Postnatal CMV Infection Research Articles

Distribution of CMV envelope glycoprotein B, H and N genotypes in infants with congenital cytomegalovirus symptomatic infection.

Cytomegalovirus (CMV) is the leading cause of congenital infections worldwide and contributes to long-term sequelae in neonates and children. CMV envelope glycoproteins play a vital role in virus entry and cell fusion. The association between CMV polymorphisms and clinical outcomes remains controversial. The present study aims to demonstrate the distribution of glycoprotein B (gB), H (gH) and N (gN) genotypes in congenitally CMV (cCMV) infected symptomatic infants and attempts to figure out the association between viral glycoprotein genotypes and clinical outcomes. Genotyping of gB, gH and gN was performed in 42 cCMV symptomatic infants and 149 infants with postnatal CMV (pCMV) infection in Children's hospital of Fudan university. Nested PCR, gene sequencing and phylogenetic analyses were used to identify the genotypes. Our study demonstrated that: 1. The CMV gB1, gH1 and gN1 were the predominant genotypes among symptomatic cCMV infected infants, while gB1, gH1 and gN3a were more prevalent in pCMV group. gH1 genotype has a significant association with symptomatic cCMV infection (p = 0.006). 2. No significant correlation was found between CMV genotypes and hearing impairment. However, gH1 was more prevalent among cCMV infected infants with moderate/severe hearing loss although without statistical difference (p = 0.130). 3. gB3 was more prevalent among infants with skin petechiae (p = 0.049) and found to be associated with an increased risk of skin petechiae (OR = 6.563). The gN4a subtype was significantly associated with chorioretinitis due to cCMV infection (p = 0.007). 4. Urine viral loads were not significantly associated with different genotypes or hearing impairment among symptomatic cCMV infected infants. Our findings demonstrated the overall distribution of gB, gH and gN genotypes in infants with symptomatic cCMV infection in Shanghai for the first time. The findings in our study may suggest a possible association between gH1 genotype and early infancy hearing loss. gB3 genotype was associated with a 6.5-fold increased risk of petechiae while gN4a strongly correlated with chorioretinitis due to cCMV infection. No significant correlation was found between urine viral loads and CMV genotypes or hearing impairment in cCMV infected infants.

Perinatal Cytomegalovirus Infection.

There have been recent advances in the field of congenital CMV infection (cCMV) related to antiviral treatment of pregnant women and infants, the implementation of newborn CMV screening programs, and the frequency and diagnosis of complications among infected children. In addition, postnatal CMV infection (pCMV) is increasingly recognized as a potential cause of long-term sequelae in addition to acute complications among preterm infants, raising important questions related to treatment, and prevention. High-dose valacyclovir appears to be safe and effective for the prevention of cCMV among women with first-trimester primary CMV infection. New studies reveal high rates of vestibular dysfunction and neuropsychiatric manifestations among children with cCMV. Some studies report associations between pCMV and long-term consequences, including neurodevelopmental delay and bronchopulmonary dysplasia, among very low birth weight infants, in addition to high risk of sepsis and death acutely, which has motivated efforts to eliminate the virus from breast milk by different methods. More long-term complications of cCMV are increasingly recognized among children previously thought to be asymptomatic. Although a preventive CMV vaccine may be achievable, strategies to reduce the burden of cCMV disease include maternal education about risk-reduction behaviors, antiviral treatment of pregnant women with primary infection, and newborn screening to allow timely, appropriate care. Similarly, although it remains unclear if pCMV causes long-term problems, there is growing interest in identifying and preventing disease from CMV infections among preterm infants.

Prevalence of Congenital CMV Infection and Antiviral Therapy in Very-Low-Birth-Weight Infants: Observations of the German Neonatal Network.

