title: Strong Cell-Mediated Immune Response to Human Cytomegalovirus Is Associated With Increased Risk of Fetal Infection in Primarily Infected Pregnant Women.
abstract: BACKGROUND
  Human cytomegalovirus (CMV) represents one of the leading causes of congenital infections worldwide. Early diagnosis of fetal infection and consequent rapid therapeutic intervention with immunoglobulin treatment may prevent fetal transmission and virus-related sequelae. In this study, the cell-mediated immunity and immunoglobulin avidity were evaluated as potential predictors of congenital transmission of the infection.
  
  
  METHODS
  CMV immunoglobulin G (IgG) avidity and CMV enzyme-linked immunospot (ELISpot) assays were employed in 80 pregnant women including 57 primary and 23 nonprimary CMV infections. Congenital infection was assessed using CMV DNA quantitative polymerase chain reaction on amniotic fluid or offspring urine. Logistic regression and receiver operating characteristic statistical methods were employed to determine the association with congenital infection.
  
  
  RESULTS
  Low CMV IgG avidity (25%) alone correlated with a probability of congenital transmission of 18.2% (95% confidence interval, 7.7%-28.8%). In contrast to the expectations, an increase in CMV ELISpot levels was statistically associated with congenital transmission (P = .006). The combined use of CMV ELISpot and low CMV IgG avidity resulted in a higher level of association than either method alone with the incidence of fetal transmission (area under the curve, 0.8685).
  
  
  CONCLUSIONS
  CMV-specific cell-mediated immunity represents a relevant marker in assessing the likelihood of congenital CMV transmission, particularly in combination with CMV IgG avidity.
authors.affiliation: Department of Molecular Medicine.
authors.forename: Alda
authors.initials: A
authors.lastname: Saldan
authors.affiliation: Department of Molecular Medicine.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Forner
authors.affiliation: Department of Molecular Medicine.
authors.forename: Carlo
authors.initials: C
authors.lastname: Mengoli
authors.affiliation: Padua Reference Center for Infections in Pregnancy, Padua General Hospital, University of Padua, Italy.
authors.forename: Nadia
authors.initials: N
authors.lastname: Gussetti
authors.affiliation: Department of Molecular Medicine.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Palù
authors.affiliation: Department of Molecular Medicine.
authors.forename: Davide
authors.initials: D
authors.lastname: Abate
mesh_terms: D000293:Adolescent; D000328:Adult; D000653:Amniotic Fluid / Q000821:virology; D000914:Antibodies, Viral / Q000276:immunology*; D000915:Antibody Affinity; D015415:Biomarkers; D003587:Cytomegalovirus / Q000276:immunology*; D003586:Cytomegalovirus Infections / Q000151:congenital / Q000175:diagnosis / Q000276:immunology* / Q000635:transmission*; D058501:Enzyme-Linked Immunospot Assay; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis / Q000821:virology*; D006801:Humans; D007111:Immunity, Cellular; D007074:Immunoglobulin G / Q000276:immunology; D007075:Immunoglobulin M / Q000276:immunology; D018445:Infectious Disease Transmission, Vertical; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000276:immunology*; D012372:ROC Curve; D012044:Regression Analysis; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000914:Antibodies, Viral; D015415:Biomarkers; D007074:Immunoglobulin G; D007075:Immunoglobulin M
keywords: ELISPOT; cell-mediated immunity; fetal infection; human cytomegalovirus; pregnancy