Conclusion . The data obtained indicate the important role of LPO products in the pathogenesis of iron deficiency anemia during exacerbation of cytomegalovirus infection in the first trimester of gestation.

Hygiene promotion might be better than serological screening to deal with Cytomegalovirus infection during pregnancy: a methodological appraisal and decision analysis

BackgroundCytomegalovirus infection is the most frequent viral congenital infection, with possible consequences such as deafness, or psychomotor retardation. In 2016, the French High Council of Public Health was mandated to update recommendations regarding prevention of cytomegalovirus infection in pregnant women. We summarize a critical appraisal of knowledge and deterministic decision analysis comparing the current no-screening situation to serological screening during pregnancy, and to hygiene promotion.MethodsScreening was defined as systematic serological testing, during the first trimester, with repeated tests as needed, to all pregnant women. Outcomes were: 1) severe sequela: intellectual deficiency with IQ ≤ 50 or hearing impairment < 70 dB or sight impairment (≤ 3/10 at best eye); 2) moderate sequela: any level of intellectual, hearing or sight deficiency; and 3) death or termination of pregnancy. We simulated the one-year course of cytomegalovirus infection in a cohort of 800,000 pregnant women. We developed a deterministic decision model, using best and min-max estimates, extracted from systematic reviews or original studies.ResultsRelevant data were scarce or imprecise. We estimated that 4352 maternal primary infections would result in 1741 foetal infections, and an unknown number of maternal reinfections would result in 1699 foetal infections. There would be 788 cytomegalovirus-related consequences, including 316 foetal deaths or terminations of pregnancy, and 424 moderate and 48 severe sequelae. Screening would result in a 1.66-fold increase of poor outcomes, mostly related to a 2.93-fold increase in deaths and terminations of pregnancy, not compensated by the decrease in severe symptomatic newborns. The promotion of hygiene would result in a 0.75-fold decrease of poor outcomes, related to both a decrease in severe sequelae among symptomatic newborns (RR = 0.75; min-max: 1.00–0.68), and in deaths and terminations of pregnancy (RR = 0.75; min-max: 0.97–0.68).ConclusionsPrevention of cytomegalovirus infection during pregnancy should promote hygiene; serological screening should not be recommended.

A Seromolecular Study on the Prevalence of Cytomegalovirus in Pregnant Women Living in Golestan Province, Iran

Background: Infection with cytomegalovirus (CMV) is highly frequent during pregnancy in human beings, which mostly results in preterm birth. Objectives: The current study aimed at comparing serological and molecular methods to determine the frequency of CMV infection in pregnant women admitted to hospitals in Golestan Province, Northern Iran. Methods: The study was conducted on 315 blood samples collected from pregnant women. After completion of the screening test questionnaire, CMV-IgG, CMV-IgM, and CMV-IgG avidity tests were performed to determine the seropositivity prevalence of CMV. Finally, after DNA extraction, the PCR technique was employed to detect the CMV genome in the samples. Results: Out of the studied women, 81.2% were positive for CMV-IgG and CMV-IgM, but only 8.2% had positive results in the molecular detection of CMV, out of which 61.9% had a history of abortion. In terms of the correlation between ethnicity and infection with CMV, 66.7% of positive samples belonged to Fars ethnic group. The relationship between ethnicity and occupational status in terms of CMV infection revealed that 85% of Fars and 29% of Turkmen housewives were positive for CMV. In terms of the relationship between ethnicity and age, 35% of pregnant women from Fars and 42% from Turkmen ethnic groups were over 30 years. Furthermore, the results showed that 71% of Fars and 42% of Turkmen pregnant women were infected with CMV during the 2nd trimester of pregnancy. Among all these variables, a significant relationship was observed only between the age of pregnant women and infection with CMV (P = 0.045). Conclusions: The current study results showed that despite the increasing frequency of CMV infection in pregnant women, seropositivity, and even higher titers of CMV-IgG have no predictive value for active CMV infection. Concerning the importance of rapid and definitive diagnosis of the disease before the emergence of manifestations, molecular techniques could be of great help as they are effective in the diagnosis of infection with smaller amounts of the pathogenic genome.

The role of eicosapentaenoic acid and superoxide dismutase in the development of hemic hypoxia in cytomegalovirus infection in pregnant women of the first trimester

The role of eicosapentaenoic acid and superoxide dismutase in the development of hemic hypoxia in cytomegalovirus infection in pregnant women of the first trimester

Диагностика и лечение цитомегаловирусной инфекции у беременных и новорожденных

Диагностика и лечение цитомегаловирусной инфекции у беременных и новорожденных

Ante- and postnatal diagnostics and complex treatment of congenital cytomegalovirus infection

Timely diagnostics and treatment of cytomegalovirus infection in pregnant women and newborns allow to avoid serious consequences, preserving the life and health of the child. The article provides an example of antenatal diagnosis of congenital cytomegalovirus infection in the fetus (positive result of polymerase chain reaction in umbilical cord blood), treatment with umbilical transfusion of donor red blood cells, postnatal therapy with antiviral drugs, including ganciclovir and specific immunoglobulin. The issues of assessing the risk of congenital cytomegalovirus infection, approaches to its prevention and treatment during pregnancy are discussed.

Estimation of distribution and immunological marker of cytomegalovirus infection in pregnant women

Estimation of distribution and immunological marker of cytomegalovirus infection in pregnant women

Evaluation of Toxoplasma gondii, Rubella virus and Cytomegalovirus Infections in Pregnant Women

Evaluation of Toxoplasma gondii, Rubella virus and Cytomegalovirus Infections in Pregnant Women

Cytomegalovirus Seroepidemiology: a Population-based Study in Alborz Province, Iran.