To determine the prevalence of congenital CMV infection (cCMV) in very-low-birth-weight infants (VLBWI) and to evaluate epidemiological characteristics of VLBWI with antiviral therapy (AT). CMV-specific PCR in umbilical cord tissue was performed (n=3330). Univariate analyses and logistic regression models were used to identify associations with outcome. 22/3330 VLBWI received AT (0.66%). 4 of these (0.12%) were PCR positive, with 2 VLBWI showing pathological screening for hearing loss. VLBWI with AT and negative PCR had significantly reduced mean birth weight (BW) and higher rates of small-for-gestational-age (SGA). Clinical sepsis, bronchopulmonary dysplasia (BPD), use of reserve antibiotics (RA) and treatment for retinopathy of prematurity were significantly increased. We further observed a higher need of transfusion of red blood cells (RBC), fresh frozen plasma and platelets. Logistic regression (controlled for gender, gestational age, SGA and BW) showed associations for AT and BPD (OR 3.4 [1.2-10.1], p=0.024), RA (OR 20.4 [4.2-98.9], p≤0.001), transfusions of RBC (OR 11.9 [1.3-105.7], p=0.026) and platelets (OR 8.7 [2.9-26.4], p≤0.001). All VLBWI with positive PCR received AT. We hypothesize from our data by assuming a postnatal aquired CMV infection in VLBWI with AT and negative PCR that VLBWI born SGA have a different risk profile. Further prospective studies concerning postnatal transmission should take VLBWI born SGA into account and should study the impact of infection on short- and long-term complications in this supposed vulnerable group.

CMV infection in a cohort of HIV-exposed infants born to mothers receiving antiretroviral therapy during pregnancy and breastfeeding

Antiretroviral therapy has been shown to reduce rates of congenital CMV infection. Little information is available on the possible impact of antiretroviral therapy on postnatal breastfeeding-associated CMV infection acquisition. A cohort of 89 HIV-infected mothers and their children was studied. Women received antiretroviral therapy from week 25 of gestation until 6months postpartum or indefinitely if meeting the criteria for treatment. All women were evaluated for CMV IgG presence and CMV DNA in breast milk. Children were tested for CMV infection by either the presence of IgM or the presence of CMV DNA in plasma at 1, 6 and 12months and by the presence of IgG at 24months. All mothers had high titers of CMV DNA in breast milk (5.7 log at Month 1 and 5.1 log at Month 6). Cumulative CMV infection rates were 60.3% at Month 6, 69% at Month 12 and 96.4% at Month 24. There was a significant negative correlation between the duration of antiretroviral treatment during pregnancy and levels of CMV DNA in breast milk at Month 1 (P=0.033). There was a trend for a correlation between high titers of CMV DNA in breast milk at 6months and CMV infection at 6months (P=0.069). In this cohort, more than 95% of the children had acquired CMV infection by 2years of age. Besides breastfeeding, which played a major role, also horizontal transmission between 1 and 2years was certainly relevant in determining CMV infection acquisition.

Postnatal Human Cytomegalovirus Infection in Preterm Infants Has Long-Term Neuropsychological Sequelae

To evaluate whether an early postnatal infection poses a long-term risk for neuropsychological impairment to neonates born very prematurely. Adolescents born very preterm (n = 42, 11.6-16.2 years, mean = 13.9; 15 girls; 19 with and 23 without an early postnatal human cytomegalovirus [CMV] infection) and typically developing, term born controls (n = 24, 11.3-16.6 years, mean = 13.6; 12 girls) were neuropsychologically assessed with the German version of the Wechsler Intelligence Scale and the Developmental Test for Visual Perception. As expected, the full cohort of adolescents born preterm had significantly lower scores than term born controls on IQ (preterm: mean [SD] = 98.43 [14.83], control: 110.00 [8.10], P = .015) and on visuoperceptive abilities (95.64 [12.87] vs 106.24 [9.95], P = .016). Furthermore, adolescents born preterm with early postnatal CMV infection scored significantly lower than those without this infection regarding overall cognitive abilities (92.67 [14.71] vs 102.75 [13.67], P = .030), but not visuoperceptive abilities (91.22 [10.88] vs 98.96 [13.45], P > .05). In our small but well-characterized group, our results provide evidence for adverse effects of early postnatal CMV infection on overall cognitive functions in adolescents born preterm. If confirmed, these results support the implementation of preventive measures.

