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Orta Anadolu bölgesinde tersiyer bir merkeze başvuran gebe hastalarda Sitomegalovirüs CMV tarama sonuçları

Year 2019, Volume: 76 Issue: 4, 423 - 430, 01.12.2019

Abstract

Amaç: Anneden çocuğa geçen enfeksiyonların önemli bir nedeni olan insan sitomegalovirüsü CMV , etkilenen bebeklerde uzun dönemde ciddi sekellere yol açabilir ve yenidoğanlarda genetik olmayan konjenital işitme kaybının en yaygın nedenini oluşturmaktadır. Gelişmekte olan ülkelerde CMV prevalansının gelişmiş ülkelere oranla daha yüksek olduğu bilinmektedir ve seroprevalansın ülkeler, hatta bölgeler arasında dahi ciddi farklılık gösterdiği bildirilmektedir. Bu çalışmanın amacı, bir bölge referans hastanesine başvuran gebe kadınlarda CMV seroprevalansının değerlendirilmesi ve gebelik sırasında CMV taramasının etkinliğinin araştırılmasıdır. Yöntem: Ocak 2016 ile Eylül 2018 tarihleri arasında bir üniversite hastanesi gebe polikliniğine ayaktan başvuran toplam 3362 hasta çalışmaya dahil edilmiştir. Serolojik inceleme sonrasında aktif enfeksiyon olduğu düşünülen olgularda avidite testi uygulanmıştır. Bu test sonucu düşük avidite izlenen olgulara invaziv amniyosentez işlemi önerilmiştir ve alınan örnekler Polimeraz Zincir Reaksiyonu PCR metodu ile incelenmiştir. Bulgular:CMV immunglobulin Ig G ve Ig M seropozitiflik oranları sırasıyla %96,40 ve %1,75 olarak bulunmuştur. CMV enfeksiyonu düşünülen hastalardaki avidite test sonuçları incelendiğinde 10 %20,83 olguda düşük avidite, 3 %6,25 olguda ara düzeyde avidite ve 35 %72,91 olguda yüksek avidite olduğu izlenmiştir. Düşük avidite saptanan 10 olguda yapılan PCR analiz sonucunda bu hastaların üçünde akut primer enfeksiyon bulguları gözlenmiştir. Doğum sonrası yapılan muayenelerde bu yenidoğanların birinde konjenital CMV enfeksiyonu bulguları saptanmıştır. Sonuç: CMV enfeksiyonunun tedavisinde kullanılan ajanların gerek maliyet, gerek terapötik etkinliği ile ilgili yeterli çalışma bulunmaması nedeniyle gebelikte rutin CMV taraması önerilmemektedir. Ancak, özellikle gelişmekte olan ülkelerdeki riskli gruplarda serolojik değerlendirme faydalı olabilir. Aşı ve anti-viral tedavi hakkında yapılacak sonraki geniş kapsamlı çalışmalar ile taramanın gerekliliği ve etkinliği hakkında daha fazla bilgi sahibi olunabilir.

