| Abstract|| |
Background: Cytomegalovirus (CMV) is one of the Human Herpes Viruses that is one of the main causes of mortality in transplant patients, acquired immunodeficiency syndrome (AIDS) patients, and neonates. It is one of the important congenital infections. CMV infections during pregnancy are important as they not only threaten maternal health, but also can cause fetal demise and congenital malformations with consequent costs and difficulties. Objective: The current study was done with the objective of determining the CMV seroepidemiology among pregnant women in Kermanshah, Iran. Material and Methods: In this descriptive cross-sectional study that lasted from March 2014 to March 2015, 300 pregnant women who presented to the Central Laboratory of Kermanshah, Iran, were included. Demographic data, clinical findings, and laboratory findings including IgM and IgG antibodies to CMV were documented. The findings were analyzed using the SPSS software (ver. 22.0). Results: There were 95 patients (31.67%) with positive CMV IgM antibody and had primary infection. Of 300 patients, 296 had positive CMV IgG antibody (98.7%) and 4 did not have CMV IgG (1.3%). There was a significant relationship between abortion and CMV infection (P < 0.05), but no such relationship was found between other factors and CMV infection. Conclusion: The CMV infection rate was 31.67% among pregnant women that is compatible with earlier studies and indicates the high prevalence of this infection among pregnant women. The observed primary infection was higher than similar studies. It is essential to implement health precautions to prevent CMV transfer to fetuses and performing screening tests in this population.
Keywords: Cytomegalovirus, pregnant women, seroepidemiology
|How to cite this article:|
Zalei B, Pourmand D, Desfolimanesh Z, Ghaderi O. Cytomegalovirus seroepidemiology in pregnant women presented to the Central Laboratory of Kermanshah, Iran in 2014. Ann Trop Med Public Health 2017;10:826-30
|How to cite this URL:|
Zalei B, Pourmand D, Desfolimanesh Z, Ghaderi O. Cytomegalovirus seroepidemiology in pregnant women presented to the Central Laboratory of Kermanshah, Iran in 2014. Ann Trop Med Public Health [serial online] 2017 [cited 2019 Sep 21];10:826-30. Available from: http://www.atmph.org/text.asp?2017/10/4/826/215844
| Introduction|| |
Cytomegalovirus (CMV) is a member of the Herpesviridae family  and is recognized as human herpes virus and morphologically it is not distinct from other herpes viruses. CMV infection is one of the main causes of mortality in transplant patients, those with acquired immunodeficiency syndrome (AIDS), and neonates., The prevalence rate of positive CMV antibody in different regions globally ranges from 40% to 100%. In developing countries, most children get infected with CMV during childhood. Transmission routes include perinatal transmission (via transplant or during delivery), breast milk, from children to parents, day care centers, organ transplantation, and blood transfusion. The most important infection caused by CMV infection is fetal infection during pregnancy and the infection in patients with immunosuppression or organ transplantation.,
CMV infection is generally more prevalent in women and the likelihood of infection rises with age. The primary infection caused by CMV occurs in 15–20% of pregnancies and transmits to the fetus in up to 40% of cases. Some of these infections lead to miscarriage, 15% lead to congenital infection with associated symptoms, and 15% lead to asymptomatic infections. One of the most important congenital infections is CMV infection as 10–14% of the fetuses with this infection will show undesirable complications such as neurologic manifestations and deafness. Perinatal infections with CMV lead to premature delivery in 34% of the cases. Perinatal infection, especially in the first trimester can lead to acute fetal infection with neurologic, ocular, and hearing manifestations. 2.4% of spontaneous abortions and fetal demises is due to CMV infection., The role of CMV infection as a culprit in miscarriage is known, and it is also one of the important factors in repeated abortions, especially in patients with acquired immunodeficiency syndrome (AIDS) and immunosuppression.