Genotype distribution, viral load and clinical characteristics of infants with postnatal or congenital cytomegalovirus infection.

BackgroundCongenital cytomegalovirus infection is a leading cause of long-term sequelae. Cytomegalovirus is also frequently transmitted to preterm infants postnatally, but these infections are mostly asymptomatic. A correlation between cytomegalovirus genotypes and clinical manifestations has been reported previously in infants with congenital infection, but not in preterm infants with postnatal infection.ObjectivesThe main objective of this study was to investigate cytomegalovirus genotype distribution in postnatal and congenital cytomegalovirus infection and its association with disease severity.MethodsInfants admitted to the neonatal intensive care unit of the University Medical Center Utrecht, The Netherlands between 2003–2010 and diagnosed with postnatal or congenital cytomegalovirus infection were included. Classification of cytomegalovirus isolates in genotypes was performed upon amplification and sequencing of the cytomegalovirus UL55 (gB) and UL144 genes. Clinical data, cerebral abnormalities, neurodevelopmental outcome and viral load were studied in relation to genotype distribution.ResultsGenotyping results were obtained from 58 preterm infants with postnatal cytomegalovirus infection and 13 infants with congenital cytomegalovirus infection. Postnatal disease was mild in all preterm infants and all had favourable outcome. Infants with congenital infection were significantly more severely affected than infants with postnatal infection. Seventy-seven percent of these infants were symptomatic at birth, 2/13 died and 3/13 developed long-term sequelae (median follow-up 6 (range 2–8) years). The distribution of cytomegalovirus genotypes was comparable for postnatal and congenital infection. UL55 genotype 1 and UL144 genotype 3 were predominant genotypes in both groups.ConclusionsDistribution of UL55 and UL144 genotypes was similar in asymptomatic postnatal and severe congenital CMV infection suggesting that other factors rather than cytomegalovirus UL55 and UL144 genotype are responsible for the development of severe disease.

Urine is superior to saliva when screening for postnatal CMV infections in preterm infants

BackgroundCytomegalovirus (CMV) is the most frequently contracted virus in preterm infants. Postnatal infection is mostly asymptomatic but is sometimes associated with severe disease. To diagnose an infection, urine or saliva samples can be tested for CMV-DNA by real-time polymerase chain reaction (rtPCR). Although the diagnostic accuracy of testing saliva samples has not been determined in preterm infants, saliva is widely used because it is easier to obtain than urine. ObjectivesTo determine whether screening of saliva is equivalent to urine to detect a postnatal CMV infection in preterm infants. Study designBetween 2010 and 2013 saliva and urine samples were collected from infants admitted to the Neonatal Intensive Care Unit of the University Medical Center Utrecht and born with a gestational age (GA) below 32 weeks. Urine samples were obtained within three weeks after birth and urine and saliva samples at term equivalent age (40 weeks GA) and tested for CMV-DNA by rtPCR. Infants with a congenital CMV infection were excluded. ResultsOf 261 preterm infants included in the study, CMV-DNA was detected in urine of 47 and in saliva of 43 children. Of 47 infants with postnatal CMV infection, CMV was detected in 42 saliva samples (sensitivity 89.4%; CI 76.9–96.5). Of 214 children without postnatal CMV infection, one saliva sample tested positive for CMV (specificity 99.5%; CI 97.4–99.9). ConclusionsScreening saliva for CMV-DNA by rtPCR is inferior to urine to diagnose postnatal CMV infections in preterm infants.