References

  • Dunn-Navarra AM, Stockwell MS, Meyer D, Larson E. Parental health literacy, knowledge and beliefs regarding upper respiratory infections (URI) in an urban Latino immigrant population. J Urban Health, 2012; 89: 848-60.
  • Revello MG, Lazzarotto T, Guerra B, Spinillo A, Ferrazzi E, Kustermann A, et al. CHIP Study Group. A randomized trial of hyperimmune globulin to prevent congenital cytomegalovirus. N Engl J Med, ; 370: 1316-26.
  • Lanzieri TM, Dollard SC, Bialek SR, Grosse SD. Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries. Int J Infect Dis, 2014; 22: 44–8.
  • Sahiner F, Cekmez F, Cetinkaya M, Kaya G, Kalayci T, Gunes O, et al. Congenital cytomegalovirus infections and glycoprotein B genotypes in live- born infants: a prevalence study in Turkey. Infect Dis (Lond), 2015; 47 (7): 465–71.
  • Ross SA, Arora N, Novak Z, Fowler KB, Britt WJ, Boppana SB. Cytomegalovirus reinfections in healthy seroimmune women. J Infect Dis, 2010; (3): 386-9.
  • Noyola DE, Demmler GJ, Williamson WD, Griesser C, Sellers S, Llorente A, et al. Cytomegalovirus urinary excretion and long term outcome in children with congenital cytomegalovirus infection. Congenital CMV Longitudinal Study Group. Pediatr Infect Dis J, ; 19(6): 505–10.
  • Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol, 2007; 17(4): 253–76.
  • Revello MG, Tibaldi C, Masuelli G, Frisina V, Sacchi A, Furione M, et al. Prevention of primary cytomegalovirus infection in pregnancy. EBioMedicine, 2015; 2(9): 1205–10.
  • Boppana SB, Pass RF, Britt WJ, Stagno S, Alford CA. Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality. Pediatr Infect Dis J, 1992; 11(2): 93–9.
  • Lazzarotto T, Varani S, Guerra B, Nicolosi A, Lanari M, Landini MP. Prenatal indicators of congenital cytomegalovirus infection. J Pediatr, 2000; 137 (1): –5. doi: 10.1067/mpd.2000.107110.
  • Nigro G, Mazzocco M, Anceschi MM, La Torre R, Antonelli G, Cosmi EV. Prenatal diagnosis of fetal cytomegalovirus infection after primary or recurrent maternal infection. Obstet Gynecol, ; 94: 909–14.
  • Pass RF. Cytomegalovirus infection. Pediatr Rev, ; 23: 163–70.
  • Lazzarotto T, Guerra B, Gabrielli L, Lanari M, Landini MP. Update on the prevention, diagnosis and management of cytomegalovirus infection during pregnancy. Clin Microbiol Infect, 2011; (9): 1285–93.
  • Ross SA, Novak Z, Pati S, Boppana SB. Overview of the diagnosis of cytomegalovirus infection. Infect Disord Drug Targets, 2011; 11(5): 466–74.
  • Sonoyama A, Ebina Y, Morioka I, Tanimura K, Morizane M, Tairaku S, et al. Low IgG avidity and ultrasound fetal abnormality predict congenital cytomegalovirus infection. J Med Virol, 2012; (12): 1928–33.
  • Tamer GS, Dundar D, Caliskan E. Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in western region of Turkey. Clin Invest Med, 2009; 32: 43–7.
  • Ocak S, Zeteroglu S, Ozer C, Dolapcıoglu K, Gungoren A. Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in Southern Turkey. Scand J Infect Dis, ; 39: 231–4.
  • Uyar Y, Alcı A, Akcalı A, Cabar C. Prevalance of rubella and cytomegalovirus antibodies among pregnant women in northern Turkey. New Microbiol, ; 31: 451–5.
  • Aynioglu A, Aynioglu O, Altunok ES. Seroprevalence of Toxoplasma gondii, Rubella and Cytomegalovirus among pregnant females in north-western Turkey. Acta Clin Belg, 2015; 70 (5): 321-4.
  • Efe Ş, Kurdoğlu Z, Korkmaz G. Van Yöresindeki Gebelerde Sitomegalovirüs, Rubella ve Toksoplazma Antikorlarının Seroprevalansı. Van Tıp Derg, 2009; : 6–9.
  • Sonoyama A, Ebina Y, Morioka I, Tanimura K, Morizane M, Tairaku S, et al. Low IgG avidity and ultrasound fetal abnormality predict congenital cytomegalovirus infection. J Med Virol, 2012; 84 (12): 1928-33.
  • Malinger G, Lev D, Lerman-Sagie T. Imaging of fetal cytomegalovirus infection. Fetal Diagn Ther, 2011; (2): 117-26.
  • Dollard SC, Grosse SD, Ross DS. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Rev Med Virol, 2007; 17 (5): 355–63.
  • Stagno S, Pass RF, Dworsky ME, Alford CA. Congenital and perinatal cytomegalovirus infections. Semin Perinatol, 1983; 7 (1): 31–42.
  • Sahiner F, Honca M, Çekmez Y, Kubar A, Honca T, Fidanci MK, et al. The role of maternal screening in diagnosing congenital cytomegalovirus infections in highly immune populations. Ir J Med Sci, 2015; 184 (2): 475-81.
  • Revello MG, Fabbri E, Furione M, Zavattoni M, Lilleri D, Tassis B, et al. Role of prenatal diagnosis and counseling in the management of 735 pregnancies complicated by primary human cytomegalovirus infection: A 20-year experience. J Clin Virol, 2011; : 303–7.
  • Grangeot-Keros L, Mayaux MJ, Lebon P, Freymuth F, Eugene G, Stricker R, et al. Value of cytomegalovirus (CMV) IgG avidity index for the diagnosis of primary CMV infection in pregnant women. J Infect Dis, ; 175(4): 944–6.
  • Ebina Y, Minematsu T, Sonoyama A, Morioka I, Inoue N, Tairaku S, et al. The IgG avidity value for the prediction of congenital cytomegalovirus infection in a prospective cohort study. J Perinat Med, 2014; : 755–9.
  • Naessens A, Casteels A, Decatte L, Foulon W. A serologic strategy for detecting neonates at risk for congenital cytomegalovirus infection. J Pediatr, ; 146 (2): 194–7.
  • Sert Y, Ozgu-Erdinc AS, Saygan S, Engin Ustun Y. Antenatal Cytomegalovirus Infection Screening Results of 32,188 Patients in a Tertiary Referral Center: A Retrospective Cohort Study. Fetal Pediatr Pathol, 2019; 38 (2): 112-20.
  • Hughes BL, Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM): Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol, ; 214: 5–11.
  • Jacquemard F, Yamamoto M, Costa JM, Romand S, Jaqz-Aigrain E, Dejean A, et al. Maternal administration of valaciclovir in symptomatic intrauterine cytomegalovirus infection. BJOG, ; 114: 1113-21.
  • Puliyanda DP, Silverman NS, Lehman D, Vo A, Bunnapradist S, Radha RK, et al. Successful use of oral ganciclovir for the treatment of intrauterine cytomegalovirus infection in a renal allograft recipient. Transpl Infect Dis, 2005; 7: 71-4.