Cytomegalovirus (CMV) is a type of herpes virus. This virus is one of the most common causes of congenital and prenatal infections. CMV infection in pregnant women, especially in the first trimester, may lead to congenital abnormalities in newborns. The prevalence of CMV infection in developed countries is approximately 40%, and in developing countries, this prevalence may be up to 100%. Because there is no information available related to the seroepidemiological patterns of this infection in different cities of Alborz province, Iran, this study was conducted. This seroprevalence study was based on sera collected from adults who were referred to health care providers or Medical Diagnostic Laboratory Centers (MDLS) in Alborz province, Iran, from 2011 to 2015 for different purposes. Using ELISA (IgG), a retrospective serological survey of CMV antibodies in serum samples was performed in a non-immunized community. Frozen sera from 2001 individuals who were randomly selected by a cluster sampling technique were collected from spring 2013 to winter 2015. Seroprevalence was stratified by age (&amp;gt;1 to &amp;lt;50 years). Mathematical techniques were used to determine whether there is a relationship between CMV seroprevalence and age, sex, and level of education in this community. Data were analyzed using Fisher&amp;rsquo;s exact test and the &amp;chi;2 test using SPSS software version 11.5. The mean age of seropositive individuals varied between 15 and 50 years. CMV IgG was found in 1813 (91%) of 2001 individuals. In total, 188 individuals (9%) were negative for CMV IgG. There were significant relationships between seropositivity (CMV IgG) and age, sex, level of education, and level of antibody titer by sex. As in other developing countries, the prevalence of CMV infection in adults in Alborz province is high. Since CMV infection is prevalent and there are potential abnormalities associated with it, we strongly recommend the expansion of preventive measures and the establishment of programs to inform at-risk populations, especially vulnerable populations such as transplant recipients, immunocompromised patients, and school children on how to prevent this infection and its associated consequences.

Cytomegalovirus Infection in Pregnancy - Our Experiences.

Introduction:Cytomegalovirus (CMV) infection is ubiquitous. It affects all age groups, and its clinical picture ranges from mild to severe, especially as a congenital infection in neonates.Aim:To determine frequency of CMV infection in pregnant women in Tuzla Canton (TC) and the risk factors that lead to the infection.Methods:This prospective study included 300 pregnant women from TC aged 18 to 42 years. CMV serology was performed on all participants, and in case of acute infection additionally IgG avidity test. Participants also completed the questionnaire on the risk factors for CMV infection.Results:The median age of the 300 women was 28 ±4.97 years. There were 161participants (53.6%) who classified their environment as urban and 295 (98.33%) were married. More than half of the women had completed secondary school 168 (56%). Positive IgG antibodies to CMV had 280 (93.0%) women. Positive IgM and IgG antibodies had 9 (3.0%) participants, but all of them had high IgG avidity, which indicates reinfection or recurrent CMV infection. There was a statistically significant higher number of seropositive participants living in rural areas than those living in urban areas (p= 0.048). Also, there was significantly higher percentage of positive anti-CMV IgG in pregnant women with lower education (p=0.04).Conclusion:In our region there is high seropositivity rates of IgG antibodies to CMV in pregnant women. No case of primary CMV infection was proven. The risk factors for CMV infection have been proven to be rural environment and lower level of education.

CYTOMEGALOVIRUS INFECTION IN PREGNANT WOMEN WITH HIV INFECTION

Purpose: еstablishment of the frequency of infection and clinical forms of cytomegalovirus infection in pregnant women with HIV infection. Materials and methods. A retrospective analysis of medical records of 254 HIV-infected pregnant women of the Krasnodar Territory was conducted, which were observed in the framework of the current regulations on HIV infection and the management of pregnant women. Verification of cytomegalovirus infection and distribution of clinical forms was carried out by serological tests. The comparison group is a prospective analysis of 29 pregnant women with HIV infection who were additionally examined for cytomegalovirus infection by polymerase chain reaction. Results. Latent form of CMV infection was diagnosed in 220 (90,5%) of HIV-infected pregnant women, primary — in 5 (2,1%) and reactivated (late primary, reinfection)— in 18 (7,4%). Cytomegalovirus infection frequency increase with growing pregnant, increasing stages of HIV infection, more frequent multiplicity pregnancy, reducing CD4+ T-lymphocytes and increase in HIV RNA. The well-being of obstetric history had no effect on the incidence of infection with cytomegalovirus and various forms of CMV infection. Reactivated forms of cytomegalovirus infection were significantly more frequent in pregnant women with HIV infection at the lowest CD4 + T-lymphocyte counts, maximal HIV viremia, later onset of perinatal antiretroviral prophylaxis, but did not depend on the well-being of the obstetric anamnesis. A comparison group study demonstrated the presence of latent cytomegalovirus infection in all pregnant women, confirmed by the detection of only specific IgG. From the whole blood, the DNA of CMV in low concentration was isolated by PCR method in 1 (3,4%) of the patient, from the cervix — in 8 (27,6%). The amount of detected CMV DNA in the cervix was different, had a direct correlation with the level of HIV RNA of pregnant women and did not depend on the number of CD4-lymphocytes. The calculation of the relative risk in our observations demonstrated that the presence of cytomegalovirus in the cervix did not increase the risk of premature termination of pregnancy.