Treatment Of Congenital Cytomegalovirus Infection Research Articles

Accumulation of Fetal IgG in Immunoglobulin Injection into the Fetal Abdominal Cavity Is Proven

Objective: There have been a number of studies on immunoglobulin injection into fetuses or mothers during pregnancy for the treatment of congenital cytomegalovirus infection. However, no study has examined the effect of injected immunoglobulin on fetal hemodynamics. In this study, we examined the effect of immunoglobulin injection on fetal hemodynamics by retrospectively measuring the concentrations of several IgG subclasses in stored umbilical cord blood sera collected during fetal therapy. Methods: Five patients who underwent immunoglobulin injection into the fetal abdominal cavity (IFAC) as a fetal therapy during pregnancy were included in this study. Frozen-stored umbilical venous blood samples collected from these patients during IFAC were measured for serum concentrations of each IgG subclass. Results: The largest change was observed in the IgG2 concentration, with a mean increase of 221% following IFAC. The IgG4 concentration also showed a mean increase of 63%. In contrast, the concentration of IgG1, which has the strongest physiological activity of all IgG subclasses examined, only exhibited an overall mean increase of 1.4%. Conclusion: Our results confirmed that immunoglobulins are incorporated into the fetal circulation following IFAC.

Diagnosis and treatment of congenital cytomegalovirus infection in neonates

Obiective To summarize the main clinical features, diagnosis and treatment of congenital cytomegalovirus (CMV) infected neonates. Methods Serum CMV antibodies were tested by enzyme-linked immunosorbent assay, and urine CMV-DNA was detected by fluorescent real-time quantitative polymerase chain reaction. From Jan. 2007 to Dec. 2008,145 neonates were diagnosed as congenital CMV infection. Effects and side effects were observed in 56 of 101 symptomatic patients treated with ganciclovir. Results The main clinical manifestations and abnormal laboratory items in symptomatic infection included pathologic jaundice, hepatosplenomegaly, interstitial pneumonitis, petechiae, poor suck, thrombocytopenia, elevated glutamic-pyruvic transaminase. There were 87 patients(60.0%) had positive urine CMV-DNA, 43(29.7%) had positive CMV-IgM, 21(14.5%) had 4 times increase of CMV-IgG titers within 2 weeks after birth, 13 patients showed positive CMV-DNA in urine or CMV-IgM in serum and their serum CMV IgG levels were more than doubled compared to their mothers. There was significant improvement in clinical and laboratory findings after ganciclovir treatment with minimal side effects including lightly decreasing of granulocyte and platelet, but without damage of liver and kidney function. Conclnsions Neonatal congenital CMV infection might lead to multiple organs damage and had various clinical features. Urine CMV-DNA test might have higher positive rate in infected neonates. The other evidence for the diagnosis is positive CMV-IgM and 4 times increasing of CMV-IgG titers. Over two times of the CMV-IgG level in the neonates than in the mothers is one of the laboratory findings also. Ganciclovir is effective in the treatment of symptomatic CMV infection. Key words: Cytomegalovirus infections; Infant, newborn; Ganciclovir

Treatment of congenital cytomegalovirus infection: implications for future therapeutic strategies

Cytomegalovirus (CMV) infection is the most common cause of congenital infection in the developed world, occurring in approximately 1% of all liveborns. Symptomatic disease occurs in 10% of all congenitally infected infants, resulting in a spectrum of clinical manifestations that include microcephaly, chorioretinitis, hepatosplenomegaly and sensorineural hearing loss, among others. Even those children who are asymptomatic at birth have a risk of hearing loss, with approximately 8% experiencing this sequela. Overall, congenital CMV infection accounts for one-third of all cases of sensorineural hearing loss. The economic burden of disease exceeds $2 billion annually in the USA. Therefore, this infection has been the target for antiviral therapy. Studies performed by the National Institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group (CASG) have evaluated ganciclovir for the treatment of symptomatic congenital CMV infection with central nervous system involvement. In a randomized, controlled clinical trial of ganciclovir treatment (6 mg/kg iv every 12 h for 6 weeks) brainstem-evoked responses were utilized as the primary endpoint and demonstrated stabilization of hearing both at 6 months and >1 year. Treatment was associated with neutropenia in over 60% of treated patients. Since ganciclovir must be given intravenously, studies with its prodrug, valganciclovir, have been performed to assess pharmacokinetics and pharmacodynamics. Currently, a clinical trial of 6 weeks versus 6 months of valganciclovir is being performed by the CASG. Notably, only intravenous ganciclovir and orally administered valganciclovir have been used to treat congenital CMV infection. Hopefully, other drugs such as maribavir will be available for evaluation in this population.

Valganciclovir for treatment of congenital cytomegalovirus infection

Valganciclovir for treatment of congenital cytomegalovirus infection

Cytomegalovirus Infection

Cytomegalovirus Infection

Relationship between seropositivity of husbands and primary cytomegalovirus infection during pregnancy.

The role of the sexual transmission of human cytomegalovirus (CMV) as a cause of congenital infection was investigated. Serum samples were collected from 756 pregnant women at 10 to 12 weeks of gestation and at 32 to 36 weeks of gestation. Serum samples were also obtained from the husbands of women who seroconverted and women who were seronegative during pregnancy. Commercially available enzyme immunoassay kits were used to detect serum IgG, IgM, and IgA antibodies against CMV. CMV from neonatal urinary specimens was isolated according to a standard tissue culture technique, using MRC-5 cells. At 10 to 12 weeks of gestation, 634 of the 756 pregnant women (83.9%) had IgG antibody to CMV. At 32 to 36 weeks of gestation, 642 of the 756 women (84.9%) had IgG antibody to CMV. A meaningful rise of serum IgG-antibody titer (seroconversion) occurred in 8 women (1.1%). CMV was isolated from the urine of an infant born to a seroconverted woman within a week after birth. The prevalence of IgG antibody to CMV was significantly higher in the husbands of women who seroconverted during pregnancy than in the husbands of the women who were seronegative during pregnancy (P < 0.01). Understanding the epidemiology of CMV is a key element in the development of strategies for the prevention of infection. The transmission of CMV by sexual contact may be important in the pathogenesis of congenital infection. Entirely new approaches to the prevention and treatment of congenital CMV infection are necessary, including antiviral interventions and the development of a vaccine strategy.