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R F Pass

Publications and source records attributed to R F Pass.

At least 37 records · Page 2Linked to original sources
PubMed1993

Diabetes insipidus associated with symptomatic congenital cytomegalovirus infection.

We report five infants with congenital cytomegalovirus infection in whom diabetes insipidus developed before initiation of treatment with ganciclovir. Four of five infants required treatment with desmopressin. Magnetic resonance imaging of the brain showed no destruction of the hypothalamus or pituitary gland in any infant. Cortisol levels and results of thyroid function studies were normal in all infants.

Cytomegalovirus Infections↗
PubMed1993

Virus-specific antibody responses in mothers and their newborn infants with asymptomatic congenital cytomegalovirus infections.

Human cytomegalovirus (HCMV)-specific antibody response was analyzed to determine its relationship with sequelae in children with asymptomatic congenital HCMV infection. IgG antibodies reactive with envelope glycoprotein gB were significantly higher in cord and maternal delivery serum of infants developing hearing loss than in those without any sequelae. Women of hearing impaired children had higher levels of serum anti-gB IgG and HCMV IgM at first prenatal visit (8-16 weeks gestation) than did those with children with normal hearing. Kinetics of the antibody response revealed that women with hearing impaired children had peak anti-gB and IgM response at the first prenatal visit compared with at or near delivery in mothers of normal children. These results suggested that women who delivered infants developing hearing loss had a more intense and prolonged antibody response, and factors such as early virus acquisition during pregnancy might contribute to the development of sequelae in asymptomatic congenital HCMV infection.

Antibodies, Viral↗
PubMed1993

Neonatal screening for congenital cytomegalovirus infection by detection of virus in saliva.

A rapid assay for detection of cytomegalovirus (CMV) in saliva was evaluated as a screening method for congenital infection. Samples of saliva were examined by detection of early antigen fluorescent foci (DEAFF) and standard tissue culture (TC). Results were compared with those from urine DEAFF. CMV was detected in saliva from 31 (1.7%) of 1870 newborns, 26 by DEAFF and TC, 1 by DEAFF alone, and 4 by TC alone. Urine DEAFF was positive in 28 of these 31 newborns. The sensitivities of various tests were saliva TC, 96.8%; saliva DEAFF, 87.1%; and urine DEAFF, 90.3%. A change in transport medium for 825 saliva samples resulted in improved sensitivities: saliva TC and saliva DEAFF, 100%; urine DEAFF, 92.3%. Screening saliva of newborns for CMV appears to be at least as sensitive a method for detecting congenital infection as detection of viruria; saliva can be collected with less difficulty and expense than urine.

Cytomegalovirus↗
PubMed1993

Maternal age and congenital cytomegalovirus infection: screening of two diverse newborn populations, 1980-1990.

Cytomegalovirus (CMV) is the leading cause of congenital viral infection in the United States. To prevent damaging congenital CMV infections, it is necessary to have accurate population estimates of prevalence and to identify maternal factors associated with an elevated risk of congenital infection in the newborn. From 1980 through 1990, 17,163 offspring of predominantly low-income nonwhite women who delivered at a public hospital and 9892 newborns of predominantly mid- to upper-income white women who delivered at a private hospital were screened for congenital CMV infection. Women < 20 years old (adjusted prevalence odds ratio [POR], 4.8; 95% confidence interval [CI], 2.6-8.9) at the public hospital and all nonwhite women (adjusted POR, 1.6; 95% CI, 1.1-2.2) had an increased risk of delivering an infected newborn. Newborns of adolescent women in both populations had the highest prevalence of clinically apparent infection. Offspring of nonwhite low-income adolescents are at greatest risk for congenital CMV infection and more damaging sequelae.

Adolescent↗
PubMed1992

The outcome of congenital cytomegalovirus infection in relation to maternal antibody status.

