Limits...
Distribution of Cytomegalovirus Genotypes among Neonates Born to Infected Mothers in Islamabad, Pakistan.

Mujtaba G, Khurshid A, Sharif S, Alam MM, Aamir UB, Shaukat S, Angez M, Rana MS, Umair M, Shah AA, Zaidi SS - PLoS ONE (2016)

Bottom Line: The seroprevalence of anti-CMV IgG and IgM was 97.5% (399 out of 409) and 12.7% (52 out of 409), respectively, while 20% (82/409) pregnant women were found positive for CMV DNA by PCR.Phylogenetic analysis of Pakistani strains showed 96%-100% homology to their prototype strains.Our findings emphasize to conduct a comprehensive large scale survey and introduction of country wide routine screening at maternity clinics for early diagnosis of CMV to reduce its associated devastating outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan.

ABSTRACT

Background: Congenital cytomegalovirus (cCMV) infection contributes to considerable long-term sequelae in neonates and children all over the world. The association between viral genotypes and severity of clinical cytomegalovirus (CMV) infection is yet to be defined. The objective of this study was to find the impact of active CMV infection during pregnancy and the clinical significance of genotypes in neonates with congenital cytomegalovirus infections in Pakistan.

Methods: A total of 409 blood samples from pregnant women seeking health care services at the two antenatal hospitals of Islamabad during January to December 2012 were tested by ELISA and nested-PCR. Pregnant women with active infection (detected as IgM positive, PCR positive or positive on both assays) were followed until delivery, to detect the outcome of overt cCMV infection in neonates. Genetic characterization of CMV strains was performed by sequence analysis of envelope glycoproteins: gB, gN and gH to detect the contributing CMV genotypes.

Results: The seroprevalence of anti-CMV IgG and IgM was 97.5% (399 out of 409) and 12.7% (52 out of 409), respectively, while 20% (82/409) pregnant women were found positive for CMV DNA by PCR. Logistic regression analysis showed a significant association of active infection with parity [OR = 2.56, 95% CI = 1.82-2.62, p = 0.04], febrile illness [OR = 1.84, 95% CI = 1.76-3.65, p = 0.01] and jaundice [OR = 22.5, 95% CI = 4.53-85.02, p = 0.002]. We were able to isolate virus in 41 out of 70 neonates; 36.6% (15 out of 41) of them were symptomatic at birth while 63.4% (26 out of 41) were asymptomatic. The most prominent clinical feature observed in symptomatic neonates was hepatosplenomegaly (26.6%; 4 out of 15). All three genotypes gB, gN and gH were found with the highest frequency of gB1 genotype, found in 75% infants with hepatic damage. Phylogenetic analysis of Pakistani strains showed 96%-100% homology to their prototype strains.

Conclusions: Active CMV infection during pregnancy is a major cause of congenital CMV infection with comparable distribution of all three genotypes: gB, gN and gH in symptomatic and asymptomatic neonates. Our findings emphasize to conduct a comprehensive large scale survey and introduction of country wide routine screening at maternity clinics for early diagnosis of CMV to reduce its associated devastating outcomes.

No MeSH data available.


Related in: MedlinePlus

The distribution of HCMV positive cases in study population during 2012.The months are given on X-axis. The data labels on Y-axis indicate the number of total and positive cases across the year. The solid black line indicates total number of cases while the number of positive cases for each assay indicated with different bar-style.
© Copyright Policy
Related In: Results  -  Collection

License
getmorefigures.php?uid=PMC4930188&req=5

pone.0156049.g001: The distribution of HCMV positive cases in study population during 2012.The months are given on X-axis. The data labels on Y-axis indicate the number of total and positive cases across the year. The solid black line indicates total number of cases while the number of positive cases for each assay indicated with different bar-style.

Mentions: Patients with active infection were defined as “those with either IgM Positive only, or PCR positive only or both IgM and PCR positive” as demarcated by CDC, USA (http://www.cdc.gov/cmv/clinical/lab-tests.html). For the clinical characteristics, (fever) [OR = 1.84, 95% CI = 1.76–3.65, p = 0.01] and history of jaundice [OR = 22.5, 95% CI = 4.53–85.02, p = 0.002] had significant associations with active CMV infection in pregnant women. Other clinical features such as lymphadenopathy, sore throat and flu showed no significant association with active CMV infection. No seasonal trend of CMV infection was observed; however, it was more frequent in March and September of the study year (Fig 1). The pregnant women who were seronegative (2.4%) were unprotected and fall within the group in which infection is likely to occur.


