Nigro Giovanni, Anceschi Maurizio M, Cosmi Ermelando V
Paediatric Institute, La Sapienza University, Rome, Italy
BJOG. 2003 Jun;110(6):572-7.
To compare the clinical manifestations and laboratory abnormalities associated with primary cytomegalovirus (CMV) infection in pregnancy with recurrent and non-active CMV infection (controls).
A prospective cohort study.
Rome, Latium and other Italian regions.
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.
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.
Identification of clinical and laboratory indicators of primary CMV infection in pregnancy.
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).
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.
比较妊娠期间原发性巨细胞病毒（CMV）感染与复发性及非活动性CMV感染（对照组）的临床表现和实验室异常情况。
前瞻性队列研究。
罗马、拉齐奥及意大利其他地区。
316例CMV感染的孕妇：102例为原发性感染，105例为复发性感染，109例非活动性感染作为对照组进行随访。
CMV诊断基于血清学检查（CMV IgG、IgM和IgG亲和力）以及通过聚合酶链反应检测孕妇血清、尿液和宫颈样本中的CMV DNA。在入组时以及随后每1至3个月的每次随访时进行临床病史和实验室评估。
确定妊娠期间原发性CMV感染的临床和实验室指标。
与复发性或非活动性感染的女性相比，原发性感染的女性发热、乏力、肌痛和流感样综合征的患病率在统计学上显著更高（P<0.001）。特别是，32例女性（31.4%）出现了相关症状，其中25例有流感样综合征，7例以持续发热为单一表现。此外，原发性感染的女性淋巴细胞≥40%的比例显著增加（分别为39.2% vs 5.7%或3.7%，P<0.001），天冬氨酸转氨酶和/或丙氨酸转氨酶水平升高（分别为35.3% vs 3.9%或0.9%，P<0.001）：53例患者（52%）出现淋巴细胞增多和/或转氨酶升高。原发性感染的61例女性（59.8%）出现了临床表现和/或实验室异常，而复发性感染的20例女性（19%）和13例对照组女性（11.9%）出现此类情况（P<0.001）。
临床表现（即流感样综合征、发热）和实验室检查异常（即淋巴细胞≥40%、转氨酶升高）可能提示原发性CMV感染的存在，应促使随后进行病毒学检查。