BACKGROUND: Intrauterine transmission of cytomegalovirus (CMV) can occur whether a mother has prior immunity or acquires CMV for the first time during pregnancy. The degree of protection afforded an infected infant by the presence of antibody in the mother before conception is uncertain. METHODS: We compared the outcomes of CMV-infected infants born to mothers who acquired primary CMV infection during pregnancy (primary-infection group) with those of CMV-infected infants born to mothers with immunity (recurrent-infection group). Screening for viruria identified 197 newborns with congenital CMV infection. Stored serum samples were used to categorize maternal infection as either primary or recurrent. We followed 125 infants from the primary-infection group and 64 from the recurrent-infection group. Serial medical, audiologic, psychometric, and eye examinations were used to identify sequelae of CMV infection. RESULTS: Only infants in the primary-infection group had symptomatic CMV infection at birth (18 percent). After a mean follow-up of 4.7 years, one or more sequelae were seen in 25 percent of the primary-infection group and in 8 percent of the recurrent-infection group. Thirteen percent of infants whose mothers had primary infection during pregnancy had mental impairment (IQ less than or equal to 70), as compared with none of those whose mothers had recurrent CMV infections. Sensorineural hearing loss was found in 15 percent of those in the primary-infection group and in only 5 percent of those in the recurrent-infection group. Bilateral hearing loss was identified only among children in the primary-infection group (8 percent). CONCLUSIONS: The presence of maternal antibody to CMV before conception provides substantial protection against damaging congenital CMV infection in the newborn. Primary maternal infection during pregnancy is associated with more severe sequelae of congenital CMV infection.

Antibodies, Viral↗
PubMed1992

Symptomatic congenital cytomegalovirus infection: neonatal morbidity and mortality.

Knowledge of the natural history of symptomatic congenital cytomegalovirus (CMV) infection in the newborn is essential in order to anticipate complications and assess the potential benefit from antiviral therapy. To define the disease course we reviewed data on 106 neonates with symptomatic congenital CMV infection diagnosed and managed by the investigators. Petechiae, jaundice and hepatosplenomegaly were each noted in 70% or more patients. Microcephaly was noted in 54 of 102 (53%) at birth. Elevated alanine aminotransferase, conjugated hyperbilirubinemia and thrombocytopenia were seen in 83, 81 and 77%, respectively. Eighty-six percent had at least two of the manifestations highly suggestive of congenital infection. Platelet count fell to its nadir during the second week of life whereas elevated alanine aminotransferase and direct bilirubin persisted past the first month. In spite of the difficulty in assessing central nervous system function in the newborn, evidence of damage was present in the majority. Seventy-two had microcephaly, poor suck, lethargy/hypotonia or seizures. Abnormal computerized tomographic scan was present in 16 of 20 (80%) and decreased hearing in 20 of 39 (56%). Cerebrospinal fluid protein was greater than 120 mg/dl in 24 of 52 (46%) and this elevation was associated with neurologic abnormalities as well as hearing loss. The mean length of hospital stay was 13 and 22.4 days for term and preterm infants, relatively. Thirteen infants (12%) died during the first 6 weeks of life. Disseminated CMV infection with multiorgan involvement was evident in 7 of 9 at postmortem examination. We conclude that neonates with symptomatic congenital CMV infection have a multi-system disease with significant morbidity and mortality.

Cytomegalovirus Infections↗
PubMed1992

Comparison of rapid methods of detection of cytomegalovirus in saliva with virus isolation in tissue culture.

Two rapid methods for the detection of cytomegalovirus (CMV) in saliva from congenitally and perinatally infected children were assessed by comparison with traditional virus isolation in tissue culture (TC). The polymerase chain reaction (PCR) was used to amplify a 300-bp segment of the CMV gB gene which was detected in ethidium bromide-stained agarose gels. A centrifugation-enhanced microtiter culture method with a monoclonal antibody for the detection of early-antigen fluorescent foci (DEAFF) was also used. Saliva specimens were collected with mouth swabs from children who were between the ages of 1 month and 14 years and who had either prenatal or perinatal CMV infection. One hundred sixty samples were tested by PCR and TC; 65 (40.6%) were found positive by TC, and 58 (36.8%) were found positive by PCR. Although four samples were found positive by PCR and negative by TC, saliva from seronegative and seropositive TC-negative adults were never found positive by PCR. One hundred fifty-two samples were tested by DEAFF and TC; 64 (42.1%) were found positive by TC, and 58 (38.2%) were found positive by DEAFF. With TC results as a standard, the sensitivity and specificity of DEAFF were, respectively, 90.6 and 97.7%. Because of the greater ease of collecting saliva than urine from newborns, both of these rapid methods merit evaluation in screening for congenital infection.

