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Diagnosis of Congenital Cytomegalovirus Infection In High Risk Neonates

Received: 6 May 2013     Published: 10 June 2013
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Abstract

Objectives: This study aimed to compare polymerase chain reaction (PCR) and IgM detection using enzyme linked immune-sorbent assay (ELISA) in diagnosis of congenital cytomegalovirus (CMV) infection. Methods: This study was conducted from May 2011 to December 2012. Urine and blood samples were collected from 94 neonates with suspected congenital CMV infection. Serum and part of urine samples were stored at -20°C freezer, until the serologic and PCR tests were achieved. A 94 fresh urine samples were processed for cell culture. Nineteen (20.2%) out of 94 urine samples were proven positive for CMV infection by viral culture. For comparing PCR and IgM ELISA we used tissue culture technique as a reference, the 19 positive samples on culture (CMV group) and 20 negative samples (control group) were included in the comparison. Some characteristics of CMV and control groups were compared including sex, age, birth weight, gestational age < 37 and small for gestational age. Clinical and laboratory abnormalities were also compared in both groups. Results: This study showed that the sensitivity and specificity of PCR in relation to viral culture were 100% and 100% respectively, there was excellent agreement between both tests (Kappa coefficient was 1 and P=0.000). On the other hand, the sensitivity of IgM CMV ELISA in relation to viral culture was 63.2% and the specificity was 85%. There was good agreement between both tests (Kappa coefficient was 0.48 and P=0.002). By comparing CMV and control groups, there were high statistically significant differences between both groups as regard the birth weight, gestational age < 37 and small for gestational age items (P= 0.00, 0.03 and 0.01 respectively). There were statistically insignificant differences as regarding the clinical and laboratory abnormalities detected for neonates of both groups. In this study jaundice (63%) and hepato-splenomegaly (42%) were the most common clinical signs in both groups. Conclusion: PCR is more sensitive and specific technique for detection of congenital CMV infection than CMV IgM ELISA. Being more cost effective, less cumbersome and less time consuming in relation to viral culture, PCR may be used in detection of congenital CMV infection.

Published in Science Journal of Clinical Medicine (Volume 2, Issue 3)
DOI 10.11648/j.sjcm.20130203.12
Page(s) 68-74
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2013. Published by Science Publishing Group

