Kinetics of CMV seroconversion in a Swiss pregnant women population

Retrospective evaluation of the kinetics of cytomegalovirus (CMV) seroconversion with CMV IgM, IgG, and IgG avidity assays, in a Swiss pregnant women population, has shown that the current published CMV serologic diagnostic algorithms were valid and fit for use. In 19% of the cases analyzed, CMV-specific IgM was detected before IgG.     

New developments in the diagnosis of maternal and congenital CMV infection

Recent advances in the screening of pregnant women with Cytomegalovirus (CMV) IgM, CMV IgG and CMV IgG avidity serologic tests, has led to a more accurate diagnosis of CMV infection. When serologic screening is performed early in gestation, it is possible to identify those women at risk of intrauterine transmission of the virus, i.e., those women with a primary CMV infection, who should be enrolled in prenatal diagnosis. The use of quantitative PCR on amniotic fluid from pregnant women at 21-22 weeks of gestation in prenatal diagnosis is an effective diagnostic tool to distinguish between CMV infection and CMV disease in the fetus and newborn. Quantitative PCR on peripheral blood leukocytes from CMV infected newborns can be used to monitor viral load, especially during treatment with ganciclovir. These advances in serology and quantitative virology should lead to more accurate diagnosis of maternal and congenital CMV infection.     

南充地区孕妇及新生儿ToRCH感染状况前瞻性调查

目的了解南充地区孕妇及新生儿TORCH感染的状况,为优生优育提供相关信息。方法采用免疫化学发光检测系统测定孕妇及新生儿血清中弓形虫（Tox）、风疹病毒（RUV）、巨细胞病毒（CMV）和单纯疱疹病毒（HSV）（1＋2）特异度kG与IgM抗体。结果所调查的孕妇与新生儿中,ToRCHIgM抗体阳性率分别为16．03％,3．77％;二种以上病原体IgG抗体阳性率分别为80．43％,91．40％。孕妇组ToRCHIgM抗体阳性率分别为1．32％,1．76％,0．55％和13．17％,其中HSV（1＋2）近期感染率最高,秋季感染率相对较低。IgG抗体阳性率分别为5．75％,62．26％,96．74％,89．22％。新生儿组ToRCHIgM抗体阳性率分别为0,0．84％,1．05％和1．89％。IgG抗体阳性率分别为1．47％,51．22％,94．27％和87．32％。结论南充地区育龄妇女和新生儿人群TORCH感染的机率明显存在。和国内其它地区比较,其易感病原体种类存在一些差异。     

Clinical factor associated with congenital cytomegalovirus infection in pregnant women with non-primary infection

The aim of this nested case-control study was to evaluate clinical factors associated with the occurrence of congenital cytomegalovirus (CMV) infection in pregnant women with non-primary CMV infection. In a cohort study of CMV screening for 2193 pregnant women and their newborns, seven newborns with congenital CMV infection were identified among 1287 pregnant women with non-primary CMV infection that was defined as negative IgM and positive IgG with IgG avidity index >45%. In the 1287 women with non-primary CMV infection, clinical findings and complications were compared between pregnancies with and without congenital CMV infection. Clinical factors associated with the occurrence of congenital CMV infection were evaluated. The birth weight of newborns with congenital CMV infection was less than that of newborns without congenital infection (p < 0.05). Univariate logistic regression analyses demonstrated that threatened premature delivery (OR 10.6, 95%CI 2.0–55.0; p < 0.01) and multiple pregnancy (OR 7.1, 95%CI 1.4–37.4; p < 0.05) were associated with congenital infection. Multivariable logistic regression analyses demonstrated that threatened premature delivery (OR 8.4, 95%CI 1.5–48.1; p < 0.05) was a single risk factor for congenital CMV infection in pregnant women with non-primary CMV infection. This study revealed for the first time that threatened premature delivery was associated with the occurrence of congenital CMV infection in pregnant women with non-primary CMV infection, the pathophysiology of which may be closely associated with CMV reactivation during pregnancy.     

