Primary Infection In Pregnant Women Research Articles

Toxoplasma gondii IgG avidity for the diagnosis of primary infection in pregnant women: Comparison between chemiluminescent microparticle immunoassay and enzyme-linked immunosorbent assay

IntroductionThis study evaluated whether IgG avidity measured by chemiluminescent microparticle immunoassay (CMIA) compared with enzyme-linked immunosorbent assay (ELISA) was useful to detect primary T. gondii infection during pregnancy and to estimate the risk for congenital T. gondii infection. MethodsOne hundred six women with positive tests for T. gondii IgG and T. gondii IgM, comprising 21 women (19.8%) with low (<30%), 6 (5.7%) with borderline (30%–35%), and 79 (74.5%) with high (>35%) IgG avidity measured by ELISA were selected. Their stored sera were used for T. gondii IgG avidity measurements by CMIA. ResultsIn CMIA, 72 (67.9%) women had low (<50%), 12 (11.3%) had borderline (50%–59.9%), and 22 (20.8%) had high (≥60%) IgG avidity. The ratio of low T. gondii IgG avidity index in CMIA was more than three-fold than that in ELISA. Eighteen (85.7%) of 21 women with ELISA low avidity also had CMIA low avidity, and 26 (96.3%) of 27 women with ELISA low or borderline avidity corresponded to CMIA low or borderline avidity, whereas 21 (26.6%) of 79 women with ELISA high avidity were diagnosed with CMIA low avidity. All three cases with congenital T. gondii infection showed coincidentally low IgG avidity in both methods. A positive correlation in IgG avidity indices was found between of ELISA and CMIA. ConclusionsCMIA for T. gondii avidity measurements compared with ELISA was clinically useful to detect pregnant women at a high risk of developing congenital T. gondii infection.

Cost-effectiveness of screening and valacyclovir-based treatment strategies for first-trimester cytomegalovirus primary infection in pregnant women in France.

To assess the effectiveness, cost and cost-effectiveness of four screening strategies for first-trimester (T1) cytomegalovirus (CMV) primary infection (PI) in pregnant women in France. In a simulated pregnant population of 800 000 (approximate number of pregnancies each year in France), using costs based on the year 2022, we compared four CMV maternal screening strategies: Strategy S1, no systematic screening (current public health recommendations in France); Strategy S2, screening of 25-50% of the pregnant population (current screening practice in France); Strategy S3, universal screening (current medical recommendations in France); Strategy S4, universal screening (as in Strategy S3) in conjunction with valacyclovir in case of T1 PI. Outcomes were total cost, effectiveness (number of congenital infections, number of diagnosed infections) and incremental cost-effectiveness ratio (ICER). Two ICERs were calculated, comparing Strategies S1, S2 and S3 in terms of euros (€) per additional diagnosis, and comparing Strategies S1 and S4 in € per avoided congenital infection. Compared with Strategy S1, Strategy S3 enabled diagnosis of 536 more infected fetuses and Strategy S4 prevented 375 congenital infections. Strategy S1 was the least expensive strategy (€98.3m total lifetime cost), followed by Strategy S4 (€98.6m), Strategy S2 (€106.0m) and Strategy S3 (€118.9m). In the first analysis, Strategy S2 was dominated and Strategy S3 led to an additional €38 552 per additional in-utero diagnosis, compared with Strategy S1. In the second analysis, Strategy S4 led to an additional €893 per avoided congenital infection compared with Strategy S1, and was cost-saving compared with Strategy S2. In France, current screening practice for CMV PI during pregnancy is no longer acceptable in terms of cost-effectiveness because this strategy was dominated by universal screening. Moreover, universal screening in conjunction with valacyclovir treatment would be cost-effective compared with current recommendations and is cost-saving compared with current practice. © 2023 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.

