Diagnosis of CMV Infection in Pregnancy

Posted by e-Medical PPT Friday, July 20, 2012
Congenital CMV infection
10–15% symptomatic at birth
80–90% asymptomatic at birth
10–20% with subtle delayed sequelae (progressive hearing loss, mental deficiency, etc)

Congenital CMV infection and maternal immunity
Preconceptional maternal immunity is protective against congenital CMV infection decreasing risk of infection by 91%

Primary CMV infection in pregnant women
Symptoms:
–clinically inapparent
–persistent fever, myalgia, sore throat, cervical adenopathy, extreme fatigue
–mononucleosis syndrome
Laboratory findings:
–atypical lymphocytosis
–elevated hepatic transaminases
–negative heterophile antibody response

Diagnosis of primary CMV infection in pregnant woman
IgM confirmation by Western blot
Determination of the IgG avidity index
Isolation of the virus from urine, saliva and blood

A confirmatory test for CMV-IgM
New immunoblot
1)Contains both structural and nonstructural proteins
2)Reactivity to vp 150 can be confirmed with recpUL32
3)Agrees with consensus of different ELISAs
4)Is easy to standardize
5)Is easy to interpret

Main conclusions
The screening for CMV in pregnancy carried out by IgM and IgG avidity identifies all women who will deliver an infected infant
The determination of the viral load in the amniotic fluid by qPCR can:
 identify a congenital infection prenatally
 identify fetuses prenatally at higher risk of developing CMV-related symptoms (work still at the investigational stage)

Factors that may be involved in determining the severity of congenital CMV infection
Maternal viral load
The strain of CMV
The repertoire of CMV-specific maternal antibodies
Factors linked to a good or weak placenta barrier
The viral load in the fetus
Co-infection with other viruses
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