Cytomegalovirus Infection

Although commonly asymptomatic, congenital CMV infection is the leading cause of nonhereditary SNHL. Other sequelae that may be evident only after the neonatal period can include chorioretinitis, neurodevelopmental delay with mental or motor impairment, and microcephaly. (13) • Congenital CMV infection is confirmed by detection of the virus in urine, blood, or saliva within the first 3 weeks of life by culture or polymerase chain reaction. A positive test does not necessarily confirm symptomatic CMV disease or need for treatment. (13) • Postnatal CMV infections transmitted through human milk have been reported and may be clinically relevant in extremely premature infants; however, the risk-benefit ratio of pasteurizing human milk for the prevention of postnatal CMV infection is unclear. • Ganciclovir, valganciclovir, foscarnet, cidofovir, and CMV hyperimmune globulin are effective in treating or preventing CMV infections in the immunocompromised host, but require close monitoring for associated toxicities. Treatment for congenital CMV is associated with significant toxicity and uncertain effectiveness. • Based on strong evidence, anticipatory guidance for congenital CMV infection should include hearing tests and neurodevelopmental assessments until school age. (3) In patients with symptomatic congenital CMV infection, lifelong ophthalmologic screening should be included. (4) • Based primarily on consensus, owing to lack of relevant clinical studies, it is not recommended to withhold human milk produced by CMV-seropositive mothers from healthy term infants. (5)(6) • Based on some research evidence, as well as consensus, treatment for congenital CMV is recommended only in symptomatic infants with central nervous system involvement. (9)

Breastfeeding: More Than Just Good Nutrition

Breastfeeding: More Than Just Good Nutrition

Post-natal CMV infection via mother's milk in ELBW infants born to CMV seropositive mothers

s for 2nd International Conference on Clinical Neonatology Comparison of conventional blood culture method and BacT/Alert system with respect to yield and time to positivity in neonatal sepsis Arti Maria⁎, Sumitha Phalgun, Charoo Hans, N. Dubey, Deepak Goyal PGIMER & Associated Dr RML Hospital, New Delhi, India ⁎Corresponding author. Efficient and faster ways of diagnosing neonatal sepsis than conventional blood culture are needed in clinical practice. Recently, automated systems have been developed to address this issue. We hypothesized that automated compared to conventional methods of blood culture may give better isolation performances and shorter time to yield in the diagnosis of neonatal sepsis. This was a single-center, prospective, cohort study enrolling neonates with suspected neonatal sepsis in tertiary neonatal referral unit of north India. From May 2008 to April 2009, ninety consecutive neonates with suspected sepsis were enrolled with the objective of comparing the sensitivity and the time needed to yield positivity of conventional vs. BacT/Alert blood culture. Conventional and automated cultureswere collected in standardized manner from each baby, the order being alternate in consecutive babies. Refusal to consent, being ELBW and showing hemodynamical unstability were the only exclusion criteria for the neonates screened for inclusion in the study. Statistical analysis was conducted with the SPSS software version 11.0. The results showed that positivity by BacT/Alert was 38.8% (35/90) compared to 14.4% (13/90)with conventionalmethod (p<0.05). BacT/ Alert detected 30% isolates as early as within 12 h and 100% by 48 h whereas conventional detected none before 48 h and 69.2% by 72 h (p<0.001). Staphylococcus aureus was the commonest isolated microorganism (40% of cases). We concluded that a greater yield and earlier detection of pathogens by the Bact/Alert system make it more suitable for early definitive diagnosis of neonatal sepsis. This has implications for timely rational antibiotic therapy with possible favourable outcomes in neonatal sepsis. doi:10.1016/j.earlhumdev.2010.12.021 Safety of aqueous chlorhexidine gluconate for skin antisepsis in VLBW infants Maria Grazia Capretti⁎, Marica Spinelli, Elisabetta Tridapalli, Santo Arcuri, Anna Malavolti, Emanuela Callea, Giacomo Faldella Neonatal Intensive Care Unit, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy Infection Control Unit, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy ⁎Corresponding author. No guidelines are available for antisepsis in infants with age <2 months. The aim of this study is to evaluate the efficacy and safety of aqueous chlorhexidine gluconate (aCG) at different concentrations for skin disinfection in VLBW (birth weight <1500 g) infants. Two different protocols for skin antisepsis were prospectively used. The rate of nosocomial infection and adverse effects were compared. In the first period (January 2007 to December 2008) we used 2%aCG solution, regardless of gestational age (GA) and birth weight (BW); in the second period (January 2009 to October 2010) 0.1%aCG was used in the first ten days of life in newborns with GA=27 weeks and/or BW=750 g and 1%aCG, in the remaining cases. Microbiological culture of CVC-tips, blood samples, urine and respiratory tract specimens were collected when infection was suspected. First period infants 15/124 vs second period infants 14/103 were found infected after 72 h of life (p=0.842); among infants with BW<750 g, 9/31were infected in the first period vs 3/21 in the second period (p=0.318). Five ELBW infants (BW<1000 g) showed burns using 2%aCG prior to insertion of umbilical venous or peripherally inserted central catheters. No burns or other adverse events were observed in the second period. Our data show that 2%aCG may not be safe when used in ELBW infants in the first days of life, suggesting that antisepsis solution in premature should be differentiated according to GA and chronologic age. doi:10.1016/j.earlhumdev.2010.12.022 Post-natal CMV infection via mother's milk in ELBW infants born to CMV seropositive mothers