Keywords

Cytomegalovirus, Neonates, Polymerase Chain Reaction

References
[1] Ryan J, Ray G (editors) (2004): Sherris Medical Microbiology (4th ed.). McGraw Hill. 556: 566–9.
[2] Koichi Y, Arvin, A, Gabriella C (2007): Definition and classification of the human herpesviruses (chapter 1) In Human herpesviruses: biology, therapy, and immunoprophylaxis. Ann Arvin, Gabriella Campadelli-Fiume, Edward Mocarski et al (editors). Cambridge University Press. 127-132.
[3] Caruso C, Buffa S, Candore G (2009): Mechanisms of immuno-senescence. Immun. Ageing 6:10.
[4] Stagno S, Pass R, Cloud G (1986): Primary cytomegalovirus infection in pregnancy. Incidence, transmission to the fetus, and clinical outcome. J.A.M.A. 256:1904–1908.
[5] Demmler G (1991): Infectious Diseases Society of America and Centers for Disease Control: summary of a workshop on surveillance for congenital cytomegalovirus disease. Rev. Infect. Dis.13:315–329.
[6] Al-Hareth Z, Monem F, Abdel Megiud N (2010): Is low birth weight a risk indicator for congenital cytomegalovirus infection? J. Infect. Dev. Ctries. 4:044-047.
[7] Priya K, Madhavan H (2002): Diagnostic value of enzyme linked immuno-sorbent assay for cytomegalovirus disease. J. Postgrad. Med. 48:176-8.
[8] Gandhoke I, Aggarwal R, Hussain A (2009): Congenital CMV infection; diagnosis in symptomatic infants. Indian J. Med. Microbiol. 27(3):222-5.
[9] Revello MG, Gerna G: Diagnosis and management of human cytomegalovirus infection in the mother, fetus, and newborn infant. Clin. Micro Rev. 2002; 15 (4): 680–715.
[10] Paul E, Ribhi M, Sue H (1990): Enhanced Recovery of Cytomegalovirus in Conventional Tube Cultures with a Spin-Amplified Adsorptiont. J. Clin. Microbiol. 5:965-969.
[11] Alfred F, Sarah L, James J (1988): Rapid Detection of Cytomegalovirus by Fluorescent Monoclonal Antibody Staining and In Situ DNA Hybridization in a Dram Vial Cell Culture System. J. Clin. Microbiol. 26: 1111-1114.
[12] William W, Mariryn A (1983): Practical Protocol for Cytomegalovirus Isolation: Use of MRC-5 Cell Monolayers Incubated for 2 Weeks. J. Clin. Microbiol.17: 605-609.
[13] Reynolds D, Stagno S, Alford C (1979): Laboratory diagnosis of cytomegalovirus infections, p. 399-439. In E. H. Lennette and N. J. Schmidt (ed.), Diagnostic procedures for viral, rickettsial and chlamydial infections, 5th ed. American Public Health Association, Inc., Washington, D.C.
[14] Starr S, Friedman H (1985): "Human CMV." Chapter 65. In Manual of Clin. Microbiol., 4th ed., Lennett, E.H. et al ed. Am.Soc. Microbiol. 771-719.
[15] Oriane S, Christelle V, Ina F (2008): Evaluation of different cytomegalovirus (CMV) DNA PCR protocols for analysis of dried blood spots from consecutive cases of neonates with congenital CMV infections. J. Clin. Microbiol. 46: 943-946.
[16] Jessica L, Mark R (2010): Prevention of maternal cytomegalovirus infection: current status and future prospects. Int. J. Womens Health. 2: 23–35.
[17] Marianne L, Christelle V, Sophie C (2011): Prospective identification of congenital cytomegalo virus infection in newborns using real-time polymerase chain reaction assays in dried blood spots. Clin. Infec. Dis. 52:575–581.
[18] 18. Morgan A, El-Ghany M, Khalifa A, Sherif A (2003): Prevalence of cytomegalovirus (CMV) infection among neonatal intensive care unit (NICU) and healthcare workers. Egypt. J. Immunol. 10: 1-8.
[19] Inoue N, Koyano S (2008): Evaluation of screening tests for congenital cytomegalovirus infection. Pediatr Infect Dis J. 27:182–184.
[20] Ornoy A, Diav-Citrin O (2006): Fetal effects of primary and secondary cytomegalovirus infection in pregnancy. Reprod. Toxicol. 21:399–409.
[21] Bolt B, Benz B, Koerner F, Bossi E (1992): A mydriatic eye-drop combination without systemic effects for premature infants : a prospective double-blind study. J. Pediatr. Ophthalmol. Strabismus. 29:157-62.
[22] Khoo K, Koh A, Cheong P, Ho K (2000): Combination cyclopentolate and phenylephrine for mydriasis in premature infants with heavily pigmented irides. J. Pediatr. Ophthalmol. Strabismus. 37:15-20.
[23] Chew C, Rahman A, Shafie M, Mohamad Z (2005): Comparison of mydriatic regimens used in screening for retinopathy of prematurity in preterm infants with dark irides. J. Pediatr. Ophthalmol. Strabismus. 42:166-73.
[24] Jones A, Isaacs D (1995): Predicting the outcome of symptomatic congenital cytomegalovirus infection. J. Paediatr. Child. Health. 31:70-1.
[25] Anderson S, Amos S, Boppan S (1996): Ocular abnormalities in congenital cytomegalovirus infection. J. Amer. Optomet. Assoc. 67: 273-278 .
[26] Mussi-Pinhata M, Yamamoto Y, Moura M (2009): Birth prevalence and natural history of congenital cytomegalovirus infection in a highly seroimmune population. Clin. Infect. Dis. 49:522-8.
[27] Yamamoto-Tabata T, McDonagh S, Chang T, Fisher S, Pereira L (2004): Human cytomegalovirus interleukin-10 downregulates metalloproteinase activity and impairs endothelial cell migration and placental cytotrophoblast invasiveness in vitro. J. Virol. 78:2831-40.
[28] Lazzarotto T, Brojanac S, Maine T (1997): Search for cytomegalovirus-specific immunoglobulin M: comparison between a new western blot, conventional western blot, and nine commercially available assays. Clin. Diagn. Lab. Immunol. 4:483–486.
[29] Christopher N, Allison I, Gail J (1995): PCR detection of cytomegalovirus DNA in serum as a diagnostic test for congenital cytomegalovirus infection. J. Clin. Microbiol.33: 3317–3318.
[30] Lazzarotto T, Guerra B, Lanari M (2008): New advances in the diagnosis of congenital cytomegalovirus infection. J. Clin. Virol. 41:192–197.
[31] Whilley J, Cloud G, Gruber W (1997): Ganciclovir treatment of symptomatic congenital infection: Results of a phase 11 study. National institute of Allergy and Infectious Diseases Collaborative Antiviral Study Group. J. Infect. Dis. 175
Cite This Article
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    Ehab Abd Elmoniem Albanna, Randa Saddek Abd El-latif, Hend Alsayed Sharaf, Maha Kamal Gohar, Basem Mohamed Ibrahim. (2013). Diagnosis of Congenital Cytomegalovirus Infection In High Risk Neonates. Science Journal of Clinical Medicine, 2(3), 68-74. https://doi.org/10.11648/j.sjcm.20130203.12