Adolescent↗
PubMed1991

Cytomegalovirus infection in sexually active adolescents.

To determine whether cytomegalovirus (CMV) infection in teenage girls is related to sexual activity, 254 girls 12-18 years old (mean, 15.8) attending a contraceptive counseling clinic were studied. Participants were screened for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis, and serum antibody to CMV was determined. Demographic and sexual history data were collected by interview. The mean number of lifetime sex partners was 2.2; 173 (68%) were seropositive. Race, greater than 3 years of sexual activity, and greater than 2 lifetime sex partners were significant risk factors for CMV infection (odds ratios [OR], 1.8-4.7; P less than .05). Using logistic regression analysis, a composite sexual activity variable was the most important risk factor for CMV infection (OR, 4.8; P = .003), followed by race (OR, 3.4; P = .004) and a sexually transmitted disease composite variable (OR, 2.4; P = .016). Sexual activity is an important risk factor for CMV infection in adolescent girls.

Adolescent↗
PubMed1991

Sexually transmitted diseases in mothers of neonates with congenital cytomegalovirus infection.

To identify maternal risk factors for intrauterine transmission of cytomegalovirus (CMV), a case-control study of 175 mothers of neonates with congenital CMV infection was undertaken. Cases and 358 randomly selected controls delivered neonates between 1980 and 1988; in this interval neonates were routinely tested for viruria. Eighty-four percent of the study population was black and greater than 87% received prenatal care. Women with gonorrhea, trichomoniasis, or bacterial vaginosis had an increased risk of intrauterine transmission of CMV, as did those who were primigravid (odds ratios, 1.8-2.5). Women who were young, unmarried, and of lower income were almost four times more likely to deliver a CMV-infected newborn than were those who did not have all three of these factors. These results in a predominantly black, low-income population indicate a greater risk for congenital CMV infection in offspring of young, single, primigravid mothers. The association with gonorrhea and other sexually transmitted infections suggests that sexual activity is an important source of maternal CMV infections that result in congenital infection in this population.

Adult↗
PubMed1990

Cytomegalovirus infection among employees of a children's hospital. No evidence for increased risk associated with patient care.

Employees of a children's hospital were studied to determine the prevalence of antibody to cytomegalovirus (CMV) and the incidence of CMV infection between 1984 and 1988 in relation to patient contact. At enrollment, 783 (63%) of 1250 employees had antibody to CMV. By logistic regression analysis, age greater than 30 years, black race, fewer than 16 years of education, employment for more than 1 year, female sex, and being married were each associated with seropositivity at enrollment. Three hundred workers who were seronegative initially were followed up; 13 seroconverted over a median follow-up interval of 1.96 years, 2.2% per year. Administrative, patient-care, laboratory, and support personnel were included among seroconverters. There were no statistically significant differences in the incidence of CMV infection when employees were grouped by job type, number of hours per week of patient contact, or nursing unit. The incidence of CMV among employees of a children's hospital was similar to the rate expected for the general population. Risk of CMV infection was not increased by patient contact in this setting.

Adolescent↗
PubMed1990

Increased rate of cytomegalovirus infection among day care center workers.

Child care workers are potentially at risk for occupational exposure to cytomegalovirus, the leading cause of congenital infection in the United States. Preschool children often shed cytomegalovirus and commonly transmit virus to peers and parents. Workers from 32 day care centers were enrolled and tested for serum antibody to cytomegalovirus; 318 (62.5%) were seropositive. By logistic regression analysis the only variables significantly (P less than 0.05) associated with seropositivity at enrollment were older age and nonwhite race, though contact with younger children (less than 2 years of age) attained a P value of 0.06. Follow-up sera were obtained at 6-month intervals from 82 initially seronegative workers; 19 seroconverted in a median interval of 14 months, a rate of 20%/year, approximately 10-fold higher than the expected rate. The only demographic or employment variable associated with seroconversion was contact with children younger than 3 years of age for at least 20 hours per week (P = 0.03). Day care center workers have a markedly increased risk for acquisition of cytomegalovirus; those who could become pregnant should be appropriately counseled regarding prevention and consequences of cytomegalovirus infection during pregnancy.

