Clinical manifestations and abnormal laboratory findings in pregnant women with primary cytomegalovirus infection.
OBJECTIVE
To compare the clinical manifestations and laboratory abnormalities associated with primary cytomegalovirus (CMV) infection in pregnancy with recurrent and non-active CMV infection (controls).


METHODS
A prospective cohort study.


METHODS
Rome, Latium and other Italian regions.


METHODS
Three hundred and sixteen pregnant women with CMV infection: 102 had primary infection, 105 had recurrent infection and 109 with non-active infection were followed up as controls.


METHODS
CMV diagnosis was based on serological examinations (CMV IgG, IgM and IgG avidity) and detection of CMV DNA by polymerase chain reaction in maternal serum, urine and cervical samples. The clinical history and laboratory evaluations were carried out at enrollment and at each subsequent visit, every one to three months.


METHODS
Identification of clinical and laboratory indicators of primary CMV infection in pregnancy.


RESULTS
Compared with women with recurrent or non-active infection, women with primary infection had a statistically significant higher prevalence of fever, asthenia, myalgia and flu-like syndrome (P < 0.001). In particular, relevant symptomatology was observed in 32 women (31.4%), of whom 25 had flu-like syndrome and 7 persistent fever as a single manifestation. Moreover, women with primary infection showed a significantly increased rate of lymphocytes >or=40% (39.2% vs 5.7% or 3.7%, respectively, P < 0.001) and elevated aspartate aminotransferase and/or alanine aminotransferase levels (35.3% vs 3.9% or 0.9%, respectively, P < 0.001): lymphocytosis and/or increased aminotransferases occurred in 53 patients (52%). In total, clinical manifestations and/or laboratory abnormalities occurred in 61 women with primary infection (59.8%) compared with 20 with recurrent infection (19%) and 13 controls (11.9%) (P < 0.001).


CONCLUSIONS
Clinical manifestations (i.e. flu-like syndrome, fever) and abnormal laboratory findings (i.e. lymphocytes >or=40%, elevated aminotransferases) may suggest the presence of primary CMV infection and should prompt subsequent virological investigations.
Nigro
Giovanni
G
Paediatric Institute, La Sapienza University, Rome, Italy
Anceschi
Maurizio M
MM
Cosmi
Ermelando V
EV
D000328:Adult; D000410:Alanine Transaminase / Q000097:blood; D000914:Antibodies, Viral / Q000097:blood; D001219:Aspartate Aminotransferases / Q000097:blood; D001247:Asthenia / Q000209:etiology; D015331:Cohort Studies; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000635:transmission / Q000821:virology; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D007136:Immunoglobulins / Q000097:blood; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D008214:Lymphocytes / Q000097:blood; D016133:Polymerase Chain Reaction; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000175:diagnosis* / Q000821:virology; D011296:Prenatal Diagnosis; D011446:Prospective Studies; D012008:Recurrence
D000914:Antibodies, Viral; D007136:Immunoglobulins; D001219:Aspartate Aminotransferases; D000410:Alanine Transaminase