Department of Molecular Medicine, University of Padova, 35121 Padua, Italy.
Pathology Unit, Padova General Hospital, 35121 Padua, Italy.
Viruses. 2022 Dec 30;15(1):112. doi: 10.3390/v15010112.
The present study aims to provide the sequential immunological, clinical and virological events occurring in a CMV-infected pregnant woman experiencing intrauterine CMV transmission. In brief, a case of primary CMV infection occurred in a 36-year-old pregnant woman. The patient exhibited early-sustained viremia and viruria, detectable presence of CMV in saliva concomitant with a strong CMV-specific cell-mediated response (427 EliSpots). CMV was detected in the amniotic fluid at 15 weeks of pregnancy (>1 × 106 CMV copies/mL). The pregnancy was deliberately interrupted at 16 weeks of gestation. Fetal histological and pathological examinations revealed placentitis and fetal brain alterations as microcephaly and cortical dysplasia. Interestingly, this clinical report shows: (1) there was a rapid and sustained CMV-specific cell mediated immune response (Th1) in association with low IgG avidity (Th2) correlated with fetal CMV transmission. (2) The levels of CMV-specific cell-mediated immune response persisted at high levels up to 200 weeks after infection despite clinical and viral clearance. (3) The histological and pathological evidence suggests that a potent pro-inflammatory condition at the placental level may lead to cCMV.
本研究旨在提供一名发生宫内 CMV 传播的 CMV 感染孕妇的连续免疫、临床和病毒学事件。简而言之，一名 36 岁孕妇发生原发性 CMV 感染。患者表现出早期持续病毒血症和病毒尿症，唾液中可检测到 CMV，同时存在强烈的 CMV 特异性细胞介导反应（427 EliSpots）。在妊娠 15 周时（>1 × 106 CMV 拷贝/ml）在羊水中检测到 CMV。妊娠在 16 周时被故意中断。胎儿组织学和病理学检查显示胎盘炎和胎儿脑改变，如小头畸形和皮质发育不良。有趣的是，本临床报告显示：（1）存在快速和持续的 CMV 特异性细胞介导免疫反应（Th1），同时 IgG 亲和力（Th2）较低，与胎儿 CMV 传播相关。（2）尽管临床和病毒清除，CMV 特异性细胞介导免疫反应的水平仍持续高水平达 200 周。（3）组织学和病理学证据表明，胎盘水平的强烈促炎状态可能导致 cCMV。