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. Received: December 14, 1999 / Accepted: April 10, 2000     

正常孕妇与不孕不育妇女血清TORCH抗体比较

目的通过对近6年佛山市禅城区中心医院TORCH结果进行回顾性分析,对正常孕妇与不孕不育妇女血清TORCH抗体结果进行比较,了解TORCH感染与不孕不育的相关性。方法采用酶联免疫吸附试验（ELISA）测定血清TORCH抗体。RT-6000酶标仪上测定OD值,根据试剂说明书判定结果。结果1920例正常孕妇弓形虫（TOX）TOX—IgG、TOX—IgM、风疹病毒RUV—IgM、微小病毒B19-IgM、巨细胞病毒CMV—IgM、单纯疱疹Ⅱ病毒（HSV）HSVII—IgG、HSV II-IgM的阳性率分别为2．14％、0．78％、0．16％、0．52％、0．36％、6．8％、0．73％;635例不孕不育妇女弓形虫（TOX）TOX—IgG、TOX—IgM、风疹婀毒RUV—IgM、微小病毒B19-IsM、巨细胞病毒CMV—IgM、单纯疱疹Ⅱ病毒（HSVII）HSVII—IgG、HSVII—IgM、的阳性半分别为3．15％、0．79％、0．31％、1．89％、1．10％、15．75％、1．26％;结论不孕育龄妇女B19-IgM、CMV—IgM、HSVII—IgG阳性率明显高于正常孕妇组,TORCH感染与不孕不育密切相关。     

Seroprevalence of CMV IgG and IgM in Korean women of childbearing age

BackgroundThe aim of this study was to investigate the seroprevalence of cytomegalovirus (CMV) infection using the serologic status of CMV IgG and IgM antibodies in Korean women of childbearing age.MethodsWe retrospectively reviewed CMV IgG and IgM test results from Korean women aged 15–49 years who underwent testing between January 2009 and December 2019. Seroprevalence of CMV IgG and IgM by year and age was investigated.ResultsThe study period was 11 years, and among 6837 samples tested, 95.8% were CMV IgG–positive. The seropositivity in women aged 15‐ <20 years was significantly lower (77.5%) than older age groups. Among 6837 total CMV IgG tests, 75.9% (5186) had concurrently measured CMV IgM results among which 2.4% were IgM‐positive.ConclusionConsidering the low CMV seropositivity of women younger than 20 years, they may need prenatal education for CMV infection.     

2861例妊娠期妇女TORCH筛查结果回顾性分析

目的研究不同季节、不同年龄段妊娠期妇女TORCH抗体阳性率。方法采用化学发光免疫分析法对2861例孕妇进行血清TORCHIgM、IgG抗体筛查,包括弓形体(TOX)、风疹病毒(RUB)、巨细胞病毒(CMV)、单纯疱疹病毒(HSV)。结果 TORCHIgM筛查中,HSVIgM阳性率最高,为22.13%;TORCHIgG筛查中,HSV1/2IgG阳性率最高,为3.64%;>40～45岁年龄段HSVIgM阳性率为52.96%,高于其他年龄段(P<0.05);夏季TOXIgM阳性率为1.68%,高于冬、春季(P<0.05),秋季为0.75%,高于冬季(P<0.05),冬、春两季间差异无统计学意义(P>0.05)。结论 TORCHIgM及IgG阳性分别代表急性或既往感染,对于临床开展优生优育筛查具有非常重要的意义。本次调查为本地区妇女选择合适的年龄和季节怀孕提供了参考。     

北京地区孕前及孕早期妇女TORCH感染情况调查

目的通过化学发光免疫分析法测定北京地区育龄妇女血清中TORCH抗体,对其感染的阳性率进行调查,为本区域孕妇保健提供参考依据。方法调查对象为在我院进行孕前筛查和孕12周前普查的妇女,共计5 870名,TORCH抗体的测定采用化学发光免疫分析法（CLIA）。结果TORCH-IgM抗体总阳性率达19.3%,其中以单纯疱疹病毒（Ⅰ＋Ⅱ）感染阳性率最高,为10.5%。调查发现秋冬季节为弓形虫、风疹病毒感染的相对高发期,巨细胞病毒（CMV）感染在夏秋季节发病率较高。IgG类抗体中CMV IgG的阳性率最高,达92.4%。结论北京地区孕前和孕早期妇女TORCH感染率较高,积极的进行监测以预防先天性TORCH感染是非常必要的。     