Comparison of conventional blood culture method and BacT/Alert system with respect to yield and time to positivity in neonatal sepsis

s for 2nd International Conference on Clinical Neonatology Comparison of conventional blood culture method and BacT/Alert system with respect to yield and time to positivity in neonatal sepsis Arti Maria⁎, Sumitha Phalgun, Charoo Hans, N. Dubey, Deepak Goyal PGIMER & Associated Dr RML Hospital, New Delhi, India ⁎Corresponding author. Efficient and faster ways of diagnosing neonatal sepsis than conventional blood culture are needed in clinical practice. Recently, automated systems have been developed to address this issue. We hypothesized that automated compared to conventional methods of blood culture may give better isolation performances and shorter time to yield in the diagnosis of neonatal sepsis. This was a single-center, prospective, cohort study enrolling neonates with suspected neonatal sepsis in tertiary neonatal referral unit of north India. From May 2008 to April 2009, ninety consecutive neonates with suspected sepsis were enrolled with the objective of comparing the sensitivity and the time needed to yield positivity of conventional vs. BacT/Alert blood culture. Conventional and automated cultureswere collected in standardized manner from each baby, the order being alternate in consecutive babies. Refusal to consent, being ELBW and showing hemodynamical unstability were the only exclusion criteria for the neonates screened for inclusion in the study. Statistical analysis was conducted with the SPSS software version 11.0. The results showed that positivity by BacT/Alert was 38.8% (35/90) compared to 14.4% (13/90)with conventionalmethod (p<0.05). BacT/ Alert detected 30% isolates as early as within 12 h and 100% by 48 h whereas conventional detected none before 48 h and 69.2% by 72 h (p<0.001). Staphylococcus aureus was the commonest isolated microorganism (40% of cases). We concluded that a greater yield and earlier detection of pathogens by the Bact/Alert system make it more suitable for early definitive diagnosis of neonatal sepsis. This has implications for timely rational antibiotic therapy with possible favourable outcomes in neonatal sepsis. doi:10.1016/j.earlhumdev.2010.12.021 Safety of aqueous chlorhexidine gluconate for skin antisepsis in VLBW infants Maria Grazia Capretti⁎, Marica Spinelli, Elisabetta Tridapalli, Santo Arcuri, Anna Malavolti, Emanuela Callea, Giacomo Faldella Neonatal Intensive Care Unit, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy Infection Control Unit, St. Orsola-Malpighi General Hospital, University of Bologna, Bologna, Italy ⁎Corresponding author. No guidelines are available for antisepsis in infants with age <2 months. The aim of this study is to evaluate the efficacy and safety of aqueous chlorhexidine gluconate (aCG) at different concentrations for skin disinfection in VLBW (birth weight <1500 g) infants. Two different protocols for skin antisepsis were prospectively used. The rate of nosocomial infection and adverse effects were compared. In the first period (January 2007 to December 2008) we used 2%aCG solution, regardless of gestational age (GA) and birth weight (BW); in the second period (January 2009 to October 2010) 0.1%aCG was used in the first ten days of life in newborns with GA=27 weeks and/or BW=750 g and 1%aCG, in the remaining cases. Microbiological culture of CVC-tips, blood samples, urine and respiratory tract specimens were collected when infection was suspected. First period infants 15/124 vs second period infants 14/103 were found infected after 72 h of life (p=0.842); among infants with BW<750 g, 9/31were infected in the first period vs 3/21 in the second period (p=0.318). Five ELBW infants (BW<1000 g) showed burns using 2%aCG prior to insertion of umbilical venous or peripherally inserted central catheters. No burns or other adverse events were observed in the second period. Our data show that 2%aCG may not be safe when used in ELBW infants in the first days of life, suggesting that antisepsis solution in premature should be differentiated according to GA and chronologic age. doi:10.1016/j.earlhumdev.2010.12.022 Post-natal CMV infection via mother's milk in ELBW infants born to CMV seropositive mothers