Adolescent↗
PubMed1989

Chlamydia trachomatis cervical infection and oral contraceptive use among adolescent girls.

This study examines the relationship between oral contraceptive use and Chlamydia trachomatis cervical infection in women less than 19 years of age. The clinical and epidemiologic data of 73 (19.4% prevalence rate) girls with chlamydial infection were analyzed, with special attention given to contraceptive use. The findings were compared with data from 303 girls who were chlamydia negative to assess the relationship between oral contraceptive use and C. trachomatis infection. Use of an oral contraceptive for 6 months or longer was associated with chlamydial infection (p = 0.005; odds ratio = 2.41; 95% confidence interval 1.53-3.29). Oral contraceptive use was not associated with an increased rate of Neisseria gonorrhoeae or Trichomonas vaginalis infection. Association of oral contraceptive use with chlamydial infection remained significant after adjustments were made for confounding variables in a logistic regression process (p = 0.013). This study suggests that oral contraceptive use may promote chlamydial infection of the cervix or enhance the detection of the C. trachomatis from the cervix in this population.

Adolescent↗
PubMed1989

Intellectual ability of children after perinatal cytomegalovirus infection.

The intellectual ability of 16 children who had not had congenital cytomegalovirus (CMV) infection, but acquired it before the age of six months, was compared with that of two other groups: one comprising 32 children who had had CMV-excreting mothers but who were not infected themselves: the other comprising 18 healthy controls. Serial audiological, ophthalmological and psychometric examinations were performed. The only statistically significant difference found was that the children with acquired CMV infection had lower mean arithmetic scores. The results suggest that healthy term infants who acquire early CMV infection are not at increased risk of intellectual impairment.

Child↗
PubMed1988

Sexually transmitted diseases and sexual behavior in urban adolescent females attending a family planning clinic.

Specimens from the lower genital tract of 102 sexually active urban adolescent females were tested for the common sexually transmitted diseases (STDs). The results were correlated with concomitant clinical, demographic, and historic data. Forty-one percent (42/102) were infected with one or more of the following organisms: Chlamydia trachomatis (26/102), Trichomonas vaginalis (13/102), Neisseria gonorrhoeae (10/102), yeast (6/102), condyloma (5/102), and herpes simplex virus (1/44). Mixed infections were found in 13%. Fifty-nine percent were negative for any infectious agents. The presence of genitourinary symptoms were of no value in predicting an STD. The rate of positive physical findings was significantly higher in the STD-positive group than in the negative group (p = 0.03), but 28% of the STD-negative group had positive physical findings, and 50% of the STD-positive group had normal physical findings. A history of genitourinary complaints or presence of physical findings was not predictive of a positive STD culture. Oral contraceptive use of more than six months appears to be a risk factor for an STD. No other factors, including the number of sexual partners, were significantly correlated with the presence of an STD. This study supports the need for routine screening of sexually active urban adolescent girls for an STD.

Adolescent↗
PubMed1987

Young children as a probable source of maternal and congenital cytomegalovirus infection.

To identify possible sources of cytomegalovirus infection in pregnant women, we studied seven families with a recent case of congenital or maternal cytomegalovirus infection and a history of maternal contact with a young child shedding the virus. We used restriction-endonuclease techniques to compare the DNA of viral isolates collected from family members. Five families contained an infant who had congenital or perinatal infection, a mother who had had evidence of primary infection during her most recent pregnancy, and a child less than three years of age who was excreting cytomegalovirus. All five of the young children attended day-care centers at least part-time. In each of these five families, strains from family members were identical, and it is most likely that the toddler-aged child was the source of the virus for both the mother and the fetus or infant. In two other families, acquisition of cytomegalovirus by children in a day-care center was followed by seroconversion in the mother along with excretion of a strain of the virus identical to that in her child, as demonstrated by restriction-endonuclease analysis. Five of the seven fathers were tested for antibody to cytomegalovirus; four were seronegative, ruling them out as a source of infection in the mothers. These results not only strengthen evidence for the transmission of cytomegalovirus from child to mother but also indicate that infections acquired by a mother from a child can be transmitted to her fetus.

Antibodies, Viral↗