Seroprevalence of Rubella Virus Infection in Susceptible Women of Childbearing Age Group Seeking Preconceptional Counselling and Infertility Treatment- A Cross-sectional Study from Eastern India

Introduction: Rubella is an acute viral infection predominantly affecting children and adults. Although natural infection with rubella provide lifelong immunity, but, primary infection in pregnant women during the initial days of pregnancy may result in spontaneous abortion, stillbirth, or a baby born with Congenital Rubella Syndrome (CRS), which can be prevented by vaccinating the susceptible non immune females one month prior to planning conception. Aim: To determine rubella virus immune status and demographic profile of women in childbearing age group, and counsel all Rubella virus infection susceptible women for vaccination prior to planning pregnancy. Materials and Methods: A cross-sectional observational study was done at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna , Bihar, India, on 112 apparently healthy, asymptomatic women in the 18-45 years age group coming for preconceptional counselling and primary and secondary infertility treatment during April 2017 to March 2019, whose serum rubella Immunoglobulin G (IgG) antibody testing was done by Enzyme- linked Immunosorbent Assay (ELISA). The data regarding their rubella virus immune status, age, parity and occupations were coded and recorded in MS Excel spreadsheet program. The Statistical Package for the Social Sciences (SPSS) version 23 (IBM Corp.) was used for data analysis. Results: Out of the total 112 women {92 (82.1%) housewife and 20 (17.9%) professionals} included in this study , a total of 67 (59.8%) women tested positive for rubella IgG antibody and 45 (40.2%) tested negative for rubella IgG antibody. The mean age of the rubella virus seropositive immune patients and seronegative susceptible women was 27.72±4.83 years was 26.09±4.68 years respectively. Among the 67 seropositive patients, maximum antirubella virus IgG seropositivity (71.4%) was seen in more than 35 years age group and maximum seronegativity 23 (46.9%) was seen in 18-26 years age group. There was no direct association of occupation and parity with rubella immune status. Conclusion: Higher rate of antirubella IgG seronegativity amongst younger age groups and nulliparous women renders them susceptible to primary Rubella virus infection. Hence, Rubella IgG antibody screening, proper counselling and prompt rubella vaccination for all primary Rubella virus infection susceptible women is necessary one month prior to planning conception, to avoid foetal congenital malformations during subsequent pregnancies.

Contribution of Serum Cytomegalovirus PCR to Diagnosis of Early CMV Primary Infection in Pregnant Women.

(1) Background: What is the role of serum CMV PCR in the diagnosis of recent primary infection (PI) in pregnant women when IgG avidity is uninformative? (2) Methods: Retrospective cohort study to compare serum versus whole blood CMV PCR. (a) Qualitative assessment: CMV PCR was performed on 123 serum samples and 74 whole blood samples collected from 132 pregnant women with recent CMV PI. PCR positivity rate was used to calculate sensitivity in serum and whole blood. (b) Quantitative assessment: CMV PCR was performed on 72 paired samples of serum and whole blood collected on the same day from 57 patients. (3) Results: In pregnant women, PCR positivity rate was 89% for serum samples versus 100% in whole blood in the case of very recent PI (<15 days), but only 27% in serum versus 68% in whole blood for PI occurring from 6 weeks to 3 months before. Comparing CMV viral loads between serum and whole blood, we determined the limit of CMV DNA detection in serum as 3 log copies/mL (whole blood equivalent). (4) Conclusions: Serum CMV PCR is reliable in confirming PI in cases when only IgM is detected. It is therefore a valuable tool in introducing valaciclovir treatment as early as possible to prevent mother-to-child CMV transmission.

