Revello Maria Grazia, Gerna Giuseppe
Servizio di Virologia, IRCCS Policlinico San Matteo, 27100 Pavia, Italy.
Clin Microbiol Rev. 2002 Oct;15(4):680-715. doi: 10.1128/CMR.15.4.680-715.2002.
Human cytomegalovirus (HCMV) is the leading cause of congenital viral infection and mental retardation. HCMV infection, while causing asymptomatic infections in most immunocompetent subjects, can be transmitted during pregnancy from the mother with primary (and also recurrent) infection to the fetus. Hence, careful diagnosis of primary infection is required in the pregnant woman based on the most sensitive serologic assays (immunoglobulin M [IgM] and IgG avidity assays) and conventional virologic and molecular procedures for virus detection in blood. Maternal prognostic markers of fetal infection are still under investigation. If primary infection is diagnosed in a timely manner, prenatal diagnosis can be offered, including the search for virus and virus components in fetal blood and amniotic fluid, with fetal prognostic markers of HCMV disease still to be defined. However, the final step for definite diagnosis of congenital HCMV infection is detection of virus in the blood or urine in the first 1 to 2 weeks of life. To date, treatment of congenital infection with antiviral drugs is only palliative both prior to and after birth, whereas the only efficacious preventive measure seems to be the development of a safe and immunogenic vaccine, including recombinant, subunit, DNA, and peptide-based vaccines now under investigation. The following controversial issues are discussed in the light of the most recent advances in the field: the actual perception of the problem; universal serologic screening before pregnancy; the impact of correct counseling on decision making by the couple involved; the role of prenatal diagnosis in ascertaining transmission of virus to the fetus; the impact of preconceptional and periconceptional infections on the prevalence of congenital infection; and the prevalence of congenitally infected babies born to mothers who were immune prior to pregnancy compared to the number born to mothers undergoing primary infection during pregnancy.
人巨细胞病毒（HCMV）是先天性病毒感染和智力发育迟缓的主要原因。HCMV感染在大多数免疫功能正常的个体中可引起无症状感染，但在孕期可由初次（及复发）感染的母亲传播给胎儿。因此，基于最敏感的血清学检测（免疫球蛋白M [IgM]和IgG亲和力检测）以及用于血液中病毒检测的传统病毒学和分子检测方法，对孕妇进行初次感染的仔细诊断是必要的。胎儿感染的母体预后标志物仍在研究中。如果能及时诊断出初次感染，可提供产前诊断，包括在胎儿血液和羊水中寻找病毒及病毒成分，而HCMV疾病的胎儿预后标志物仍有待确定。然而，先天性HCMV感染确诊的最后一步是在出生后的1至2周内检测血液或尿液中的病毒。迄今为止，抗病毒药物对先天性感染的治疗在出生前后都只是姑息性的，而唯一有效的预防措施似乎是研发一种安全且具有免疫原性的疫苗，包括目前正在研究的重组疫苗、亚单位疫苗、DNA疫苗和基于肽的疫苗。根据该领域的最新进展，讨论了以下有争议的问题：对该问题的实际认知；孕前普遍血清学筛查；正确咨询对相关夫妇决策的影响；产前诊断在确定病毒向胎儿传播中的作用；孕前和孕早期感染对先天性感染患病率的影响；与孕期初次感染的母亲所生先天性感染婴儿的数量相比，孕前免疫的母亲所生先天性感染婴儿的患病率。
