A seromolecular study to determine the prevalence of cytomegalovirus in pregnant women referred to health centers in the north of Iran
-
Negin Mesgar Saravi
,
Faegheh Aghajani
,
Ahmad Najafi
,
Rezvan Khajavi
,
Zahra Rahmani
,
Hossein Jalali
,
Tahoora Mousavi
Abstract
Background and Objectives: Because of the controversial aspects of the CMV virus during pregnancy, it should be considered a serious health threat, especially in developing countries. The present seromolecular study aimed to determine cytomegalovirus prevalence in pregnant women referred to health centers in the north of Iran.
Materials and Methods: One hundred and twenty-five pregnant women who were referred to health centers in Mazandaran province for regular health checks were randomly selected from Jan 2022 to Oct 2022. To detect the presence of the CMV genome and specific IgM and IgG antibodies against cytomegalovirus, the conventional PCR and ELISA tests were applied respectively.
Results: All 125 pregnant women that attended the study were from Mazandaran province with a mean age of 30 years ranging from 20 to 42 years. The result showed that 2 (1.6%), 92 (73.6%), and 2 (1.6%) of the cases were positive for IgM, IgG, and IgM/IgG, respectively. The PCR test results indicated that the CMV DNA was present in 10 (8%) pregnant women. Our study shows that all PCR-positive cases were negative for the IgM test. Of the 10 PCR-positive samples 3 were positive and 1 was suspicious for the IgG test.
Conclusion: Our study revealed that there is an urgent need for vaccination or other strategies to prevent and treat congenital CMV infection. Reducing the burden of congenital CMV infection requires global awareness. Further studies are recommended to obtain accurate estimates of the risk of congenital CMV infection.
1. Bagheri L, Mokhtarian H, Sarshar N, Ghahramani M. Seroepidemiology of cytomegalovirus infection during pregnancy in Gonabad, east of Iran: a cross-sectional study. J Res Health Sci 2012; 12: 38-44.
2. Lazzaro A, Vo ML, Zeltzer J, Rawlinson W, Nassar N, Daly K, et al. Knowledge of congenital cytomegalovirus (CMV) in pregnant women in Australia is low, and improved with education. Aust N Z J Obstet Gynaecol 2019; 59: 843-849.
3. Tanimura K, Tairaku S, Ebina Y, Morioka I, Nagamata S, Deguchi K, et al. Prediction of Congenital Cytomegalovirus infection in high-risk pregnant women. Clin Infect Dis 2017; 64: 159-165.
4. Nicloux M, Peterman L, Parodi M, Magny J-F. Outcome and management of newborns with congenital cytomegalovirus infection. Arch Pediatr 2020; 27: 160-165.
5. Manicklal S, Emery VC, Lazzarotto T, Boppana SB, Gupta RK. The "silent" global burden of congenital cytomegalovirus. Clin Microbiol Rev 2013; 26: 186-102.
6. Tabatabaee M, Tayyebi D. Seroepidemiologic study of human cytomegalovirus in pregnant women in Valiasr Hospital of Kazeroon, Fars, Iran. J Matern Fetal Neonatal Med 2009; 22: 517-521.
7. Erfanianahmadpoor M, Nasiri R, Vakili R, Hassannia T. Seroprevalence, transmission, and associated factors of specific antibodies against cytomegalovirus among pregnant women and their infants in a regional study. Saudi Med J 2014; 35: 360-364.
8. Carlson A, Norwitz ER, Stiller RJ. Cytomegalovirus infection in pregnancy: should all women be screened? Rev Obstet Gynecol 2010; 3: 172-179.
9. Shahar-Nissan K, Pardo J, Peled O, Krause I, Bilavsky E, Wiznitzer A, et al. Valaciclovir to prevent vertical transmission of cytomegalovirus after maternal primary infection during pregnancy: a randomised, double-blind, placebo-controlled trial. Lancet 2020; 396: 779-785.
10. Pass RF, Fowler KB, Boppana SB, Britt WJ, Stagno S. Congenital cytomegalovirus infection following first trimester maternal infection: symptoms at birth and outcome. J Clin Virol 2006; 35: 216-220.
11. Foulon I, Naessens A, Foulon W, Casteels A, Gordts F. Hearing loss in children with congenital cytomegalovirus infection in relation to the maternal trimester in which the maternal primary infection occurred. Pediatrics 2008; 122(6):e1123-7.
12. Yamada H, Tanimura K, Tairaku S, Morioka I, Deguchi M, Morizane M, et al. Clinical factor associated with congenital cytomegalovirus infection in pregnant women with non-primary infection. J Infect
Chemother 2018; 24: 702-706.
