Meyer E. Dworsky

Congenital Cytomegalovirus Infection: The Relative Importance of Primary and Recurrent Maternal Infection

We studied the incidence of primary and recurrent cytomegalovirus infection in 3712 pregnant women--2698 of middle to high income and 1014 of low income--to determine whether there were differences in the effects on the fetus. In the higher-income group, 1203 women (45 per cent) did not have antibodies to cytomegalovirus and were therefore susceptible to primary infection, as compared with 179 women (18 per cent) of low income. Congenital infection occurred more often (1.6 vs. 0.6 per cent) in infants in the low-income group. In this group it was associated with recurrent maternal infection more often (in 82 per cent) than with primary maternal infection, whereas in the upper-income group, it was associated with primary maternal infection in half the cases. Altogether, there were 32 cases of congenital cytomegalovirus infection - 16 in each group. Whereas primary maternal infection resulted in fetal infection in only half the cases, it was more likely to ge associated with clinically apparent disease than was recurrent infection. When these cases were combined with 28 cases of congenital infection retrospectively identified at other prenatal clinics, five of 33 infected infants born after primary maternal infection had clinically apparent disease, as compared with none of 27 born after recurrent maternal infection. We conclude that congenital cytomegalovirus infection resulting from primary maternal infection is more likely to be serious than that resulting from recurrent infection, and is more likely to occur in upper socioeconomic groups.

Occupational Risk for Primary Cytomegalovirus Infection among Pediatric Health-Care Workers

The risk of acquiring cytomegalovirus (CMV) from infected infants concerns pediatric health-care workers, particularly those who may be pregnant. We determined the prevalence of CMV antibody, and thus of past infection, in groups of medical students and house staff, nurses, and physicians, and in groups of pregnant and nonpregnant young women in the community. Although age, sex, and race influenced the results, occupation did not. We then estimated the exposure of the health-care workers by determining the prevalence of CMV infection in three groups of asymptomatic infants for whom they provided care; CMV was shed in urine or saliva of 1.6 per cent of newborns, 13 per cent of premature infants hospitalized for over a month, and 5 per cent of older infants seen in outpatient settings. When we determined the incidence of primary infection in the adult groups by retesting the seronegative members about two years later, we found that the annual attack rates in the medical students (0.6 per cent), house staff (2.7 per cent), and nurses (3.3 per cent) were not higher than in young women in the community (2.5 per cent during pregnancy and 5.5 per cent between pregnancies). We conclude that although pediatric health-care workers frequently and unknowingly care for infants shedding CMV, this occupational contact confers no greater risk than that faced by young women in the community at large.

Cytomegalovirus Infection in a Day-Care Center

IN North America and Western Europe, up to 50 per cent of the population escapes cytomegalovirus (CMV) infection during childhood and adolescence, whereas in some primitive cultures infection rates...

Prevalence and importance of congenital cytomegalovirus infection in three different populations.

A Chilean population was compared to low-income and middle/upper-class populations in Birmingham, Ala., with regard to prevalence of congenital cytomegalovirus infection as well as the importance of this infection in neonatal deaths. In the highly seroimmune Chilean (98%) and low-income Birmingham (82%) groups, congenital infections occurred more often (1.7% and 1.9%, respectively) than in the less immune (56%) middle/upper-income group in Birmingham (0.6%). In 407 autopsies reviewed in Chile no neonatal deaths were attributed to cytomegalic inclusion disease, whereas in Birmingham cytomegalovirus was the cause of death in nine of 938 (1%) newborn infants. These findings further support the concept that, despite an apparent lack of protection against intrauterine transmission, maternal immunity reduces the risk of severe fetal infection.

Cytomegalovirus infection in day-care center.

IN North America and Western Europe, up to 50 per cent of the population escapes cytomegalovirus (CMV) infection during childhood and adolescence, whereas in some primitive cultures infection rates...

Cytomegalovinis infection in a day-care center.

IN North America and Western Europe, up to 50 per cent of the population escapes cytomegalovirus (CMV) infection during childhood and adolescence, whereas in some primitive cultures infection rates...

355 RECOMMENDED AMIKACIN DOSES IN NEWBORNS OFTEN PRODUCE EXCESSIVE SERUM LEVELS

Emergence of a multiply drug resistant Enterobacter cloacae during a 7 week period in 1980 resulted in serious systemic disease in 4 infants and a high colonization rate in other infants in a newborn intensive care unit. Amikacin was employed as the aminoglycoside of choice in the initial treatment of suspected sepsis until the organism disappeared from the unit. Peak and trough serum amikacin levels were available in 18 infants. Recommended doses (7.5-10mg/kg loading; 15mg/kg bid IV) were given to 5 infants < 1000gm (range 590-980gm) and to 13 larger babies (range 1020-3300gm). Duration of therapy was similar in both groups prior to determination of antibiotic concentrations and averaged 3.2 ± 2.1 doses (× ± SD). Serum amikacin levels were measured using a Bacillus globii bioassay method with an accuracy of ± 1μg/m1. Trough levels 11.5 hours after a dose were 16.6 ± 11.9μg/m1 in infants < 1000gm and 6.5 ± 4.3μg/m1 in the larger infants (p < .02). Peak levels 1 hour post-infusion exceeded 40μg/m1 in 3 of 5 < 1000gm babies and 4 of 12 > 1000gm infants (p = NS). These data show that surprisingly excessive blood levels of amikacin are likely in infants < 1000gm and may also occur in larger infants using currently recommended dosage schedules (J. Pediatr. 91:358, 1977). These unexpected findings emphasize the need to monitor drug levels and individualize therapy in very low birthweight infants.