Evaluation of Cytomegalovirus (CMV) IgM level and IgG Avidity in Detection of Primary Infection in Pregnant Women

Evaluation of Cytomegalovirus (CMV) IgM level and IgG Avidity in Detection of Primary Infection in Pregnant Women

Neutralizing and ELISA IgG antibodies to human cytomegalovirus glycoprotein complexes may help date the onset of primary infection in pregnancy

BackgroundDefinition of onset for primary human cytomegalovirus (HCMV) infection during pregnancy is critical for several reasons, including diagnosis of pre-conceptional infections and definition of gestational age at the time of infection. ObjectiveTo determine the onset of primary HCMV infection, differential kinetics of antibodies neutralizing infection of epithelial and fibroblast cells, as well as ELISA IgG antibodies to HCMV glycoprotein complexes (gC) gH/gL/pUL128L, gH/gL/gO, and gB were exploited and compared with conventional assays. Study designIn a series of 40 pregnant women with primary HCMV infection and ascertained HCMV-related mild clinical symptoms, the kinetics of different types of neutralizing and ELISA IgG antibodies were investigated with the aim of establishing criteria for dating the onset of primary infection in pregnant women without clinical symptoms. ResultsIgG antibodies to gB and gH/gL/pUL128L, as well as antibodies neutralizing infection of epithelial cells appeared early after infection onset (within 2–3 weeks) and increased rapidly, whereas antibodies to gH/gL/gO and antibodies neutralizing infection of fibroblasts appeared later (>30 days) and increased slowly. Both the conventional diagnostic assays (IgG, and IgM antibody, and IgG avidity index) and the novel assays for determination of antibody responses directed against HCMV gC allowed the definition of an algorithm indicating the onset of primary HCMV infection in asymptomatic women within a period of 1–2 months. ConclusionNew neutralization and ELISA IgG assays to HCMV gC provide additional tools for dating the onset of primary infection in pregnancy.

Comparison of the LIAISON® CMV IgG Avidity II and the VIDAS® CMV IgG Avidity II assays for the diagnosis of primary infection in pregnant women

BackgroundThe accuracy of IgG avidity assays is crucial for the diagnosis of primary CMV infection in pregnancy. ObjectiveTo compare the performance of the second generation avidity assays LIAISON® CMV IgG Avidity II and VIDAS® CMV IgG Avidity II for the diagnosis of primary infection in pregnant women. Study designIn our laboratory, in sera of pregnant women presenting with positive CMV IgG and positive CMV IgM, the two avidity assays were run in parallel from January 2013 to April 2015. ResultsThe results of the 2 avidity assays were analyzed in 280 sera. The correlation between the second generation LIAISON® and VIDAS® avidity results was significantly higher than between the results of the first generation assays (77% versus 49%, p<0.001). Discrepant results were mainly explained by the difficulty of the VIDAS® assay to reach intermediate and high avidity status over time, suggesting the superiority of the LIAISON® assay to achieve high avidity levels. In 4 sera from 3 pregnant women (1.4%) with documented primary infection the LIAISON® avidity was falsely high. In these cases the level of CMV IgG was low (<50U/mL). ConclusionThe LIAISON® CMV IgG Avidity II assay reached more rapidly higher avidity status than the VIDAS® CMV IgG Avidity II. However, with the LIAISON® CMV IgG Avidity II, we identified rare sera with high positive avidity values in documented recent seroconversion. The advantages and drawbacks of each assay must be known for a sound interpretation of the results.

Sero-epidemiology and risk factors for Toxoplasma gondii among pregnant women in Arab and African countries.

The epidemiology of toxoplasmosis in pregnancy is a major issue for public health. Primary infection in pregnant women can lead to serious sequelae. This review examined current sero-epidemiology and risks factor data for Toxoplasma gondii in pregnant women in Arab and African countries. A systematic electronic search of published literature was conducted. Data were extracted from relevant studies. Seropositivity is high in both regions. African countries have higher seropositivity than Arab countries due to differences in risk factors. Data on T. gondii infection in pregnancy are scant in many countries, especially where there is lack of political stability. Identified risk factors included eating raw meat, proximity with cats, undercooked food, and increasing maternal age. Toxoplasmosis in pregnancy in Arab and African countries is an underestimated health problem. Further research is needed. This report is a foundation for strategies and policies for intervention needed to combat the consequences of congenital toxoplasmosis.