Postnatal CMV Infection Outcomes Poor in VLBW Infants

Postnatal CMV Infection Outcomes Poor in VLBW Infants

A haemophagocytic lymphohistiocytosis (HLH)-like picture following breastmilk transmitted cytomegalovirus infection in a preterm infant

Due to septic illness, neutro- and thrombocytopenia, blocked myelopoiesis, CMV-positive breast milk and CMV-pp65 antigen in bone marrow mononuclear cells, CMV-related HLH was presumed in a breast fed neonate (gestational age 24 weeks). Treatment was successful with foscarnet and methylprednisolone. HLH may be a complication of post-natal CMV-infection acquired from breast milk.

Cytomegalovirus in Human Breast Milk: Risk to the Premature Infant

Human cytomegalovirus (HCMV) can be transmitted through breast milk to neonates. Although healthy full-term infants rarely develop symptoms of CMV infection; premature or low-birth-weight infants can experience symptomatic infection that is occasionally severe. There is limited information on the long-term effects of postnatal CMV infection in premature infants, suggesting that these infants do not develop cognitive function delays or hearing loss, although those with intrapartum infection do. Readily available methods of treating breast milk to inactivate the CMV either diminish the immunologic and nutritive benefits of breast milk or incompletely inactivate the virus. This review considers the data on measuring CMV in breast milk, the recent clinical studies on CMV transmission via breast milk, reported methods of inactivation of CMV in breast milk, and immunologic factors that may play a role in transmission. CMV-IVIG treatment needs further evaluation but appears promising. Recommendations are made to help address the issue of CMV transmission to premature infants in clinical practice in the neonatal intensive care unit (NICU).

191 Cytomegalovirus In Breast Milk: Does It Make Very Premature Babies Ill?

Background: It is well known that babies often become infected with CMV from their mother's milk. It has been suggested that postnatal CMV infection in very premature babies causes illness but there have been inadequate controls.Primary Aim: To determine, in very premature babies born in the Royal Women's Hospital, the incidence and severity of illnesses caused by CMV shed in their mothers' fresh unfrozen expressed breast milk (EBM).Methods: Mothers of babies born at <32 weeks and <1250g were invited to join the study. Only CMV antibody +ve mothers were enrolled. EBM and babies' urine and saliva were collected weekly, until discharge, for culture. All new neonatal symptoms, signs and treatments were documented. Results: 247 mothers were approached, 202 consented. Mothers of 95 babies were CMV antibody +ve (47%). 88 babies and their 75 mothers were studied. The mean (SD) mothers' age was 29 (6) y, parity 2.2 (1.3), and babies' birth weight 937 (212)g, 33% were delivered vaginally, 47% were male and 30% twins. CMV was cultured from EBM deposit and supernatant starting at week 1 in 66% of the EBM that was culture +ve at any time. 33% of the babies grew CMV in urine or saliva starting about week 7. 97% of the CMV culture +ve infants had CMV culture +ve EBM. 66% of the CMV culture −ve infants had CMV +ve EBM.Conclusion: About half the mothers of very premature babies are CMV antibody +ve. Two-thirds shed CMV in their EBM from the first week. 33% of the babies of CMV antibody +ve mothers grew CMV from the urine or saliva. They had no more signs or symptoms of illness than the babies who remained CMV culture −ve. Very premature babies with CMV acquired from mother's EBM did not have significantly more illnesses than babies from CMV antibody +ve mothers who were not infected.

