Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan; Graduate School of Nursing Science, Faculty of Medicine, University of Miyazaki, 5200 Kihara, Kiyotake, Miyazaki, 889-1692, Japan.
J Infect Chemother. 2023 Nov;29(11):1071-1074. doi: 10.1016/j.jiac.2023.07.004. Epub 2023 Jul 13.
Human cytomegalovirus (HCMV) is the major cause of neurological sequelae in infants. Immune control of primary HCMV infection appears to depend on the interaction between humoral and cell-mediated immune responses. We report the case of an HCMV-transmitter mother observed with dissociation between humoral and cell-mediated immune responses. The patient had immunoglobulin (Ig) G and M positivity at 11 weeks of gestation and showed fetal hyperechoic bowel and minimal ascites at 21 weeks of gestation. At 25 weeks of gestation, the polymerase chain reaction result for HCMV using amniotic fluid was positive. The numbers of spots in the enzyme-linked immunosorbent spot (ELISPOT) assay at 25, 36, and 39 weeks of gestation were three, five, and six spots/2 × 10 peripheral blood mononuclear cells, respectively. Furthermore, IgG avidity indexes (AIs) at 21, 25, 36, and 39 weeks of gestation were 37.6, 49.7, 72.5, and 74.3, respectively. At 40 weeks of gestation, the patient delivered a symptomatic infected newborn with a weight of 2,384 g (-2.6 SD) and a head circumference of 30 cm (-2.6 SD). The neonate had a petechial rash and bilateral hearing loss although did not show liver dysfunction or thrombocytopenia. Cranial magnetic resonance imaging revealed mild ventriculomegaly, left lateral/parietal polymicrogyria, and a punctate white matter lesion. This case showed that IgG AI increased with increasing gestational age, whereas the numbers of spots in the ELISPOT assay had no change. The dissociation between humoral and cell-mediated immune responses may be characteristic of the immune response of a transmitter mother.
人巨细胞病毒（HCMV）是导致婴儿神经后遗症的主要原因。原发性 HCMV 感染的免疫控制似乎取决于体液和细胞介导免疫反应的相互作用。我们报告了一例 HCMV 传播者母亲的病例，该患者表现出体液和细胞介导免疫反应的分离。患者在妊娠 11 周时 IgG 和 IgM 阳性，并在妊娠 21 周时显示胎儿肠回声增强和少量腹水。在妊娠 25 周时，羊水 HCMV 聚合酶链反应结果为阳性。在妊娠 25、36 和 39 周时，酶联免疫斑点（ELISPOT）检测的斑点数分别为 3、5 和 6 个/2×10 个外周血单个核细胞。此外，在妊娠 21、25、36 和 39 周时 IgG 亲和力指数（AI）分别为 37.6、49.7、72.5 和 74.3。在妊娠 40 周时，患者分娩了一名有症状的感染新生儿，体重 2384 克（-2.6SD），头围 30 厘米（-2.6SD）。新生儿有瘀点皮疹和双侧听力损失，但没有出现肝功能异常或血小板减少症。头颅磁共振成像显示轻度脑室扩大、左侧/顶叶多微脑回和点状白质病变。该病例表明，IgG AI 随妊娠周数的增加而增加，而 ELISPOT 检测的斑点数没有变化。体液和细胞介导免疫反应的分离可能是传播者母亲免疫反应的特征。