Considering the adverse outcomes of perinatal CMV infection, screening for CMV is important during pregnancy. By the early detection of CMV infection in pregnancy, it is possible to offer elective termination of pregnancy and the prevention of delivery of a neonate with complications. The present study was done with the objective of determining CMV seroepidemiology among pregnant women. Other factors investigated included the history of abortion, previous infection, and determining the relationship between basic characteristics, which predispose to CMV infection.
| Materials and Methods|| |
This descriptive cross-sectional study lasted from March 2014 to March 2015. The study population consisted of pregnant women who presented to the Central Laboratory of Kermanshah, Iran. The sampling method was convenient. The minimum sample size with the confidence level of 95% and the accuracy of 5% and the average ratio of 77.3% (17) was calculated as 200 samples. Demographic data as well as clinical findings and laboratory findings including IgM and IgG antibodies to CMV were documented. The IgM and IgG antibodies were detected by the ELISA method.
The gathered data were analyzed using the SPSS software (ver. 22).
| Results|| |
Of 300 studied women, 296 patients had CMV IgG and primary infection (31.67%) and 205 (68.3%) cases did not have CMV IgM. There were 296 cases (98.7%) with positive CMV IgG. Mean (SD) age of the patients was 22.29 (6.40) years. The highest rate of CMV infection was seen in age range of 26–31 years (35%). With increase in age until 31 years, the frequency of CMV infection increases, and then a gradual decrease until 41 years. However, no significant difference (P = 0.88) was seen between the age group and the CMV infection rate [Table 1]. In addition, no significant association was observed between educational level and CMV infection. Sixty-five patients (31.6%) among literate patients and 58 (28.3%) of illiterate patients had CMV infection [Table 2].
|Table 1: Comparison of Cytomegalovirus (CMV) infection prevalence between different age groups|
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|Table 2: Comparison of education, history of abortion, residential place, and history of organ transplantation and blood transfusion between positive and negative CMV infection groups|
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There were 94 cases with previous history of abortion. In this group, 39 (41.5%) had CMV infection, whereas 56 (58.5%) were without the infection. In those without previous history of abortion, 56 (36.78%) had CMV infection, whereas 150 cases (63.22%) were without the infection. There was a significant association between the history of abortion and CMV infection (P < 0.05); [Table 2].
There were 229 cases who were residing in the cities and 71 cases living in rural areas. CMV infection prevalence rate was 77.6% (74 cases) in city dwellers and 22.1% (21 cases) among rural residents which indicates that there was no significant association between residential place and CMV infection [Table 2].
Of those with organ transplantation (0.27%), only one patient had CMV infection with no significant association between organ transplantation and CMV infection [Table 2].
There were 18 patients (0.6%) with the history of blood transfusion. Of this, six cases had CMV infection (0.33%). No significant difference was seen between those with the history of blood transfusion and those without such history.
| Discussion|| |
Several studies have been undertaken in recent years about the epidemiology and diagnosis of CMV infection, which reflects the importance of this infection. The prevalence rate of CMV antibodies has been reported to be 42.6–97.14%. This depends on socio-economic status and the study location. In some African and Asian countries, most children become seropositive for CMV in pre-school years, but in the US and UK, this figure is less than 20%. The rate of CMV infection rises with age and most acquired infections are asymptomatic. Annually, 30,000–40,000 neonates are born with CMV infection. Of this, 10% will show classic manifestations of congenital CMV infection including intrauterine growth restriction and hepatosplenomegaly (100%), jaundice (65%), petechial and purpura (50%), microcephaly (82%), developmental delay (80%), chorioretinitis (30%), and intracerebral calcifications (22%) with sensorineural hearing loss. About 90% of symptomatic neonates have neurologic manifestation with hearing impairment or loss. Differentiation between primary and secondary infections in pregnant women is important. Detecting CMV IgM is the most appropriate parameter for screening purposes in pregnant women and shows recent or active infection and is the best method for diagnosing acute infection.,
In this study, serum samples of 300 pregnant women were studied. The prevalence rate of acute infection was 31.7% (95 cases with positive CMV IgM). There were 296 cases with positive CMV IgG that shows previous exposure to CMV and immunity to this virus. Therefore, exposure to this virus is high in the community, and it can be stated that most women in Kermanshah have been exposed to this virus. In similar studies in Tehran, the prevalence rate of CMV-specific IgG was reported as 20% in women younger than 20 years and 100% in those older than 40 years with the average number of 99.1%. In other studies in Tabriz, Iran, the prevalence rates of CMV IgG rates were 82% and 87% in 2004 and 2006, respectively. Spano et al. in Brazil reported the prevalence rate of CMV antibody in pregnant and non-pregnant women as 98% and 98.3%, respectively. In Iraq in 1991, the figure was 90% and 84% in pregnant and non-pregnant women, respectively. In another study in Kerman, Iran, in 2007, seroprevalence of CMV IgG was 91.94% among mothers. The results we observed here are compatible with other studies and reflect high prevalence rate of CMV infection in the community.
