A serological assessment algorithm for the medical diagnosis of primary CMV an infection in women that are pregnant

A serological assessment algorithm for the medical diagnosis of primary CMV an infection in women that are pregnant. detrimental by BIFA, 10 by ELFA, and 15 by CIA and EIA. In both these avidity groupings, BIFA IgM-negative sera were bad with the various other 3 assays also. These results demonstrate an algorithm needing CMV IgM reactivity being a criterion for CMV IgG avidity examining does not recognize all low-avidity sera and therefore misses some situations of severe CMV an infection. INTRODUCTION Principal cytomegalovirus (CMV) an infection during being pregnant could cause intrauterine an infection from the fetus, resulting in deep sensory and cognitive flaws in the newborn (1,C3). On the other hand, intrauterine an infection is normally seldom connected with CMV reactivation or reinfection during being pregnant (2, 4). Thus, laboratory tools allowing for an accurate diagnosis of primary CMV infections PH-797804 play an important role in managing pregnant women with suspected CMV disease (5, 6). The measurement of CMV IgG avidity has emerged as one of the most useful laboratory assays for identifying primary CMV contamination; this assay also enables an estimation of the length of time that has elapsed since the contamination occurred (5, 6). IgG avidity, defined as the aggregate strength of IgG binding to multiple antigenic epitopes of a given protein, gradually increases with time, reaching high levels by 5 to 6 months after the primary contamination (1, 4, 7,C9). Thus, a obtaining of low CMV IgG avidity in a pregnant patient, particularly during the second or third trimester, suggests that CMV contamination may IKK-alpha have occurred after conception, which carries an increased risk of fetal contamination (2, 7, 10). Another sensitive laboratory tool for identifying primary CMV contamination is usually CMV IgM detection (2, 4). However, the interpretation of a positive CMV IgM result can be problematic, since CMV IgM persists in some individuals for one or more years following primary contamination; further, IgM production occurs in some patients following CMV reactivation (2, 5, 6, 11). To enable accurate and efficient identification of primary CMV contamination in pregnant women, several investigators have recommended a testing algorithm that combines the good sensitivity of CMV IgM detection with the good sensitivity and specificity of CMV IgG avidity testing (5, 8, 9, 12, 13). Per this reflexive algorithm, serum from a patient found to be positive for PH-797804 CMV IgG is usually first tested for CMV IgM, and only those sera found to be IgM reactive are tested in a CMV IgG avidity assay. However, a small PH-797804 number of CMV IgM-negative patients with low CMV IgG avidity have been described, raising questions about the clinical utility of this algorithm (4, 12, 14). Clearly, the success of the algorithm depends on the sensitivity and specificity of the CMV IgM assay employed (15). We thus evaluated the accuracies and efficiencies of four different CMV IgM assays for identifying sera with low or intermediate CMV IgG avidity among serum samples submitted to an esoteric reference laboratory for CMV IgG avidity testing. MATERIALS AND METHODS Specimens. The study utilized 369 consecutive PH-797804 CMV IgG-positive serum samples submitted to the Focus Diagnostics Reference Laboratory for CMV IgG avidity testing (16); 91% of these samples were supplied by women of childbearing age (15 to 49 years old), PH-797804 but no clinical data were available for any.