化学发光法与PCR法联合检测孕妇单纯疱疹病毒感染率分析

目的对化学发光法与聚合酶链反应(PCR)联合检测孕妇单纯疱疹病毒(HSV)的感染率进行分析,为临床诊断提供依据。方法采集该院孕期常规建卡的孕妇血清,用化学发光法检测血清HSV IgM与IgG抗体水平;对其中任一项结果阳性者取宫颈分泌物进行HSV DNA定性检测。结果HSV1DNA阳性率为0.5%(7/1 422),HSV2DNA阳性率为1.1%(16/1422)。HSV IgM和IgG同时阳性者HSV1DNA阳性率为0.4%(4/1 008),HSV2DNA阳性率为0.6%(6/1 008);仅HSV IgM阳性者HSV1DNA阳性率为0.8%(1/130),HSV2DNA阳性率为3.1%(4/130);仅HSV IgG阳性者HSV1DNA阳性率为0.7%(2/284),HSV2DNA阳性率为2.1%(6/284)。3种情况HSV抗体阳性者HSV1DNA阳性率比较差异无统计学意义(P0.05),而HSV2DNA阳性率比较差异有统计学意义(P0.05)。结论在孕期对HSV抗体进行常规检查,对抗体阳性者进行DNA检测,能提高诊断准确率。尽量做到早期筛查、早期发现、及早对孕妇进行治疗。     

Prevalence of Cytomegalovirus DNA in Cord Blood and Voided Urine Obtained from Pregnant Women at the End of Pregnancy

Objective

This study was undertaken to determine the prevalence of congenital cytomegalovirus (CMV) infection in pregnant women at the end of pregnancy in Kuwait using cord blood and maternal urine.

Subjects and Methods

Urine samples were collected prior to childbirth, and cord blood was collected immediately after delivery from 983 women. Anti-CMV IgG and IgM antibodies were determined using ELISA; CMV DNA was detected using nested PCR, and viral load was calculated using real-time PCR. CMV concentration in samples was categorized as low when the viral load ≤10³ copies/µl, intermediate when the viral load = 10³−10⁴ copies/µl, and high when the viral load >10⁴ copies/µl. The cord blood serology outcome was compared to cord blood PCR, cord blood viral load, maternal urine PCR and viral load analyses.

Results

Serology showed that of the 983 cord blood samples, 89 (9%) were positive for anti-CMV IgM antibodies; PCR test showed 44 (4.5%) contained CMV DNA, and there was a high viral load in all. Maternal urine PCR showed that 9 (10.11%) women had CMV DNA, and there was a high viral load in 7 (78%). The kappa test for measures of agreement showed a reasonable agreement (0.45) between cord blood PCR and urine PCR.

Conclusion

This study showed that CMV infection in the cord blood sera of pregnant women is common in Kuwait and highlights the need for more clinically based studies to follow up newborns with congenital CMV infection.Key Words: Active cytomegalovirus infection, Cord blood, Maternal urine, Polymerase chain reaction, Viral load     

Prevalence of congenital cytomegalovirus infection according to the type of maternal infection in Japan

IntroductionVariable rates of cytomegalovirus (CMV) seropositivity in mothers from different individual's background may translate to distinct epidemiological patterns of congenital CMV infection.MethodsThe prospective cohort study was conducted in Japan to evaluate the prevalence of vertical transmission rate according to the type of maternal infection. Post hoc power as a follow-up analysis was evaluated to compare the statistical power with other studies from France, Finland and Brazil. One thousand one hundred sixty-three pregnant women were measured IgG, IgM and IgG avidity index. The urine samples of neonates of these women were evaluated using polymerase chain reaction to diagnose the vertical transmission.ResultsThe prevalence of congenital CMV infection in the study population was 0.4%. The proportions of patients with primary and nonprimary infections were 60% and 40%, respectively, with a maternal seroprevalence of 82.5%. The rate of vertical transmission among the seronegative pregnant women before pregnancy was statistically higher than that among the seropositive pregnant women before pregnancy (p < 0.05), with a study power of 52.7%. The same difference was observed in France and Finland for maternal seroprevalence of 61% and 72% and statistical power of 56.9% and 66.7%, respectively.ConclusionThe maternal seroprevalence of the present study conducted in Japan was much higher than that of studies in France and Finland. Nevertheless, seronegative pregnant women had a higher risk of vertical transmission before pregnancy.     