Distribution of Cytomegalovirus Genotypes among Neonates Born to Infected Mothers in Islamabad, Pakistan.

Mujtaba G, Khurshid A, Sharif S, Alam MM, Aamir UB, Shaukat S, Angez M, Rana MS, Umair M, Shah AA, Zaidi SS - PLoS ONE (2016)

The distribution of HCMV positive cases in study population during 2012.The months are given on X-axis. The data labels on Y-axis indicate the number of total and positive cases across the year. The solid black line indicates total number of cases while the number of positive cases for each assay indicated with different bar-style.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4930188&req=5

pone.0156049.g001: The distribution of HCMV positive cases in study population during 2012.The months are given on X-axis. The data labels on Y-axis indicate the number of total and positive cases across the year. The solid black line indicates total number of cases while the number of positive cases for each assay indicated with different bar-style.
Mentions: Patients with active infection were defined as “those with either IgM Positive only, or PCR positive only or both IgM and PCR positive” as demarcated by CDC, USA (http://www.cdc.gov/cmv/clinical/lab-tests.html). For the clinical characteristics, (fever) [OR = 1.84, 95% CI = 1.76–3.65, p = 0.01] and history of jaundice [OR = 22.5, 95% CI = 4.53–85.02, p = 0.002] had significant associations with active CMV infection in pregnant women. Other clinical features such as lymphadenopathy, sore throat and flu showed no significant association with active CMV infection. No seasonal trend of CMV infection was observed; however, it was more frequent in March and September of the study year (Fig 1). The pregnant women who were seronegative (2.4%) were unprotected and fall within the group in which infection is likely to occur.

Bottom Line: The seroprevalence of anti-CMV IgG and IgM was 97.5% (399 out of 409) and 12.7% (52 out of 409), respectively, while 20% (82/409) pregnant women were found positive for CMV DNA by PCR.Phylogenetic analysis of Pakistani strains showed 96%-100% homology to their prototype strains.Our findings emphasize to conduct a comprehensive large scale survey and introduction of country wide routine screening at maternity clinics for early diagnosis of CMV to reduce its associated devastating outcomes.

View Article: PubMed Central - PubMed

Affiliation: Department of Microbiology, Quaid-i-Azam University, Islamabad, Pakistan.

ABSTRACT

Background: Congenital cytomegalovirus (cCMV) infection contributes to considerable long-term sequelae in neonates and children all over the world. The association between viral genotypes and severity of clinical cytomegalovirus (CMV) infection is yet to be defined. The objective of this study was to find the impact of active CMV infection during pregnancy and the clinical significance of genotypes in neonates with congenital cytomegalovirus infections in Pakistan.

Methods: A total of 409 blood samples from pregnant women seeking health care services at the two antenatal hospitals of Islamabad during January to December 2012 were tested by ELISA and nested-PCR. Pregnant women with active infection (detected as IgM positive, PCR positive or positive on both assays) were followed until delivery, to detect the outcome of overt cCMV infection in neonates. Genetic characterization of CMV strains was performed by sequence analysis of envelope glycoproteins: gB, gN and gH to detect the contributing CMV genotypes.

Results: The seroprevalence of anti-CMV IgG and IgM was 97.5% (399 out of 409) and 12.7% (52 out of 409), respectively, while 20% (82/409) pregnant women were found positive for CMV DNA by PCR. Logistic regression analysis showed a significant association of active infection with parity [OR = 2.56, 95% CI = 1.82-2.62, p = 0.04], febrile illness [OR = 1.84, 95% CI = 1.76-3.65, p = 0.01] and jaundice [OR = 22.5, 95% CI = 4.53-85.02, p = 0.002]. We were able to isolate virus in 41 out of 70 neonates; 36.6% (15 out of 41) of them were symptomatic at birth while 63.4% (26 out of 41) were asymptomatic. The most prominent clinical feature observed in symptomatic neonates was hepatosplenomegaly (26.6%; 4 out of 15). All three genotypes gB, gN and gH were found with the highest frequency of gB1 genotype, found in 75% infants with hepatic damage. Phylogenetic analysis of Pakistani strains showed 96%-100% homology to their prototype strains.

Conclusions: Active CMV infection during pregnancy is a major cause of congenital CMV infection with comparable distribution of all three genotypes: gB, gN and gH in symptomatic and asymptomatic neonates. Our findings emphasize to conduct a comprehensive large scale survey and introduction of country wide routine screening at maternity clinics for early diagnosis of CMV to reduce its associated devastating outcomes.

No MeSH data available.


Related in: MedlinePlus