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Am J Perinatol 2021; 38(13): 1403-1411
DOI: 10.1055/s-0040-1713001
Original Article

Clinical Features, Treatment Courses, and Distribution of Cytomegalovirus Genotypes among Thrombocytopenia Patients Aged Younger than 12 Months

Hongbo Hu
1   Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
,
Ying Cheng
2   Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
,
Qiaoying Peng
3   Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
,
Kun Chen
4   Department of Laboratory, Wuhan Ninth Hospital, Wuhan, China
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Abstract

Objective The aims of this study were to evaluate the clinical characteristics, laboratory data, and treatment of the cytomegalovirus (CMV)-associated thrombocytopenia in infants aged younger than 12 months and to investigate the possible relationship between genotypes of glycoprotein B (gB) and glycoprotein H (gH) and CMV-associated thrombocytopenia.

Study Design Infants with positive identification of cytomegalovirus (CMV) and thrombocytopenia, being treated at Hubei Maternal and Child Health Hospital from January 2015 to June 2019 were included. Genotype of gB and gH analysis were done by nested polymerase chain reaction (nPCR) and restrictions length polymorphism.

Results The prevalence of CMV congenital, perinatal, and postnatal infection were 1.4% (76/5428), 29.1% (378/1301), and 41.8% (243/581), respectively. A total of 29 immunocompetent patients with CMV-associated thrombocytopenia were analyzed, including 7 (9.2%, 7/76) congenital infections, 14 (3.7%, 14/378) perinatal infections, and 8 (3.3%, 8/243) postnatal infections. Platelet count at diagnosis <20 × 109/L was the common hematologic finding of CMV-associated thrombocytopenia in perinatal infection (1/7 congenital infection vs. 10/14 perinatal infection vs. 3/8 postnatal infection, Chi-square (χ2) = 6.616, p = 0.037). Notably, significantly higher frequency of hepatobiliary symptoms was found in congenital and perinatal infections groups (4/7 congenital infection vs. 10/14 perinatal infection vs. 1/8 postnatal infection, χ2 = 7.188, p = 0.027). Intravenous immunoglobulin was prescribed for 24 (82.8%, 24/29) patients, and antiviral agents were prescribed for 9 (31.0%, 9/29) patients. The most prevalent genotypes of CMV in the study were gB1 (60.7%, 17/28) and gH2 (57.1%, 16/28).

Conclusion There was a substantial percentage of symptomatic CMV infection in patients aged younger than 12 months. Thrombocytopenia is one of the common clinical manifestations in congenital CMV infection. The gB1 genotype had more virulence in infants with acquired CMV infection. There might be an association between gH2 genotype of CMV and CMV-associated thrombocytopenia.

Keywords

cytomegalovirus - cytomegalovirus-associated thrombocytopenia - glycoprotein B - glycoprotein H