Role of cytomegalovirus (CMV) IgG avidity testing in diagnosing primary CMV infection during pregnancy.

The risk of intrauterine transmission of cytomegalovirus (CMV) during pregnancy is much greater for women who contract primary CMV infection after conception than for women with evidence of infection (circulating CMV antibodies) before conception. Thus, laboratory tests that aid in the identification of recent primary CMV infection are important tools for managing the care of pregnant women suspected of having been exposed to CMV. CMV IgM detection is a sensitive marker of primary CMV infection, but its specificity is poor because CMV IgM is also produced during viral reactivation and persists following primary infection in some individuals. Studies conducted over the last 20 years convincingly demonstrate that measurement of CMV IgG avidity is both a sensitive and a specific method for identifying pregnant women with recent primary CMV infection and thus at increased risk for vertical CMV transmission. IgG avidity is defined as the strength with which IgG binds to antigenic epitopes expressed by a given protein; it matures gradually during the 6 months following primary infection. Low CMV IgG avidity is an accurate indicator of primary infection within the preceding 3 to 4 months, whereas high avidity excludes primary infection within the preceding 3 months. In this minireview, we summarize published data demonstrating the clinical utility of CMV IgG avidity results for estimating time since primary infection in pregnant women, describe commercially available CMV IgG avidity assays, and discuss some of the issues and controversies surrounding CMV IgG avidity testing during pregnancy.

The relationship between TORCH complex false positivity and obstetric outcome in patients with antiphospholipid syndrome

The presence of TORCH IgM positivity is not a specific indicator of primary infection; the assessment of IgG avidity index has been shown to be useful in identifying or excluding primary infection in pregnant women with no pre-gestational TORCH serology. TORCH is an acronym for Toxoplasmosis, Others (HBV, syphilis, Varicella-Zoster virus, Epstein Barr virus, Coxsackie virus and Parvovirus), Rubella, Cytomegalovirus (CMV) and Herpes Simplex. Data from 54 pregnancies in women with antiphospholipid syndrome (APS) were assessed in comparison with data from 222 healthy pregnant women as controls. Each woman in both groups was systematically screened for TORCH IgG and IgM during pre-conceptional evaluation and/or at the beginning of pregnancy. The assessment of IgG avidity was also evaluated in order to identify primary infection or false positivity. A significant increase of CMV IgM false positivity in APS in comparison with controls was detected. A worse pregnancy outcome was observed among APS patients having CMV IgM false positivity in comparison with APS patients without false positivity; in particular a statistically significant lower neonatal birth weight and a lower neonatal birth weight percentile were observed. Our data suggest that the presence of CMV IgM false positivity could represent a novel prognostic factor for poor pregnancy outcome in APS patients.

Toxoplasma gondiiinfection in pregnant women in China

Toxoplasmosis, caused by the protozoan parasite Toxoplasma gondii, is one of the most common parasitic infections in humans. Primary infection in pregnant women can be transmitted to the fetus leading to miscarriage or congenital toxoplasmosis. Carefully designed nationwide seroprevalence surveys and case-control studies of risk factors conducted primarily in Europe and America, have shaped our view of the global status of maternal and congenital infection, directing approaches to disease prevention. However, despite encompassing 1 in 5 of the world's population, information is limited on the status of toxoplasmosis in China, partly due to the linguistic inaccessibility of the Chinese literature to the global scientific community. By selection and analysis of studies and data, reported within the last 2 decades in China, this review summarizes and renders accessible a large body of Chinese and other literature and aims to estimate the seroprevalence in Chinese pregnant women. It also reviews the prevalence trends, risk factors, and clinical manifestations. The key findings are (1) the majority of studies show that the overall seroprevalence in Chinese pregnant women is less than 10%, considerably lower than a recently published global analysis; and (2) the few available appropriate studies on maternal acute infection suggested an incidence of 0·3% which is broadly comparable to studies from other countries.

