Accuracy of the serological ELISA test compared with the polymerase chain reaction for the diagnosis of cytomegalovirus infection in pregnancy

CONTEXT: The most frequently used methods for detecting antibodies are the indirect immunofluorescence test and the enzymatic immunoassay (ELISA). The polymerase chain reaction is a molecular biology technique in which the production of large amounts of specific DNA fragments is induced from very low concentrations of complex substrates aloowing the detection of very low amounts of viral particles. OBJECTIVE: To assess the accuracy of serological/ELISA tests in comparison with the polymerase chain reaction in maternal blood to diagnose cytomegalovirus infection. DESIGN: A descriptive study was performed. SETTING: High-risk outpatient clinic of Campinas University (Unicamp). PARTICIPANTS: We selected 243 pregnant women. All of them had been indicated for blood sampling because of suspicions of cytomegalovirus infection and also because of other infections. MAIN MEASUREMENTS: The group was tested for cytomegalovirus. Serological tests were run and compared to the polymerase chain reaction, which was considered to be the gold standard. Status analyses were done using Fisher's exact test, via the SAS software. RESULTS: The previous cytomegalovirus infection rate was 94.6 percent. The main reasons for inclusion in the study were fetal nervous system malformation (25.5 percent), maternal toxoplasmosis (25.5 percent) and Rh isoimmunization (14.8 percent). Only two women were included because of positive serological immunoglobulin M test for cytomegalovirus. The sensitivity and specificity of the serological tests were 94 percent and 6 percent for immunoglobulin G. CONCLUSION: Serological tests had lower sensitivity in comparison with the polymerase chain reaction test when diagnosing cytomegalovirus infection. The consequences of positive polymerase chain reaction and negative immunoglobulin M in women remain unknown

Dermatopolimiosite e gravidez / Dermatopolimyositis and pregnancy

A dermatopolimiosite é uma doença auto-imune de etiologia desconhecida, pouco freqüente na populaçåo geral e raramente associada ao ciclo grávido-puerperal. Entretanto, suspeita-se que essa patologia cause efeitos nocivos sobre o produto conceptual, aumentando a incidência de natimortos, e que haja uma piora clínica da doença durante o ciclo grávido-puerperal. Foram descritos três casos de pacientes com dermatopolimiosite, num total de sete gestaçöes, cinco delas após diagnóstico da patologia. Os resultados perinatais såo melhores do que os da literatura, com apenas um óbito neonatal, nåo relacionado à patologia. Houve, porém, piora clínica importante da doença em duas das pacientes observadas, tanro na gravidez como no puerpério