Infections due to Epstein-Barr virus during pregnancy

Epstein-Barr virus infection during pregnancy and the risk of adverse pregnancy outcome

OBJECTIVES

To study the association between Epstein-Barr virus (EBV) antibody status in early pregnancy and pregnancy outcomes including fetal death, length of gestation and fetal weight and length at birth.

DESIGN

Nested control study.

SETTING

Population based health registers.

POPULATION

The source population comprised 35,940 pregnant women. Cases were all (280) women with fetal death and a random sample of 940 women with a live born child.

METHOD

Information on pregnancy outcome was obtained from the Norwegian Medical Birth Registry. Serum samples from the first trimester were tested for EBV antibodies. In women seronegative for EBV, further serum from late pregnancy was analysed to detect seroconversion. Main outcome measures Vital status, length of gestation, weight and length at birth.

RESULTS

There was no association between EBV antibody status and fetal death. Women with significant EBV reactivation had a significantly shorter duration of pregnancy, and associated lighter babies, compared with women without significant reactivation (stillborn: 176 vs 197 days, P=0.16, and live born: 271 vs 279 days, P=0.03, respectively).

CONCLUSION

Significant reactivation of EBV infection during pregnancy may influence pregnancy duration.

Extrahepatic bile duct atresia and viral involvement

Several etiological factors have been suggested in the pathogenesis of extrahepatic biliary atresia (EHBA); congenital, metabolic, infectious, and multifactorial. Herein we present a study of 10 children with EHBA, the aim being to explore viral infection as a possible cause of their condition. During a period of 2 yr, all infants with EHBA were included in a study and examined on viral disease on admittance for Kasai operation. In eight of the 10 children and in one parental couple the laboratory results suggested recent or persistent viral infection. Four infections were caused by cytomegalovirus (CMV) and another five by Epstein-Barr virus (EBV). CMV-DNA was detected in two liver biopsies, EBV-DNA in one liver biopsy. In a control group of 10 patients matched by age and tested by PCR in serum and viral antibodies, no sign of viral infections were detected. CMV or EBV infection were present in an unexpectedly high proportion of infants with EHBA, justifying exhaustive examination on viral disease in these children.

Study of mother-to-child Epstein-Barr virus transmission by means of nested PCRs

The aim of this study was to investigate the possibility of vertical Epstein-Barr virus (EBV) transmission. We developed two nested-PCR methods for amplifying distinct regions of EBV DNA (BNRF1 and BamHI W) in circulating lymphocytes. Nested PCR was applied to samples obtained from 67 mother-infant pairs within 1 week of birth. We also tested samples from 16 neonates born to human immunodeficiency virus (HIV)-infected mothers to determine whether HIV increases the potential risk of vertical EBV transmission. About half of the 67 women in the first population were positive by nested PCR. Two neonates born to EBV PCR-positive women were also PCR positive. One of the 16 neonates born to HIV-infected women was PCR positive for EBV. These results strongly support the possibility of EBV transmission in utero or during delivery but do not suggest that HIV infection increases this risk. Further studies are required to confirm these findings, to identify the precise mode of vertical EBV transmission, and to determine the outcome for infants who are positive at birth for EBV DNA by nested PCR.

Viral infections during pregnancy: a guide for the emergency physician

Emergency physicians are frequently called on to treat or advise pregnant patients. When faced with a pregnant patient who has clinical evidence of or exposure to a viral illness, the emergency physician must be aware of the potential maternal and fetal risks posed by various viral agents. This review provides current, accurate information and guidance for the pregnant patient.

Detection of active Epstein-Barr infection in pregnant women

Sera taken from pregnant patients and their newborns at delivery were examined for evidence of primary or reactivated Epstein-Barr virus infection. Of 102 women, 37 showed serological signs of reactivated and two signs of primary infection. A mild congenital defect was observed in association with one of the two cases of maternal primary infection. Infants of mothers with reactivated infections remained healthy during the one year follow-up after birth.

Epstein-Barr virus in normal pregnant women

Acquired immune suppression accompanying normal pregnancy may be associated with reactivation of Epstein-Barr virus (EBV). Pregnant women with reactivated EBV having anti-EA antibodies show high titers of antiviral capsid antigen (VCA) geometric mean titers (GMT) of 522 versus 170 in those lacking anti-early antigen (EA). Among twenty-seven seropositive women at parturition, 17 (63%) had generated antibody to EA, and all 27 (100%) demonstrated significant increases in antibody to VCA (p less than 0.01). In contrast, antibody titers to cytomegalovirus, herpes hominis, varicella-zoster, and rubella viruses in the pregnant women were comparable to those found in nonpregnant controls. (Am J Reprod Immunol. 1982; 2:217-221.)

Acyclovir treatment of herpes simplex virus infections in immunocompromised humans. An overview

As reflected in the preclinical and early clinical data, acyclovir seems destined to have a very useful role in the treatment and/or prophylaxis of herpes virus (HSV) infections in immunosuppressed humans. If the preclinical predictions can be extrapolated to varicella-zoster (V-Z) infections, acyclovir could well also play a meaningful role in therapy of V-Z infections in the immunosuppressed host; however, this conjecture awaits proof of controlled studies in humans. Clearly the usefulness of acyclovir for treatment of V-Z infections should be compared with that of adenine arabinoside (ara-A) to put into proper perspective the relative efficacies of the two drugs for future therapeutic regimens. The need for comparative studies is most important at this early stage of antiviral drug development, to avoid ethical problems that will cloud the knowledge needed to move forward in a positive way. In any event, the development of acyclovir, with its targeted approach, represents a real fundamental advance in antiviral drug development. Together with the development and deployment of ara-A, it should provide the needed impetus for a surge in the creation of new antiviral compounds for tomorrow.

Reactivation of Epstein-Barr virus in pregnant women: social factors, and immune competence as determinants of lymphoproliferative diseases-a hypothesis

In normal pregnant women, reactivation of Epstein-Barr virus (EBV) frequently occurs. Cellular immune responses are apparently suppressed, but high titer EBV-specific antibodies of IgG class may compensate. The antibodies cross the placenta and protect the infant against primary infection for many months. Reactivation of EBV in pregnancy and oral excretion of virus by normal pregnant women could be one explanation why young children in large sibships (among families of low social classes) become infected early in life. Infants are likely infected by EBV from their pregnant mothers who shed virus in saliva. Moreover, the natural protection for several months in the perinatal period against Burkitt lymphoma and fatal EBV-induced lymphoproliferative diseases in congenitally immune deficient children is explained. The maturity and immunocompetence of the immune system at the time of primary infection by EBV and the size of the sibship seem to determine whether infectious mononucleosis occurs. Gammaglobulin derived from human cord blood may be a valuable source of viral-specific antibodies for serotherapy in immune deficient patients.