13. Perillaud-Dubois C, Bouthry E, Jadoui A, Leng A-L, Roque-Afonso A-M, Vauloup-Fellous C. Positive predictive values of CMV-IgM and importance of CMV-IgG avidity testing in detecting primary infection in three different clinical settings. A French retrospective cohort study. J Clin Virol 2020; 132: 104641.
14. Dollard SC, Dreon M, Hernandez-Alvarado N, Amin MM, Wong P, Lanzieri TM, et al. Sensitivity of dried blood spot testing for detection of Congenital Cytomegalovirus infection. JAMA Pediatr 2021; 175(3): e205441.
15. Mujtaba G, Khurshid A, Sharif S, Alam MM, Aamir UB, Shaukat S, et al. Distribution of Cytomegalovirus Genotypes among Neonates Born to infected mothers in Islamabad, Pakistan. PLoS One 2016; 11(7): e0156049.
16. Mhandire D, Rowland-Jones S, Mhandire K, Kaba M, Dandara C. Epidemiology of Cytomegalovirus among pregnant women in Africa. J Infect Dev Ctries 2019; 13: 865-876.
17. Sharghi M, Musavi H, Mansurkhani SM, Kooti W, Behzadifar M, Ashrafi-Zadeh H, et al. Seroprevalence of cytomegalovirus among women of reproductive age in Iran: a systematic review and meta-analysis. Iran J Public Health 2019; 48: 206-216.
18. Acosta E, Bowlin T, Brooks J, Chiang L, Hussein I, Kimberlin D, et al. Advances in the development of therapeutics for cytomegalovirus infections. J Infect Dis 2020; 221 (Suppl 1): S32-S44.
19. Chiopris G, Veronese P, Cusenza F, Procaccianti M, Perrone S, Dacco V, et al. Congenital cytomegalovirus infection: update on diagnosis and treatment. Microorganisms 2020; 8: 1516.
20. Yang Z, Tang X, Hasing ME, Pang X, Ghosh S, McMullen TPW, et al. Human cytomegalovirus seropositivity and Viral DNA in Breast Tumors are associated with poor patient prognosis. Cancers (Basel) 2022; 14: 1148.
21. Mesgar Saravi N, Mousavi T. Seroprevalence of cytomegalovirus antibodies and primary infection among hemodialysis patients: a systematic and meta-analysis review. Transpl Immunol 2022; 72: 101587.
22. Ho M. The history of cytomegalovirus and its diseases. Med Microbiol Immunol 2008; 197: 65-73.
23. Gouarin S, Vabret A, Gault E, Petitjean J, Regeasse A, Hurault de Ligny B, et al. Quantitative analysis of HCMV DNA load in whole blood of renal transplant patients using real-time PCR assay. J Clin Virol 2004; 29: 194-201.
24. Baniak N, Kanthan R. Cytomegalovirus Colitis: An Uncommon Mimicker of Common Colitides. Arch Pathol Lab Med 2016; 140: 854-858.
25. Lindholm K, O'Keefe M. Placental Cytomegalovirus Infection. Arch Pathol Lab Med 2019; 143: 639-642.
26. Arechavaleta-Velasco F, Koi H, Strauss JF 3rd, Parry S. Viral infection of the trophoblast: time to take a serious look at its role in abnormal implantation and placentation? J Reprod Immunol 2002; 55: 113-121.
27. Gaytant MA, Steegers EA, Semmekrot BA, Merkus HM, Galama JM. Congenital cytomegalovirus infection: review of the epidemiology and outcome. Obstet Gynecol Surv 2002; 57: 245-256.
28. Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis 2010; 50: 1439-1447.
29. Munro SC, Hall B, Whybin LR, Leader L, Robertson P, Maine GT, et al. Diagnosis of and screening for cytomegalovirus infection in pregnant women. J Clin Microbiol 2005; 43: 4713-4718.
30. Kouri V, Correa CB, Verdasquera D, Martinez PA, Alvarez A, Aleman Y, et al. Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns: 2007-2008. Pediatr Infect Dis J 2010; 29: 1105-1110.
31. Taniguchi K, Watanabe N, Sato A, Jwa SC, Suzuki T, Yamanobe Y, et al. Changes in cytomegalovirus seroprevalence in pregnant Japanese women-a 10-year single center study. J Clin Virol 2014; 59: 192-194.
32. Wang C, Dollard SC, Amin MM, Bialek SR. Cytomegalovirus IgM Seroprevalence among Women of Reproductive Age in the United States. PLoS One 2016; 11(3): e0151996.
33. Nabizadeh E, Ghotaslou A, Salahi B, Ghotaslou R. The screening of Rubella Virus, Cytomegalovirus, Hepatitis B Virus, and Toxoplasma gondii antibodies in prepregnancy and reproductive-age women in Tabriz, Iran. Infect Dis Obstet Gynecol 2022; 2022: 4490728.