Cytomegalovirus CMV screening results in pregnant women admitted to a tertiary center in the middle Anatolia

Year 2019, Volume: 76 Issue: 4, 423 - 430, 01.12.2019

Abstract

Objective: Human cytomegalovirus CMV is a common cause of mother-to-child infection that may lead to severe long-term sequelae in affected infants and is the most common non-genetic cause of hearing loss. CMV prevalence is reported to be higher in developing countries and seroprevalence varies between countries and even regions. The aim of this study was to evaluate the seroprevalence of CMV in pregnant women who applied to regional reference hospital and to investigate the efficacy of antenatal CMV screening. Methods: A total of 3362 patients admitted to a university hospital pregnant outpatient clinic between January 2016 and September 2018 were included in the study. After serological examination, avidity test was performed in cases with results suggestive of active infection. Amniocentesis was recommended to patients with low avidity and these patients were evaluated by Polymerase Chain Reaction PCR method. Results: The frequency of CMV immunglobulin Ig G and M seropositivity rates were 96.40% and 1.75%, respectively. According to avidity test results of patients with CMV infection; low, intermediate and high avidity levels were found in 10 20.83% , 3 6.25% and 35 72.91% patients, respectively. PCR analysis results showed primary infection in 3 of the cases with low avidity. Only one infant had signs of congenital CMV infection at the time of birth. Conclusion: Although routine CMV screening in pregnancy is not recommended due to lack of adequate studies on the validity of treatment and costeffectiveness, serological examination may be beneficial especially in risky groups in developing countries. Further studies on vaccination and anti-viral therapy may provide more comprehensive information about the necessity and efficacy of screening.