Publikationsverlauf

Eingereicht: 11. Dezember 2019

Angenommen: 04. Mai 2020

Artikel online veröffentlicht:
11. Juni 2020

© 2020. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 Jin Q, Su J, Wu S. Cytomegalovirus infection among pregnant women in Beijing: seroepidemiological survey and intrauterine transmissions. J Microbiol Biotechnol 2017; 27 (05) 1005-1009
    CrossrefPubMedGoogle Scholar
  • 2 Wang S, Wang T, Zhang W. et al. Cohort study on maternal cytomegalovirus seroprevalence and prevalence and clinical manifestations of congenital infection in China. Medicine (Baltimore) 2017; 96 (05) e6007
    CrossrefPubMedGoogle Scholar
  • 3 Liu LW, Qian JH, Zhu TW, Zhang YH, Zhu JX. [A 5-year retrospective clinical study of perinatal cytomegalovirus infection]. Zhongguo Dang Dai Er Ke Za Zhi 2016; 18 (02) 99-104 (in Chinese)
    PubMedGoogle Scholar
  • 4 Rodeghiero F, Stasi R, Gernsheimer T. et al. Standardization of terminology, definitions and outcome criteria in immune thrombocytopenic purpura of adults and children: report from an international working group. Blood 2009; 113 (11) 2386-2393
    CrossrefPubMedGoogle Scholar
  • 5 Jin MJ, Kim Y, Choi EM. et al. Clinical characteristics and treatment courses for cytomegalovirus-associated thrombocytopenia in immunocompetent children after neonatal period. Blood Res 2018; 53 (02) 110-116
    CrossrefPubMedGoogle Scholar
  • 6 Arcangeletti MC, Vasile Simone R, Rodighiero I. et al. Combined genetic variants of human cytomegalovirus envelope glycoproteins as congenital infection markers. Virol J 2015; 12: 202
    CrossrefPubMedGoogle Scholar
  • 7 Chiuppesi F, Wussow F, Johnson E. et al. Vaccine-derived neutralizing antibodies to the human cytomegalovirus gH/gL pentamer potently block primary cytotrophoblast infection. J Virol 2015; 89 (23) 11884-11898
    CrossrefPubMedGoogle Scholar
  • 8 Barrado L, Prieto C, Hernando S, Folgueira L. Detection of glycoproteins B and H genotypes to predict the development of Cytomegalovirus disease in solid organ transplant recipients. J Clin Virol 2018; 109: 50-56
    CrossrefPubMedGoogle Scholar
  • 9 Khalafkhany D, Makhdoomi K, Taghizadeh Afshari A, Motazakker M. Prevalence and genotype distribution of cytomegalovirus UL55 sequence in renal transplant recipients in north west of Iran. J Med Virol 2016; 88 (09) 1622-1627
    CrossrefPubMedGoogle Scholar
  • 10 Shen Z, Shang SQ, Zou CC, Zheng JY, Yu ZS. The detection and clinical features of human cytomegalovirus infection in infants. Fetal Pediatr Pathol 2010; 29 (06) 393-400
    CrossrefPubMedGoogle Scholar
  • 11 Rawlinson WD, Boppana SB, Fowler KB. et al. Congenital cytomegalovirus infection in pregnancy and the neonate: consensus recommendations for prevention, diagnosis, and therapy. Lancet Infect Dis 2017; 17 (06) e177-e188
    CrossrefPubMedGoogle Scholar
  • 12 Provan D, Stasi R, Newland AC. et al. International consensus report on the investigation and management of primary immune thrombocytopenia. Blood 2010; 115 (02) 168-186
    CrossrefPubMedGoogle Scholar
  • 13 Hou M, Qin P. The interpretation of the Chinese consensus to adult primary immune ITP (version 2016). J Clin Hematol 2016; 29 (07) 523-527
    PubMedGoogle Scholar
  • 14 Yu ZS, Zou CC, Zheng JY, Zhao ZY. Cytomegalovirus gB genotype and clinical features in Chinese infants with congenital infections. Intervirology 2006; 49 (05) 281-285
    CrossrefPubMedGoogle Scholar
  • 15 Guo S, Yu MM, Li G, Zhou H, Fang F, Shu SN. [Studies on genotype of human cytomegalovirus glycoprotein H from infantile clinical isolates]. Zhonghua Er Ke Za Zhi 2013; 51 (04) 260-264
    PubMedGoogle Scholar
  • 16 Sheng Yu Z, Tang LF, Zou CC, Yan Zheng J, Zhao ZY. Cytomegalovirus-associated idiopathic thrombocytopenic purpura in Chinese children. Scand J Infect Dis 2008; 40 (11-12): 922-927
    CrossrefPubMedGoogle Scholar
  • 17 Bai Y, Yu H, Qiu YN. et al. Cell immune conditions and curative turn over of idiopathic thrombocytopenic purpura with human cytomegalovirus infection in children. Shi Yong Lin Chuang Er Ke Za Zhi 2008; 23 (10) 754-756
    PubMedGoogle Scholar
  • 18 Mack I, Burckhardt MA, Heininger U, Prüfer F, Schulzke S, Wellmann S. Symptomatic congenital cytomegalovirus infection in children of seropositive women. Front Pediatr 2017; 5: 134
    CrossrefPubMedGoogle Scholar
  • 19 Mitsuiki N, Tamanuki K, Sei K. et al. Severe neonatal CMV infection complicated with thrombotic microangiopathy successfully treated with ganciclovir. J Infect Chemother 2017; 23 (02) 107-110
    CrossrefPubMedGoogle Scholar
  • 20 Putri ND, Wiyatno A, Dhenni R. et al. Birth prevalence and characteristics of congenital cytomegalovirus infection in an urban birth cohort, Jakarta, Indonesia. Int J Infect Dis 2019; 86: 31-39
    CrossrefPubMedGoogle Scholar
  • 21 Paixão P, Brito MJ, Virella D, Neto MT. Recurrent maternal CMV infection associated with symptomatic congenital infection: results from a questionnaire study in Portugal. BMJ Paediatr Open 2019; 3 (01) e000455
    CrossrefPubMedGoogle Scholar
  • 22 Levy AS, Bussel J. Immune thrombocytopenic purpura: investigation of the role of cytomegalovirus infection. Br J Haematol 2004; 126 (04) 622-623
    CrossrefPubMedGoogle Scholar
  • 23 Lipes J, Skamene E, Newkirk MM. The genotype of mice influences the autoimmune response to spliceosome proteins induced by cytomegalovirus gB immunization. Clin Exp Immunol 2002; 129 (01) 19-26
    CrossrefPubMedGoogle Scholar
  • 24 Yu K, Davidson CL, Wójtowicz A. et al; Swiss Transplant Cohort Study. LILRB1 polymorphisms influence posttransplant HCMV susceptibility and ligand interactions. J Clin Invest 2018; 128 (04) 1523-1537
    CrossrefPubMedGoogle Scholar
  • 25 Galitska G, Biolatti M, De Andrea M. et al. Biological relevance of cytomegalovirus genetic variability in congenitally and postnatally infected children. J Clin Virol 2018; 108: 132-140
    CrossrefPubMedGoogle Scholar
  • 26 Alwan SN, Shamran HA, Ghaib AH. et al. Genotyping of cytomegalovirus from symptomatic infected neonates in Iraq. Am J Trop Med Hyg 2019; 100 (04) 957-963
    CrossrefPubMedGoogle Scholar
  • 27 Yang ZQ, Mai JY, Wang Y, Yu J. Analysis of glycoprotein B genotypes of human cytomegalovirus in infants. Zhonghua Yi Yuan Gan Ran Za Zhi 2013; 23 (15) 3566-3568
    PubMedGoogle Scholar
  • 28 Yu ZS, Zheng JY, Wu JB. [Association between clinical manifestations of infants with human cytomegalovirus infection and glycoprotein B genotype]. Zhonghua Yi Xue Za Zhi 2007; 87 (04) 259-261
    PubMedGoogle Scholar
  • 29 Chen LY, Li W, Xu JL. et al. [Relationship between gH genotyping and clinical characteristics of children with congenital cytomegalovirus infection]. Zhonghua Er Ke Za Zhi 2019; 57 (08) 597-602
    PubMedGoogle Scholar
  • 30 Li W, Liu L, Tao R, Zheng X. Li. Pediatr Neonatol 2020; 61 (01) 63-67
    CrossrefPubMedGoogle Scholar