Cytomegalovirus infections in pregnancy and the newborn.
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Biomedical subjects
Publications and source records attributed to D J Lang.
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Inhibition of mitosis in vitro was observed in leukocytes from patients with acute infectious hepatitis. Similarly, in cultures of normal leukocytes, after the addition of small amounts of serum from patients with hepatitis, mitosis was suppressed. Althoutgh the incidence of mitosis became normal in leukocytes from convalescent patients, there were chromosomal abnormalities.
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After extracorporeal perfusion some patients develop evidence of cytomegalovirus (CMV) infection. It is proposed that antigenically stimulated donor and recipient leukocytes may divide and activate latent CMV associated with leukocytes. To test this hypothesis, alternate patients were perfused with leukocyte-depleted or whole blood (controls). Four of six controls who were CMV antibody negative preoperatively seroconverted after perfusion. Virus was recovered from the blood of three and from the urine of two of these patients. One of four controls who were seropositive preoperatively developed a significant titer rise. Only one of eight patients perfused with leukocyte poor blond who were seronegative prior to surgery developed a viremia and became antibody positive; another manifested a viruria but remained antibody negative. These findings are consistent with the proposed hypothesis and suggest a means for reducing transfusion-associated CMV infections.
A retrospective study of the serum of 104 patients treated at Chelsea Naval Hospital between 1969 and 1972 was done. The donor blood products were not tested for the hepatitis B antigen before transfusion. The incidence of hepatitis B antigen following transfusion was about 2.8 per cent. The incidence of antibody to HBsAg prior to transfusion was 16 per cent, and about 27 per cent of the patients developed antibody to HBsAg following transfusion. The incidence of antibody to cytomegalovirus was about 22 per cent before transfusion, and 22 per cent of the patients developed complement fixing antibody against cytomegalovirus after transfusion. Since the patients received a variety of blood products it was not possible to determine retrsopectively which product, if any, produced the lowest incidence of hepatitis B antigen and transmission of cytomegalovirus.
The purpose of this study was to compare the effects of murine cytomegalovirus infection introduced after an EL4 ascites tumor allograft with cytomegalovirus infection accompanying or preceding the allograft. Parameters that were measured included documentation to the host's immune system. Depressed immune response of splenocytes from mice infected at any time before assay was documented by decreased responsiveness to phytohemagglutinin, to lipopolysaccharide, and to an alloantigen in mixed lymphocyte culture. In contrast, animals infected after grafting had enhanced lymphocyte-mediated cytolysis (LMC), enhanced serum-mediated cytolysis (SMC), and larger spleens than did animals that were only grafted and animals that were infected before grafting. Neither a depressive nor an enhancing effect of virus administered after grafting was reflected in vivo in reduced or increased graft clearance. Nonspecific effects of virus increased LMC and SMC in vitro, but the primary effect of viral infection after grafting is immune depression.
The cytomegaloviruses (CMV), members of the herpesvirus group, are widely disseminated; however, among healthy, nonpregnant adults these viruses are not usually responsible for serious illness or disability. However, CMV infections associated with pregnancy are an important cause of prenatal infection and are significantly associated with sensorineural injury and mental retardation in the offspring of infected mothers. CMV infections also constitute a significant threat to patients with disseminated malignancies, to allograft recipients, and to others who are debilitated and immunosuppressed. The development of a program of immunization against CMV has been proposed as a means to control prenatal infection and injury as well as to reduce the relevant morbidity and mortality of these infections among allograft recipients and others at high risk. In this review the potential benefits, problems, and risks associated with CMV immunoprophylaxis are discussed and results of preliminary trials of prototype CMV vaccines are presented and evaluated.