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    ACS Style

    Ehab Abd Elmoniem Albanna; Randa Saddek Abd El-latif; Hend Alsayed Sharaf; Maha Kamal Gohar; Basem Mohamed Ibrahim. Diagnosis of Congenital Cytomegalovirus Infection In High Risk Neonates. Sci. J. Clin. Med. 2013, 2(3), 68-74. doi: 10.11648/j.sjcm.20130203.12

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    AMA Style

    Ehab Abd Elmoniem Albanna, Randa Saddek Abd El-latif, Hend Alsayed Sharaf, Maha Kamal Gohar, Basem Mohamed Ibrahim. Diagnosis of Congenital Cytomegalovirus Infection In High Risk Neonates. Sci J Clin Med. 2013;2(3):68-74. doi: 10.11648/j.sjcm.20130203.12

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  • @article{10.11648/j.sjcm.20130203.12,
      author = {Ehab Abd Elmoniem Albanna and Randa Saddek Abd El-latif and Hend Alsayed Sharaf and Maha Kamal Gohar and Basem Mohamed Ibrahim},
      title = {Diagnosis of Congenital Cytomegalovirus Infection In High Risk Neonates},
      journal = {Science Journal of Clinical Medicine},
      volume = {2},
      number = {3},
      pages = {68-74},
      doi = {10.11648/j.sjcm.20130203.12},
      url = {https://doi.org/10.11648/j.sjcm.20130203.12},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20130203.12},
      abstract = {Objectives: This study aimed to compare polymerase chain reaction (PCR) and IgM detection using enzyme linked immune-sorbent assay (ELISA) in diagnosis of congenital cytomegalovirus (CMV) infection. Methods: This study was conducted from May 2011 to December 2012. Urine and blood samples were collected from 94 neonates with suspected congenital CMV infection. Serum and part of urine samples were stored at -20°C freezer, until the serologic and PCR tests were achieved. A 94 fresh urine samples were processed for cell culture. Nineteen (20.2%) out of 94 urine samples were proven positive for CMV infection by viral culture. For comparing PCR and IgM ELISA we used tissue culture technique as a reference, the 19 positive samples on culture (CMV group) and 20 negative samples (control group) were included in the comparison. Some characteristics of CMV and control groups were compared including sex, age, birth weight, gestational age < 37 and small for gestational age. Clinical and laboratory abnormalities were also compared in both groups. Results: This study showed that the sensitivity and specificity of PCR in relation to viral culture were 100% and 100% respectively, there was excellent agreement between both tests (Kappa coefficient was 1 and P=0.000). On the other hand, the sensitivity of IgM CMV ELISA in relation to viral culture was 63.2% and the specificity was 85%. There was good agreement between both tests (Kappa coefficient was 0.48 and P=0.002). By comparing CMV and control groups, there were high statistically significant differences between both groups as regard the birth weight, gestational age < 37 and small for gestational age items (P= 0.00, 0.03 and 0.01 respectively). There were statistically insignificant differences as regarding the clinical and laboratory abnormalities detected for neonates of both groups. In this study jaundice (63%) and hepato-splenomegaly (42%) were the most common clinical signs in both groups. Conclusion: PCR is more sensitive and specific technique for detection of congenital CMV infection than CMV IgM ELISA. Being more cost effective, less cumbersome and less time consuming in relation to viral culture, PCR may be used in detection of congenital CMV infection.},
     year = {2013}
    }
    