34. Rahimzadeh G, Safar MJ, Rezai S, Rezai MS, Movahedi FS. Seroepidemiology of HBV, HCV, HIV, HTLV, and CMV in Pregnant Women Referring to Sari Birth Cohort. Adv Biomed Res 2022; 11: 97.
35. Sherkat R, Meidani M, Zarabian H, Rezaei A, Gholamrezaei A. Seropositivity of cytomegalovirus in patients with recurrent pregnancy loss. J Res Med Sci 2014; 19(Suppl 1): S22-25.
2. Lazzaro A, Vo ML, Zeltzer J, Rawlinson W, Nassar N, Daly K, et al. Knowledge of congenital cytomegalovirus (CMV) in pregnant women in Australia is low, and improved with education. Aust N Z J Obstet Gynaecol 2019; 59: 843-849.
3. Tanimura K, Tairaku S, Ebina Y, Morioka I, Nagamata S, Deguchi K, et al. Prediction of Congenital Cytomegalovirus infection in high-risk pregnant women. Clin Infect Dis 2017; 64: 159-165.
4. Nicloux M, Peterman L, Parodi M, Magny J-F. Outcome and management of newborns with congenital cytomegalovirus infection. Arch Pediatr 2020; 27: 160-165.
5. Manicklal S, Emery VC, Lazzarotto T, Boppana SB, Gupta RK. The "silent" global burden of congenital cytomegalovirus. Clin Microbiol Rev 2013; 26: 186-102.
6. Tabatabaee M, Tayyebi D. Seroepidemiologic study of human cytomegalovirus in pregnant women in Valiasr Hospital of Kazeroon, Fars, Iran. J Matern Fetal Neonatal Med 2009; 22: 517-521.
7. Erfanianahmadpoor M, Nasiri R, Vakili R, Hassannia T. Seroprevalence, transmission, and associated factors of specific antibodies against cytomegalovirus among pregnant women and their infants in a regional study. Saudi Med J 2014; 35: 360-364.
8. Carlson A, Norwitz ER, Stiller RJ. Cytomegalovirus infection in pregnancy: should all women be screened? Rev Obstet Gynecol 2010; 3: 172-179.
9. Shahar-Nissan K, Pardo J, Peled O, Krause I, Bilavsky E, Wiznitzer A, et al. Valaciclovir to prevent vertical transmission of cytomegalovirus after maternal primary infection during pregnancy: a randomised, double-blind, placebo-controlled trial. Lancet 2020; 396: 779-785.
10. Pass RF, Fowler KB, Boppana SB, Britt WJ, Stagno S. Congenital cytomegalovirus infection following first trimester maternal infection: symptoms at birth and outcome. J Clin Virol 2006; 35: 216-220.
11. Foulon I, Naessens A, Foulon W, Casteels A, Gordts F. Hearing loss in children with congenital cytomegalovirus infection in relation to the maternal trimester in which the maternal primary infection occurred. Pediatrics 2008; 122(6):e1123-7.
12. Yamada H, Tanimura K, Tairaku S, Morioka I, Deguchi M, Morizane M, et al. Clinical factor associated with congenital cytomegalovirus infection in pregnant women with non-primary infection. J Infect
Chemother 2018; 24: 702-706.
13. Perillaud-Dubois C, Bouthry E, Jadoui A, Leng A-L, Roque-Afonso A-M, Vauloup-Fellous C. Positive predictive values of CMV-IgM and importance of CMV-IgG avidity testing in detecting primary infection in three different clinical settings. A French retrospective cohort study. J Clin Virol 2020; 132: 104641.
14. Dollard SC, Dreon M, Hernandez-Alvarado N, Amin MM, Wong P, Lanzieri TM, et al. Sensitivity of dried blood spot testing for detection of Congenital Cytomegalovirus infection. JAMA Pediatr 2021; 175(3): e205441.
15. Mujtaba G, Khurshid A, Sharif S, Alam MM, Aamir UB, Shaukat S, et al. Distribution of Cytomegalovirus Genotypes among Neonates Born to infected mothers in Islamabad, Pakistan. PLoS One 2016; 11(7): e0156049.
16. Mhandire D, Rowland-Jones S, Mhandire K, Kaba M, Dandara C. Epidemiology of Cytomegalovirus among pregnant women in Africa. J Infect Dev Ctries 2019; 13: 865-876.
17. Sharghi M, Musavi H, Mansurkhani SM, Kooti W, Behzadifar M, Ashrafi-Zadeh H, et al. Seroprevalence of cytomegalovirus among women of reproductive age in Iran: a systematic review and meta-analysis. Iran J Public Health 2019; 48: 206-216.
18. Acosta E, Bowlin T, Brooks J, Chiang L, Hussein I, Kimberlin D, et al. Advances in the development of therapeutics for cytomegalovirus infections. J Infect Dis 2020; 221 (Suppl 1): S32-S44.