References

  • Dunn-Navarra AM, Stockwell MS, Meyer D, Larson E. Parental health literacy, knowledge and beliefs regarding upper respiratory infections (URI) in an urban Latino immigrant population. J Urban Health, 2012; 89: 848-60.
  • Revello MG, Lazzarotto T, Guerra B, Spinillo A, Ferrazzi E, Kustermann A, et al. CHIP Study Group. A randomized trial of hyperimmune globulin to prevent congenital cytomegalovirus. N Engl J Med, ; 370: 1316-26.
  • Lanzieri TM, Dollard SC, Bialek SR, Grosse SD. Systematic review of the birth prevalence of congenital cytomegalovirus infection in developing countries. Int J Infect Dis, 2014; 22: 44–8.
  • Sahiner F, Cekmez F, Cetinkaya M, Kaya G, Kalayci T, Gunes O, et al. Congenital cytomegalovirus infections and glycoprotein B genotypes in live- born infants: a prevalence study in Turkey. Infect Dis (Lond), 2015; 47 (7): 465–71.
  • Ross SA, Arora N, Novak Z, Fowler KB, Britt WJ, Boppana SB. Cytomegalovirus reinfections in healthy seroimmune women. J Infect Dis, 2010; (3): 386-9.
  • Noyola DE, Demmler GJ, Williamson WD, Griesser C, Sellers S, Llorente A, et al. Cytomegalovirus urinary excretion and long term outcome in children with congenital cytomegalovirus infection. Congenital CMV Longitudinal Study Group. Pediatr Infect Dis J, ; 19(6): 505–10.
  • Kenneson A, Cannon MJ. Review and meta-analysis of the epidemiology of congenital cytomegalovirus (CMV) infection. Rev Med Virol, 2007; 17(4): 253–76.
  • Revello MG, Tibaldi C, Masuelli G, Frisina V, Sacchi A, Furione M, et al. Prevention of primary cytomegalovirus infection in pregnancy. EBioMedicine, 2015; 2(9): 1205–10.
  • Boppana SB, Pass RF, Britt WJ, Stagno S, Alford CA. Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality. Pediatr Infect Dis J, 1992; 11(2): 93–9.
  • Lazzarotto T, Varani S, Guerra B, Nicolosi A, Lanari M, Landini MP. Prenatal indicators of congenital cytomegalovirus infection. J Pediatr, 2000; 137 (1): –5. doi: 10.1067/mpd.2000.107110.
  • Nigro G, Mazzocco M, Anceschi MM, La Torre R, Antonelli G, Cosmi EV. Prenatal diagnosis of fetal cytomegalovirus infection after primary or recurrent maternal infection. Obstet Gynecol, ; 94: 909–14.
  • Pass RF. Cytomegalovirus infection. Pediatr Rev, ; 23: 163–70.
  • Lazzarotto T, Guerra B, Gabrielli L, Lanari M, Landini MP. Update on the prevention, diagnosis and management of cytomegalovirus infection during pregnancy. Clin Microbiol Infect, 2011; (9): 1285–93.
  • Ross SA, Novak Z, Pati S, Boppana SB. Overview of the diagnosis of cytomegalovirus infection. Infect Disord Drug Targets, 2011; 11(5): 466–74.
  • Sonoyama A, Ebina Y, Morioka I, Tanimura K, Morizane M, Tairaku S, et al. Low IgG avidity and ultrasound fetal abnormality predict congenital cytomegalovirus infection. J Med Virol, 2012; (12): 1928–33.
  • Tamer GS, Dundar D, Caliskan E. Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in western region of Turkey. Clin Invest Med, 2009; 32: 43–7.
  • Ocak S, Zeteroglu S, Ozer C, Dolapcıoglu K, Gungoren A. Seroprevalence of Toxoplasma gondii, rubella and cytomegalovirus among pregnant women in Southern Turkey. Scand J Infect Dis, ; 39: 231–4.
  • Uyar Y, Alcı A, Akcalı A, Cabar C. Prevalance of rubella and cytomegalovirus antibodies among pregnant women in northern Turkey. New Microbiol, ; 31: 451–5.
  • Aynioglu A, Aynioglu O, Altunok ES. Seroprevalence of Toxoplasma gondii, Rubella and Cytomegalovirus among pregnant females in north-western Turkey. Acta Clin Belg, 2015; 70 (5): 321-4.
  • Efe Ş, Kurdoğlu Z, Korkmaz G. Van Yöresindeki Gebelerde Sitomegalovirüs, Rubella ve Toksoplazma Antikorlarının Seroprevalansı. Van Tıp Derg, 2009; : 6–9.
  • Sonoyama A, Ebina Y, Morioka I, Tanimura K, Morizane M, Tairaku S, et al. Low IgG avidity and ultrasound fetal abnormality predict congenital cytomegalovirus infection. J Med Virol, 2012; 84 (12): 1928-33.
  • Malinger G, Lev D, Lerman-Sagie T. Imaging of fetal cytomegalovirus infection. Fetal Diagn Ther, 2011; (2): 117-26.
  • Dollard SC, Grosse SD, Ross DS. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Rev Med Virol, 2007; 17 (5): 355–63.
  • Stagno S, Pass RF, Dworsky ME, Alford CA. Congenital and perinatal cytomegalovirus infections. Semin Perinatol, 1983; 7 (1): 31–42.
  • Sahiner F, Honca M, Çekmez Y, Kubar A, Honca T, Fidanci MK, et al. The role of maternal screening in diagnosing congenital cytomegalovirus infections in highly immune populations. Ir J Med Sci, 2015; 184 (2): 475-81.
  • Revello MG, Fabbri E, Furione M, Zavattoni M, Lilleri D, Tassis B, et al. Role of prenatal diagnosis and counseling in the management of 735 pregnancies complicated by primary human cytomegalovirus infection: A 20-year experience. J Clin Virol, 2011; : 303–7.
  • Grangeot-Keros L, Mayaux MJ, Lebon P, Freymuth F, Eugene G, Stricker R, et al. Value of cytomegalovirus (CMV) IgG avidity index for the diagnosis of primary CMV infection in pregnant women. J Infect Dis, ; 175(4): 944–6.
  • Ebina Y, Minematsu T, Sonoyama A, Morioka I, Inoue N, Tairaku S, et al. The IgG avidity value for the prediction of congenital cytomegalovirus infection in a prospective cohort study. J Perinat Med, 2014; : 755–9.
  • Naessens A, Casteels A, Decatte L, Foulon W. A serologic strategy for detecting neonates at risk for congenital cytomegalovirus infection. J Pediatr, ; 146 (2): 194–7.
  • Sert Y, Ozgu-Erdinc AS, Saygan S, Engin Ustun Y. Antenatal Cytomegalovirus Infection Screening Results of 32,188 Patients in a Tertiary Referral Center: A Retrospective Cohort Study. Fetal Pediatr Pathol, 2019; 38 (2): 112-20.
  • Hughes BL, Gyamfi-Bannerman C. Society for Maternal-Fetal Medicine (SMFM): Diagnosis and antenatal management of congenital cytomegalovirus infection. Am J Obstet Gynecol, ; 214: 5–11.
  • Jacquemard F, Yamamoto M, Costa JM, Romand S, Jaqz-Aigrain E, Dejean A, et al. Maternal administration of valaciclovir in symptomatic intrauterine cytomegalovirus infection. BJOG, ; 114: 1113-21.
  • Puliyanda DP, Silverman NS, Lehman D, Vo A, Bunnapradist S, Radha RK, et al. Successful use of oral ganciclovir for the treatment of intrauterine cytomegalovirus infection in a renal allograft recipient. Transpl Infect Dis, 2005; 7: 71-4.
There are 33 citations in total.