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  • TY  - JOUR
    T1  - Diagnosis of Congenital Cytomegalovirus Infection In High Risk Neonates
    AU  - Ehab Abd Elmoniem Albanna
    AU  - Randa Saddek Abd El-latif
    AU  - Hend Alsayed Sharaf
    AU  - Maha Kamal Gohar
    AU  - Basem Mohamed Ibrahim
    Y1  - 2013/06/10
    PY  - 2013
    N1  - https://doi.org/10.11648/j.sjcm.20130203.12
    DO  - 10.11648/j.sjcm.20130203.12
    T2  - Science Journal of Clinical Medicine
    JF  - Science Journal of Clinical Medicine
    JO  - Science Journal of Clinical Medicine
    SP  - 68
    EP  - 74
    PB  - Science Publishing Group
    SN  - 2327-2732
    UR  - https://doi.org/10.11648/j.sjcm.20130203.12
    AB  - Objectives: This study aimed to compare polymerase chain reaction (PCR) and IgM detection using enzyme linked immune-sorbent assay (ELISA) in diagnosis of congenital cytomegalovirus (CMV) infection. Methods: This study was conducted from May 2011 to December 2012. Urine and blood samples were collected from 94 neonates with suspected congenital CMV infection. Serum and part of urine samples were stored at -20°C freezer, until the serologic and PCR tests were achieved. A 94 fresh urine samples were processed for cell culture. Nineteen (20.2%) out of 94 urine samples were proven positive for CMV infection by viral culture. For comparing PCR and IgM ELISA we used tissue culture technique as a reference, the 19 positive samples on culture (CMV group) and 20 negative samples (control group) were included in the comparison. Some characteristics of CMV and control groups were compared including sex, age, birth weight, gestational age < 37 and small for gestational age. Clinical and laboratory abnormalities were also compared in both groups. Results: This study showed that the sensitivity and specificity of PCR in relation to viral culture were 100% and 100% respectively, there was excellent agreement between both tests (Kappa coefficient was 1 and P=0.000). On the other hand, the sensitivity of IgM CMV ELISA in relation to viral culture was 63.2% and the specificity was 85%. There was good agreement between both tests (Kappa coefficient was 0.48 and P=0.002). By comparing CMV and control groups, there were high statistically significant differences between both groups as regard the birth weight, gestational age < 37 and small for gestational age items (P= 0.00, 0.03 and 0.01 respectively). There were statistically insignificant differences as regarding the clinical and laboratory abnormalities detected for neonates of both groups. In this study jaundice (63%) and hepato-splenomegaly (42%) were the most common clinical signs in both groups. Conclusion: PCR is more sensitive and specific technique for detection of congenital CMV infection than CMV IgM ELISA. Being more cost effective, less cumbersome and less time consuming in relation to viral culture, PCR may be used in detection of congenital CMV infection.
    VL  - 2
    IS  - 3
    ER  - 

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Author Information
  • Pediatric, Departments. Faculty of Medicine, Zagazig University

  • Microbiology & Immunology Departments. Faculty of Medicine, Zagazig University

  • Microbiology & Immunology Departments. Faculty of Medicine, Zagazig University

  • Microbiology & Immunology Departments. Faculty of Medicine, Zagazig University

  • Ophthalmology Departments. Faculty of Medicine, Zagazig University

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