237 Reducing The CMV Infectivity of Mother's Own Breast Milk

Background: Infants can acquire primary postnatal CMV infection from the breast milk of their CMV infected mothers(1). About 60% of Australian mothers are CMV positive. Most of these will eventually excrete CMV into their breast milk(1). CMV transmission has been documented in 37% of preterm infants of CMV infected mothers(1) -symptomatic infection such as neutropenia, thrombocytopenia, hepatopathy, sepsis-like deterioration occurred in about half of these (1). The infants most at risk of symptomatic infection are the extremely low birth weight infants and those who acquire CMV early(2). An increased risk of adverse neurodevelopmental outcome in low-birth weight infants who acquired CMV early has been suggested (3). Preventing CMV transmission in extremely preterm infants from maternal milk is a clinical problem. Methods that reliably remove CMV such as heating also remove beneficial properties of breast milk. Freezing is not harmful to the protective effects of breast milk. Previous small studies of freezing (to −20°C) breast milk with naturally acquired CMV showed a reduction in CMV titres, or elimination of CMV. These studies used a culture method with a low sensitivity.

Cytomegalovirus infection of preterm infants by breast milk

Background: After elimination of CMV transmission by blood products we have still observed preterm infants with postnatally acquired CMV infections. 16 preterm infants with CMV infection by breast milk were identified. Methods: CMV-DNA PCR and viral cultures. Criteria of transmission: CMV in breast milk; viruria in preterm infants; exclusions of congenital infection, of donor's breast milk and of CMV seropositive blood transfusions. Results: 8 infants (50 %) had marked symptoms of an acute CMV infection: sepsis-like symptoms with apnoea and bradycardia (4), cholestasis/hepatitis (4/2), thrombocytopenia (6), neutropenia (5). Infection in the latter group occurred at an median postnatal age of 46 vs. 62 days in asymptomatic infected infants (p < 0.01). Conclusion: There is a high incidence of symptomatic CMV infections in preterm infants due to breast milk transmission. An early postnatal CMV infection seems to be associated with a symptomatic clinical course.

Prospective study on maternal, intrauterine, and perinatal infections with cytomegalovirus in Japan during 1976-1990.

Since 1976, sera obtained serially from 10,218 pregnant women during the first, second, and third trimesters of gestation and cord sera were tested for CMV complement-fixing (CF) and immunofluorescent (IF) antibodies. CMV IgG-IF antibody was positive in 9,735/10,218 (95%) in the first trimester, and a significant rise of CF antibodies during pregnancy was found in 70/9,206 (0.76%) of the seropositive group and in 5/438 (1.14%) of the seronegative group. IgM antibody was found in 6/9,206 (0.06%) of seropositive women during the first trimester and in 7/70 (10.0%) of seropositive mothers with CF antibody rise and in 4/5 of seroconverted mothers of the seronegative group, suggesting that the incidence of primary infection with CMV during pregnancy was approximately 1% of susceptible women. All the mothers with immune response had infants with neither viruria nor IgM antibody in the cord blood, whereas seropositive mothers without an immune response had infants with viruria (7/1,826; 0.4%) or with IgM antibody in the cord blood (6/9,136; 0.06%). None of these 13 babies, shedding CMV or with IgM IF antibody, had physical or mental retardation. CMV IgG-IF antibody was present in almost 80% of infants between 7 and 12 months of age in 1988, suggesting that perinatal or postnatal CMV infection may occur in infants born to seropositive mothers in 70-80% of pregnancies.

Prevalence and duration of postnatally acquired human cytomegalovirus infection

Four of seven children with postnatal CMV infection were found to excrete CMV for prolonged periods of time ranging from 7 to 38 months. The incidence of CMV infection among 66 children over a time interval of 47.8 months was 19 per cent. Prevalence of CMV excretion determined at 39 months of age in this group was 8 per cent. Prolonged excretion of CMV among those children infected appeared to account for the high prevalence. The excretion characteristics of this agent undoubtedly play an important role in its ubiquitous occurrence.