19. Chiopris G, Veronese P, Cusenza F, Procaccianti M, Perrone S, Dacco V, et al. Congenital cytomegalovirus infection: update on diagnosis and treatment. Microorganisms 2020; 8: 1516.
20. Yang Z, Tang X, Hasing ME, Pang X, Ghosh S, McMullen TPW, et al. Human cytomegalovirus seropositivity and Viral DNA in Breast Tumors are associated with poor patient prognosis. Cancers (Basel) 2022; 14: 1148.
21. Mesgar Saravi N, Mousavi T. Seroprevalence of cytomegalovirus antibodies and primary infection among hemodialysis patients: a systematic and meta-analysis review. Transpl Immunol 2022; 72: 101587.
22. Ho M. The history of cytomegalovirus and its diseases. Med Microbiol Immunol 2008; 197: 65-73.
23. Gouarin S, Vabret A, Gault E, Petitjean J, Regeasse A, Hurault de Ligny B, et al. Quantitative analysis of HCMV DNA load in whole blood of renal transplant patients using real-time PCR assay. J Clin Virol 2004; 29: 194-201.
24. Baniak N, Kanthan R. Cytomegalovirus Colitis: An Uncommon Mimicker of Common Colitides. Arch Pathol Lab Med 2016; 140: 854-858.
25. Lindholm K, O'Keefe M. Placental Cytomegalovirus Infection. Arch Pathol Lab Med 2019; 143: 639-642.
26. Arechavaleta-Velasco F, Koi H, Strauss JF 3rd, Parry S. Viral infection of the trophoblast: time to take a serious look at its role in abnormal implantation and placentation? J Reprod Immunol 2002; 55: 113-121.
27. Gaytant MA, Steegers EA, Semmekrot BA, Merkus HM, Galama JM. Congenital cytomegalovirus infection: review of the epidemiology and outcome. Obstet Gynecol Surv 2002; 57: 245-256.
28. Bate SL, Dollard SC, Cannon MJ. Cytomegalovirus seroprevalence in the United States: the national health and nutrition examination surveys, 1988-2004. Clin Infect Dis 2010; 50: 1439-1447.
29. Munro SC, Hall B, Whybin LR, Leader L, Robertson P, Maine GT, et al. Diagnosis of and screening for cytomegalovirus infection in pregnant women. J Clin Microbiol 2005; 43: 4713-4718.
30. Kouri V, Correa CB, Verdasquera D, Martinez PA, Alvarez A, Aleman Y, et al. Diagnosis and screening for cytomegalovirus infection in pregnant women in Cuba as prognostic markers of congenital infection in newborns: 2007-2008. Pediatr Infect Dis J 2010; 29: 1105-1110.
31. Taniguchi K, Watanabe N, Sato A, Jwa SC, Suzuki T, Yamanobe Y, et al. Changes in cytomegalovirus seroprevalence in pregnant Japanese women-a 10-year single center study. J Clin Virol 2014; 59: 192-194.
32. Wang C, Dollard SC, Amin MM, Bialek SR. Cytomegalovirus IgM Seroprevalence among Women of Reproductive Age in the United States. PLoS One 2016; 11(3): e0151996.
33. Nabizadeh E, Ghotaslou A, Salahi B, Ghotaslou R. The screening of Rubella Virus, Cytomegalovirus, Hepatitis B Virus, and Toxoplasma gondii antibodies in prepregnancy and reproductive-age women in Tabriz, Iran. Infect Dis Obstet Gynecol 2022; 2022: 4490728.
34. Rahimzadeh G, Safar MJ, Rezai S, Rezai MS, Movahedi FS. Seroepidemiology of HBV, HCV, HIV, HTLV, and CMV in Pregnant Women Referring to Sari Birth Cohort. Adv Biomed Res 2022; 11: 97.
35. Sherkat R, Meidani M, Zarabian H, Rezaei A, Gholamrezaei A. Seropositivity of cytomegalovirus in patients with recurrent pregnancy loss. J Res Med Sci 2014; 19(Suppl 1): S22-25.
| Files | ||
| Issue | Vol 15 No 4 (2023) | |
| Section | Original Article(s) | |
| DOI | https://doi.org/10.18502/ijm.v15i4.13514 | |
| Keywords | ||
| Seromolecular; Cytomegalovirus; Pregnant women; Iran | ||
| Rights and permissions | |
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This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |
How to Cite
1.
Mesgar Saravi N, Aghajani F, Najafi A, Khajavi R, Rahmani Z, Jalali H, Mousavi T. A seromolecular study to determine the prevalence of cytomegalovirus in pregnant women referred to health centers in the north of Iran. Iran J Microbiol. 2023;15(4):594-600.
