Congenital HCMV infection: a collaborative and comparative study of virus detection in amniotic fluid by culture and by PCR

Cytomegalovirus (HCMV) infection is the leading cause of congenital virus i nfection in developed countries, affecting an estimated 1%, of births. This antenatal infection can cause serious sequelae. Strategies for prevention and treatment must, therefore, be agreed upon, entailing a preliminary perf ormance assessment of antenatal virus diagnosis techniques. Between 1992 an d 1999, HCMV serology status was established for 19 456 pregnant women in f our French hospitals. Seronegative patients (55.4%) were given serology scr eening, and antenatal diagnosis was given to 152 women who had shown seroco nversion during their pregnancies(1.4%). The detection of HCMV transmission from mother to fetus was finally established in 95 cases, using polymerase chain reaction (PCR) and viral culture methods for detecting HCMV in the a mniotic fluid. These results were compared with viral culture of children's urine after birth, enabling us to distinguish between children really infe cted in utero (30%) and non-infected children (70%). The results of the vir us culture and those of PCR were identical in 94 of the 95 cases, with one discrepancy (culture - /PCR +). The two diagnosis techniques had identical sensitivity (72%), with culture proving slightly more specific than PCR (98 .4%, as opposed to 96.9%). Positive prediction values for culture and for P CR were, respectively, 95.6 and 91.3%. Antenatal virus diagnosis on amnioti c fluid was negative with both techniques in 8 out of 29 cases of children born with HCMV infection (VPN = 89%). Over half of these wrongly negative r esults can be explained by amniocentesis carried out too early in the pregn ancy or too early with respect to the mother's primary infection. (C) 2001 Elsevier Science B.V. All rights reserved.