TORCH 感染孕妇IgG 亲和力检测的临床价值

目的：通过检测TORCH感染孕妇IgG亲和力指数（AI）,探讨 TORCH感染类型与妊娠结局间关系。方法收集TORCH各型病原体IgM阳性孕妇血清,检测其IgG亲和力指数（AI）,并追踪妊娠结局。结果在TORCH各病原体近期感染的孕妇中,HSV（含1型及2型）、RUB、CMV、TOXO原发感染（AI＜30％）的比例分别为0、3．8％、9．3％、7．9％;在CMV原发感染的10例孕妇中,2例妊娠结局异常（稽留流产）,CMV疑似原发感染孕妇中发现1例为异常妊娠;TOXO原发感染孕妇发现1例为胎儿畸形（脑积水）,其余均为正常妊娠。结论在TORCH各病原体近期感染的孕妇中,以非原发性感染为主;而巨细胞及弓形虫原发感染对胎儿的侵害则远大于非原发感染。     

自然流产与TORCH感染相关性分析

目的　探讨杭州地区自然流产与弓形体(TOX)、风疹病毒(RV)、巨细胞病毒(CMV)和单纯疱疹病毒 (HSV)4种病原体(简称TORCH)感染的相关性。方法　选择2000年10月～2003年10月自然流产孕妇,用酶 联免疫吸附试验(ELISA)分析TORCH各项IgM,与同时间段正常育龄孕妇TORCHIgM进行比较,探讨自然流产 与TORCH感染的关系。结果　自然流产孕妇TOX、RV、CMV和HSVIgM抗体阳性率分别为14.47%、11.18%、 25.66%和3.95%。而同时段正常育龄孕妇相应的IgM抗体阳性率为0.11%、0.29%、0.50%和0.16%。自然 流产孕妇TORCH各项IgM阳性率均显著增高(P<0.01)。结论　孕妇TORCH感染是自然流产的重要原因。     

孕产妇四种病原体感染血清学筛查的研究

目的 探讨正常孕妇弓形虫、风疹病毒、巨细胞病毒、单纯疱疹病毒(Torch)感染血清学筛查的意义，妊娠伴胚胎停止发育及产史不良与Torch感染的关系。方法 间接荧光法检测血清Torch—IgG抗体和酶免疫捕获法检测Torch—IgM抗体。303例孕妇、27例妊娠伴胚胎停育及192例产史不良妇女进行了弓形虫血清学筛查，进行风疹病毒血清学筛查的分别278，30和214例，巨细胞病毒(CMV)筛查的分别为280，31和228例，单纯疱疹病毒(HSV)筛查的分别为236，25和168例。结果 孕妇、妊娠伴胚胎停育和产史不良妇女血清弓形虫IgG／IgM抗体阳性率分别为2．3％／0．33％，0／0，1．04％／0；风疹病毒IgG／IgM抗体阳性率分别为93．2％／1．4％，96．7％／0，98．6％／0；CMV—IgG／IgM阳性率分别为88．6％／1．1％，87．1％／0，91．2％／0；HSV—IgG／IgM阳性率分别为93．2％/1.3％，88．0％／0，94．6％/0。外院Torch—IgM抗体阳性的31份孕妇血清标本仅确认1份为真正阳性。结论 孕妇弓形虫感染率低，常规筛查的价值需要探讨。妊娠前确定风疹的免疫状态对孕妇风疹筛查意义重大。孕妇CMV血清学筛查方案需要进一步研究。初筛Torch—IgM抗体阳性的血清标本应当复查和确认，以避免假阳性。未发现妊娠伴胚胎停止发育以及产史不良与Torch感染存在关联。     

Cytomegalovirus infection in acute respiratory tract disease accompanying hepatitis in infancy

To elucidate relationship between acute respiratory tract diseases (ARTD) accompanying hepatitis and cytomegalovirus (CMV) infection in infancy, 74 full-term inpatients with ARTD and 34 control patients without ARTD or hepatitis were subjected to this study. By determining specific antibodies to CMV, IgG early antigen (IgG EA) and IgM membrane antibody (IgM MA) which are markers of active CMV replication, the following results were obtained. Thirty-one (41%) of the 74 patients with ARTD and 12 of the 34 control group (35%) had significant IgG EA (greater than or equal to 1:8). The geometric mean reciprocal titer in the group with ARTD (1:33.0) was higher than that in the control group (1:15.3). On the other hand, while 6 of the 74 patients with ARTD (8%) had significant IgM MA (greater than or equal to 1:8), none of the control group had positive IgM MA. Out of the 74 patients with ARTD, 8 (10%) patients, all except one being younger than 2-month-old, also had hepatitis. Of the 8 patients with hepatitis, 6 (75%) had significant IgG EA. The geometric mean reciprocal titer of the patients with hepatitis was higher than that of the patients without hepatitis, the titer being 1:42.6 and 1:30.7, respectively. On the other hand, 3 of the 8 patients with hepatitis (37%) had significant IgM MA while only 3 of the 66 patients without hepatitis (4.5%) had IgM MA. The frequencies of IgM MA between two groups were significantly different (p less than 0.05). CMV infection may be involved in some infants with ARTD, particularly in younger infants with both of ARTD and hepatitis.     