Review of cytomegalovirus seroprevalence and demographic characteristics associated with infection

Cytomegalovirus establishes a lifelong latent infection following primary infection that can periodically reactivate with shedding of infectious virus. Primary infection, reactivation and reinfection during pregnancy can all lead to in utero transmission to the developing fetus. Congenital CMV infections are a major cause of permanent hearing loss and neurological impairment. In this literature review, we found that CMV infection was relatively common among women of reproductive age, with seroprevalence ranging from 45 to 100%. CMV seroprevalence tended to be highest in South America, Africa and Asia and lowest in Western Europe and United States. Within the United States, CMV seroprevalence showed substantial geographic variation as well, differing by as much as 30 percentage points between states, though differences might be explained by variation in the types of populations sampled. Worldwide, seroprevalence among non-whites tended to be 20-30 percentage points higher than that of whites (summary prevalence ratio (PR) = 1.59, 95% confidence interval (CI) = 1.57-1.61). Females generally had higher seroprevalences than males, although in most studies the differences were small (summary PR = 1.13, 95% CI = 1.11-1.14). Persons of lower socioeconomic status were more likely to be CMV seropositive (summary PR = 1.33, 95% CI = 1.32-1.35). Despite high seroprevalences in some populations, a substantial percentage of women of reproductive age are CMV seronegative and thus at risk of primary CMV infection during pregnancy. Future vaccine or educational campaigns to prevent primary infection in pregnant women may need to be tailored to suit the needs of different populations.

Toxoplasmosis in pregnancy

Toxoplasmosis is a parasite infestation in which the definitive host is the cat. In healthy adults. most cases are asymptomatic and usually require no treatment. However, the primary infection in pregnant women can cause congenital toxoplasmosis to the baby. Therefore, pregnant women with no history of infection should avoid cat feces, and soil - which may be contaminated with cat feces - should be cleaned thoroughly and meat should be cooked well because it may contain tissue cysts. This article reviews the toxoplasmosis and the management during pregnancy.

Síndrome de rubéola congénita en un hospital general tras un brote de rubéola en la Comunidad de Madrid

Introduction The importance of rubella lies in the possible teratogenic effects of primary infection in pregnant women. The objective of this study was to determine the epidemiological and clinical characteristics of a series of suspected cases of congenital rubella syndrome (CRS) in children born in 2005 in the Hospital Universitario 12 de Octubre (Madrid). Material and methods We used the classification of CRS cases of the Centers for Disease Control and Prevention (CDC, Atlanta). Blood samples for serological tests were obtained at birth and at the first consultation (between 15 and 30 days of life) from the newborns of mothers with rubella infection during pregnancy. Pharyngeal and urine samples were taken for polymerase chain reaction tests in children with a serological diagnosis of congenital rubella infection (CRI). Results In 2005, seven cases of seroconversion to rubella were detected in pregnant women in the Hospital Universitario 12 de Octubre. Six of the women reported not having received rubella vaccination. In three of the newborns, positive IgM for rubella was demonstrated; in two children the only manifestation of CRS was unilateral hypoacusia while the third newborn diagnosed with CRI was asymptomatic. Conclusion Optimal immunization status against rubella in susceptible persons, especially fertile women, is essential to avoid repetition of outbreaks and prevent CRS cases.

Laboratory diagnosis of toxoplasmosis – possibilities and limitations Die Labordiagnose der Toxoplasmose – Möglichkeiten und Grenzen

Abstract Toxoplasma gondii is a protozoan parasite that is distributed worldwide. Primary infection in immunocompetent individuals is usually subclinical, only few patients exhibit lymphadenopathy. Primary infection in pregnant women may cause severe damage to the fetus and reactivation of a chronic infection can cause life-threatening disease in immunocompromised patients. Diagnosis of toxoplasmosis can be established by serological methods or by direct detection of the parasite or its DNA. This paper discusses the present possibilities and limitations of laboratory diagnosis and points out that specialized centers are needed for a sucessful handling of difficult cases.