The prevalence rate of primary acute infection in this study was 31.7% that was detected using assaying CMV IgM. In the Kerman study, this rate was 33.8% and when the primary infection was investigated using IgG avidity, which is a more reliable test, the prevalence rate was found to be 32.24%. In several studies in other countries, the prevalence rate of CMV infection before 2007 was 1–4%. In women who were presented in Blood Transfusion Center of Zahedan, Iran, 5.27% of volunteers to donate blood were found to have CMV IgM. In a Study was done in Mashad (Iran). The prevalence rate of CMV IgG was 99.1% in males and 100% in women. The prevalence rate of CMV IgM was 1.6% in men and 10.5% in women, and the highest rate was detected in age range of 30–39 years, and the lowest rate was seen in those younger than 20 years. The rate of infection increases with age and the lowest rate is seen in those younger than 20 years, which was observed in our study and several other studies. In the current study, the highest rate of infection was seen in age range of 26–31 years, which is in contrast to the Mashhad study. In another study, undertaken among blood donors in Shiraz, Iran, 98.9% had CMV IgG and 4.4% had CMV IgM. In Tabriz, Iran, the prevalence rate of CMV IgG and IgM antibodies were, respectively, 82% and 5%. In Zanjan, 3.4% had CMV IgM and 89.2% had CMV IgG. In Urumia, 100% had CMV IgG and 2.8% had CMV IgM. In these studies, no significant associations were seen between age, number of children, gender, and educational level and CMV infection, but in the Mashahad study, a significant difference was seen between genders regarding CMV IgM. The rate of CMV infection is also high in other developing countries, similar to our country. For instance, in China, 94.45% had positive CMV IgM and 4.65% had positive CMV IgG. In Taiwan, 92.7% and in Thailand, 93.31% had positive CMV IgG., In Ghana, 93.2% had positive CMV IgG and none had CMV IgM, similar to India. There are different reports from developed countries. For example, in Canada, the rate of CMV IgG and IgM antibodies were 40.5% and 0.9%, respectively., In the US, the prevalence rate was 58.9% in those older than 6 years, 36.3% in 6–11 year age range, and 90.8% in those older than 80 years. In Australia, the overall prevalence rate was 57% and in Spain the rate was 58.4% in men and 66.7% in women in the age range of 2–60 years.
In this study, the rate of primary infection, which was detected using CMV IgM, was higher (31.67%) than other studies. This figure was 1% lower than the study of Arabzadeh et al. in Kerman that reported the prevalence rate of 33.8%. This difference can be attributed to factors such as study population and better laboratory techniques in detecting CMV infection in recent years. In addition, several factors such as age, gender, residential place, health condition, and socio-economic conditions may be contributing factors. Here, we did found that there was a significant relationship between previous history of abortion and primary CMV infection, but other factors were not significantly associated.
| Conclusion|| |
Considering the observed findings and reports from similar studies, CMV infection is one of the most important factors of mortality in patients with organ transplantation and also an important infection in pregnant women that can result in fetal demise and congenital infection. Therefore, CMV seroepidemiology is important in pregnant women.
We thank the head of the Central Laboratory of Kermanshah, Iran, and the Research Deputy of Kermanshah University of Medical Sciences, Kermanshah, Iran, for their support in this study.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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Ms of Immunology, Department of Medical Laboratory Sciences, School of Paramedicine, Kermanshah University of Medical Sciences, Kermanshah
Source of Support: None, Conflict of Interest: None
[Table 1], [Table 2]