A case of breast milk-acquired cytomegalovirus infection in an extremely low birth weight infant.

INTRODUCTION: Although breast milk is considered the optimal nutrition for infants, it is also the primary cause of postnatal cytomegalovirus (CMV) infection. Preterm infants with postnatal CMV infections are susceptible to a variety of life-threatening conditions. CASE SUMMARY: Twin male infants were delivered via emergency caesarian section at 27 weeks' gestation secondary to maternal complete uterine rupture. The Apgar scores at 1 and 5 min were 1 and 1 for the older twin (Twin A) and 0 and 3 for the younger twin (Twin B). Their birth weights were 1203 g (+ 0.65SD) and 495 g (- 3.79SD) respectively. On day 41, laboratory blood test results for Twin B showed a moderate elevation in C-reactive protein (CRP), thrombocytopenia. CMV quantitative polymerase chain reaction (qPCR) tests in Twin B's urine and blood as well as in the mother's breast milk were positive, but stored, dried umbilical cord CMV qPCR tests were negative. Twin B was diagnosed with a postnatal CMV infection secondary to infected breast milk and ganciclovir was commenced on day 52. Treatment was switched to valganciclovir at 74 days of age, but a negative CMV-DNA level in the blood was not achieved. Postnatal CMV infection in this infant led to an exacerbation of pre-existing bronchopulmonary dysplasia (BPD) and he demised at 182 days of age. CONCLUSION: Postnatal cytomegalovirus infections may lead to exacerbations of BPD. Early use of raw breast milk in preterm infants should be done with careful consideration of this potential complication.

Anti-cytomegalovirus immunoglobulin M titer for congenital infection in first-trimester pregnancy with primary infection: a multicenter prospective cohort study.

OBJECTIVE: We evaluated cytomegalovirus (CMV) immunoglobulin M (IgM) titer in pregnant women with primary infection as a predictive factor for congenital infection. STUDY DESIGN: Maternal CMV antibody screening during the first trimester was conducted prospectively at 16 centers in Japan between September 2013 and 2015. Women with confirmed maternal primary infection underwent testing for fetal congenital infection, and we investigated the positive predictive value of CMV IgM titer levels for congenital infection in women with a low IgG avidity. RESULTS: We identified 6 (8.6%) cases of congenital infection among 70 pregnant women with positive/borderline IgG, positive IgM and IgG avidity index ⩽35.0% and 11 (39.3%) among 28 women with IgG and/or IgM seroconversion. IgM titer level ⩾6.00 index showed the highest positive predictive value (17.1%). CONCLUSION: High titer of CMV IgM during the first trimester in pregnant women with primary infection is a risk factor for congenital infection.

Feline immunodeficiency virus infection in cats of Japan.

A seroepidemiologic survey for feline immunodeficiency virus (FIV) infection was conducted in Japan. Between June and December 1987, individual sera (n = 3,323) were submitted by veterinary practitioners from many parts of the country. Specimens were from 1,739 cats with clinical signs suggestive of FIV infection and from 1,584 healthy-appearing cats seen by the same practitioners. The overall FIV infection rate among cats in Japan was 960/3,323 cats (28.9%). The infection rate was more than 3 times higher in the clinically ill cats, compared with that in the healthy cats of the same cohort (43.9 vs 12.4%). Male cats were 1.5 times as likely to be infected as were females. Almost all FIV-infected cats were domestic cats (as opposed to purebred cats). Complete clinical history was available for 700 of 960 FIV-infected cats. Of these 700 FIV-infected cats, 626 (89.4%) were clinically ill, and the remainder did not have clinical signs of disease. The mean age at the time of FIV diagnosis for the 700 cats was 5.2 years, with younger mean age for males (4.9 years) than for females (5.8 years). Most of the infected cats (94.7%) were either allowed to run outdoors or had lived outdoors before being brought into homes. The mortality for FIV-infected cats during the 6 months after diagnosis was 14.7%, and the mean age at the time of death was 5.7 years. Concurrent FeLV infection was seen in 12.4% of the FIV-infected cats, but this was not much different from the historical incidence of FeLV infection in similar groups of cats not infected with FIV.(ABSTRACT TRUNCATED AT 250 WORDS)