弓形虫感染与孕妇免疫水平检测

目的探讨弓形虫感染孕妇免疫水平。方法用免疫扩散法检测弓形虫抗体阳性孕妇血清IgGI、gAI、gM和C3含量,用BSA检测其T细胞亚群。结果与正常孕妇相比,弓形虫抗体阳性孕妇其血清IgGI、gA、CD 4 含量下降,CD 4 /CD 8 比值下降,而血清IgM及补体C3水平上升。结论弓形虫感染孕妇体液免疫和细胞免疫均紊乱。     

Combination of line immunoassays Mikrogen recomLine CMV IgG and recomLine CMV IgG Avidity helps to date the onset of CMV primary infection

CMV IgG avidity assays are widely used and can be helpful in pregnant women to date the onset of CMV primary infection; however, these tests are not standardized and sometimes give inconclusive results. We evaluated the performances of Mikrogen recomLine CMV IgG and IgG Avidity compared to the VIDAS CMV IgG Avidity. On a first sample set of 89 sequential sera collected from 40 women with precisely determined onset of CMV primary infection, the combination of Mikrogen recomLine CMV IgG and IgG Avidity showed an accurate interpretation in 83.1% (74/89), an incorrect result in 4.5% (4/89), and an inconclusive result in 12.4% (11/89) and showed a better sensitivity to diagnose infections <14?weeks compared to VIDAS (85.9% vs. 76.9%). On a second sample set of 89 sera with an intermediate VIDAS CMV IgG Avidity, the combination of line immunoassays provided additional information on the time of infection in 79% (70/89) of the samples. This combination of line assays is useful as additional confirmatory testing and can help to date more precisely the onset of CMV primary infection.     

骨髓移植患者血及尿中巨细胞病毒感染核酸标志物的检测

目的　为骨髓移植患者寻找较好的诊断和治疗巨细胞病毒（ＣＭＶ） 感染的分子生物学依据。方法　用聚合酶链反应（ＰＣＲ） 方法测尿中ＣＭＶＤＮＡ,逆转录（ＲＴ）ＰＣＲ 法测血中ＣＭＶ即刻早期抗原（ＩＥ）ｍＲＮＡ。结果　在被测的２７ 例患者１０３ 份标本中,发现１０ 例ＣＭＶ 感染者的尿ＣＭＶＤＮＡ 及血ＩＥ ｍＲＮＡ 几乎同时阳转。在连续使用抗病毒药甘昔洛瓦（ＤＨＰＧ） 治疗的６ 例患者中,ＩＥ ｍＲＮＡ 约一周左右阴转,而ＤＮＡ 约２０ 天左右阴转。结论　ＣＭＶＩＥｍＲＮＡ 可能反映病毒即刻早期转录的停止,对临床抗病毒治疗可能是一个较好的参考指标。     

Seropositivity toChlamydia trachomatis during pregnancy and perinatal complications

We studied the relationship between seropositivity toChlamydia trachomatis during pregnancy and perinatal complications. Of 178 pregnant women, 10 (5.62%) had IgG and IgM antibodies toC. trachomatis by enzyme linked immunosorbent assay at 10 and 20 weeks of gestation. Twenty-one of 178 (11.8%) women had IgG and IgA antibodies toC. trachomatis. None of these seropositive women received therapy during pregnancy. Five babies born to women with IgG and IgA antibodies had fetal or neonatal distress; 1 mother had meconium-stained amniotic fluid. Of 307 pregnant women at 30 weeks of gestation, 5 (1.63%) had IgG and IgM antibodies, and 24 (7.82%) had IgG and IgA antibodies toC trachomatis. Seropositive women in this group received therapy with clarithromycin, 400 mg/day, for 2 weeks during pregnancy. No babies born to women with IgG and IgA positive antibodies had fetal or neonatal distress; 9 mothers had premature rupture of the membrane, and 5 had meconium-stained amniotic fluid. Chlamydial antigen (identified as E strain) was detected in 2 of the 5 neonates born to women with IgG and IgM antibodies. The incidence of perinatal complications was significantly higher in pregnant women withC. trachomatis-positive IgG and IgA antibodies than in seronegative pregnant women at 30 weeks of gestation (P<0.05).C. trachomatis infection present near the time of labor was considered to be associated with perinatal complications.