V-3544. Diagnostic Value of Tests Employed in the Diagnosis of CMV Infection in Pregnancy: Experience of the Reference Unit for Gestational and Congenital Infections of Padova
Session: Poster Session: Herpes Viruses
Monday, October 27, 2008: 12:00 AM
Room: Hall C
Background: CMV is the most common cause of congenital infection, and its incidence is increasing. The predictive power of several laboratory tests, either singly or in combination, was evaluated on pregnant women with suspected gestational CMV infection. Methods: From a cohort of 1229 pregnant women observed in the period January 2000-August 2007, 814 were selected as the infectious state of the baby was available after delivery. All women were anti-CMV IgG antibodies-positive. Anti-CMV IgM, anti-CMV IgG avidity, blood CMV DNA by real-time PCR TaqMan, pp65 antigen detection on peripheral blood leukocytes (PBL), CMV viruria by culture, were assayed. CMV in amniotic fluid (AF) was investigated by PCR and culture, if the risk of fetal infection was high. Primary end-point was newborn infection. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and odds ratio (OR) were calculated. The combined PPV, if all markers were positive, was evaluated, as the combined PPV using CMV in AF as a secondary end-point. Results: The diagnostic indexes are reported (table). With the 1st end-point, the combined PPV was 98.9%. The combined PPV of positive IgM, low IgG avidity, positive markers of active maternal infection, was 71.5%, using the 2nd end-point, and the cohort prevalence of baby infection. Conclusions: The sequential approach (serology - markers of active maternal infection - amniotic fluid CMV detection) appeared effective for diagnosis of CMV congenital infection, aiming at reducing invasive procedures of prenatal diagnosis and unnecessary medical abortions.
Diagnostic accuracy indexes
IgMIgG, low avidityActive maternal infectionAF CMV DNA
sensitivity76.7%68.5%38.4%92.0%
specificity54.5%84.5%87.6%100.0%
PPV14.3%30.3%23.3%100.0%
NPV96.0%96.5%93.599.1%
OR3.9511.834.394220.60
p-value6.56E-073.34E-266.97E-096.06E-49
observations812814814249
Carlo Mengoli, M D1, Gabriella Forner, M D2, Giorgio Palu', M D2, Maria Biasolo, Ph D2, Nadia Gussetti, M D3, Riccardo Cusinato, M D3 and  C. Mengoli, None., (1)Department of Histology, Mcrobiology, and medical Biotechnology, (2)University of Padua, (3)Azienda Ospedale


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