Human cytomegalovirus infections in pregnancy and the newborn: epidemiology, laboratory diagnosis and Medico legal aspects

ABSTRACT

Human Cytomegalovirus [HCMV] has established itself as the most significant cause of congenital infection in the developed world, leading to mental and developmental retardation. HCMV infection in expectant mothers is a major concern with the greatest risk being almost exclusively associated with women who experience the primary infection during pregnancy. Infants infected in utero may develop symptomatic or asymptomatic congenital infections with symptoms varying from modest hepato-splenomegaly to fatal illness. Majority of symptomatic neonates will develop neurological sequelae. A critical appraisal of the published data related to HCMV infection in pregnancy and the newborn in the Gulf Cooperation Council countries is presented in this review. It is apparent that validation of more recent and sensitive laboratory diagnostic tests, both serological and molecular, is needed in the region. Current data shows that a combination of IgG, IgM and IgG avidity test as first diagnostic screening is a cost effective approach for discriminating between primary and latent/reactivated infections. For high risk pregnancies, further testing incorporating viral culture and molecular techniques on various specimens including amniotic fluid is recommended. Viral load and viral typing can provide additional information about the risk of in utero transmission and symptomatic infection in the newborn. We therefore, propose a diagnostic algorithm to optimize utilization of available laboratory resources in making a diagnosis of HCMV infection during the progressive stages of pregnancy