Details

Primary Language English
Journal Section Research Article
Authors

Özgür Kan This is me

Özgür Koçak This is me

Publication Date December 1, 2019
Published in Issue Year 2019 Volume: 76 Issue: 4

Cite

APA Kan, Ö., & Koçak, Ö. (2019). Cytomegalovirus CMV screening results in pregnant women admitted to a tertiary center in the middle Anatolia. Türk Hijyen Ve Deneysel Biyoloji Dergisi, 76(4), 423-430.
AMA Kan Ö, Koçak Ö. Cytomegalovirus CMV screening results in pregnant women admitted to a tertiary center in the middle Anatolia. Turk Hij Den Biyol Derg. December 2019;76(4):423-430.
Chicago Kan, Özgür, and Özgür Koçak. “Cytomegalovirus CMV Screening Results in Pregnant Women Admitted to a Tertiary Center in the Middle Anatolia”. Türk Hijyen Ve Deneysel Biyoloji Dergisi 76, no. 4 (December 2019): 423-30.
EndNote Kan Ö, Koçak Ö (December 1, 2019) Cytomegalovirus CMV screening results in pregnant women admitted to a tertiary center in the middle Anatolia. Türk Hijyen ve Deneysel Biyoloji Dergisi 76 4 423–430.
IEEE Ö. Kan and Ö. Koçak, “Cytomegalovirus CMV screening results in pregnant women admitted to a tertiary center in the middle Anatolia”, Turk Hij Den Biyol Derg, vol. 76, no. 4, pp. 423–430, 2019.
ISNAD Kan, Özgür - Koçak, Özgür. “Cytomegalovirus CMV Screening Results in Pregnant Women Admitted to a Tertiary Center in the Middle Anatolia”. Türk Hijyen ve Deneysel Biyoloji Dergisi 76/4 (December 2019), 423-430.
JAMA Kan Ö, Koçak Ö. Cytomegalovirus CMV screening results in pregnant women admitted to a tertiary center in the middle Anatolia. Turk Hij Den Biyol Derg. 2019;76:423–430.
MLA Kan, Özgür and Özgür Koçak. “Cytomegalovirus CMV Screening Results in Pregnant Women Admitted to a Tertiary Center in the Middle Anatolia”. Türk Hijyen Ve Deneysel Biyoloji Dergisi, vol. 76, no. 4, 2019, pp. 423-30.
Vancouver Kan Ö, Koçak Ö. Cytomegalovirus CMV screening results in pregnant women admitted to a tertiary center in the middle Anatolia. Turk Hij Den Biyol Derg. 2019;76(4):423-30.