Diagnostic and prognostic value of human cytomegalovirus load and IgM antibody in blood of congenitally infected newborns

Background: Diagnosis of congenital human cytomegalovirus (HCMV) infection relies on virus isolation from urine collected in the first 3 weeks of life . However, very little is known about the presence, levels and duration of HCMV pp65 antigenemia, viremia and DNAemia in congenitally infected newborn s. Objectives: To investigate the diagnostic and prognostic value of HCMV load determination in blood of newborns/infants with congenital HCMV infection. Study design: HCMV pp65 antigenemia, viremia and DNAemia were investigated in 116 sequential peripheral blood leukocytes (PBL) samples from 41 newborn s/infants with congenital HCMV infection and in 34 PBL samples from 34 unin fected newborn. Virus-specific IgM were determined in parallel on 145 seque ntial serum samples. Results: Compared to virus isolation from urine, sensitivities of DNAemia, antigenemia, viremia, and IgM determination were 100, 42.5, 28.2, and 70.7% , respectively. Specificity was 100% for all assays. Antigenemia, viremia a nd DNAemia levels were significantly higher and persisted longer in newborn s with symptomatic infection compared to subclinically infected babies, whe reas no difference was observed for virus-specific IgM antibody between the two groups. Conclusions: (i) determination of viral DNA in blood at birth appears to be a sensitive and specific marker for diagnosis of congenital HCMV infection ; (ii) significantly higher levels of HCMV load were detected in infants wi th symptomatic HCMV infection; and (iii) virus clearance from blood occurs spontaneously both in symptomatic and subclinically infected infants. Howev er, the process takes longer in infants presenting with symptoms at birth. (C) 1999 Elsevier Science B.V. All rights reserved.