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Mirsalehi N, Yavarian J, Ghavami N, Naseri M, Khodakhah F, Shatizadeh Malekshahi S, Zadheidar S, Mokhtari-Azad T, Shafiei-Jandaghi NZ. Congenital cytomegalovirus infection in newborns suspected of congenital rubella syndrome in Iran: a cross-sectional study. BMC Pediatr 2024; 24:31. [PMID: 38200453 PMCID: PMC10777647 DOI: 10.1186/s12887-023-04502-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 12/20/2023] [Indexed: 01/12/2024] Open
Abstract
BACKGROUND Following rubella virus control, the most important cause of congenital infections is human cytomegalovirus (HCMV). Congenital CMV (cCMV) may happen both in primary and non-primary maternal infections. The present study aimed to screen cCMV in symptomatic newborns suspected of congenital rubella syndrome (CRS) in Iran. METHODS Out of 1629 collected infants' serum samples suspected of CRS but negative for rubella IgM, 524 samples were selected regarding cCMV complications. These samples were divided into two age groups: 1- one month and younger, 2- older than 1 month up to one year. Anti-HCMV IgM detection was performed on these serums. Then HCMV IgG avidity assay and HCMV DNA detection were carried out on all samples with positive and borderline results in IgM detection. RESULTS Herein, 3.67% of symptomatic infants aged one month and younger had positive and borderline HCMV IgM, 12.5% of which had a low avidity index (AI). HCMV IgM detection rate among symptomatic infants older than one month to one year was 14.5%. Identified genotypes in this study were gB-1(63.63%), gB2 (18.18%), and gB3 (18.18%), respectively. CONCLUSIONS This comprehensive study was performed on serum samples of symptomatic infants clinically suspected of cCMV from all over Iran. There was a good correlation between serology findings and PCR.
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Affiliation(s)
- Negar Mirsalehi
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Jila Yavarian
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nastaran Ghavami
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Maryam Naseri
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Farshad Khodakhah
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Sevrin Zadheidar
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Nazanin-Zahra Shafiei-Jandaghi
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Virology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
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Moglad EH, Hassan AO, Atta Elmanan MS, Saeed SM, Abdalla WM, Mohammedsalih KA, Ali HT, Abd Elaziz MS, Ahmed HH. Seroepidemiological Survey of Cytomegalovirus Infection among Pregnant Women in Sudan. Pol J Microbiol 2023; 72:269-275. [PMID: 37668434 PMCID: PMC10508969 DOI: 10.33073/pjm-2023-026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2023] [Accepted: 06/09/2023] [Indexed: 09/06/2023] Open
Abstract
Human Cytomegalovirus (HCMV) is a leading healthcare problem associated with stillbirth and congenital abnormalities. Determining the seroprevalence and the possible risk factors related to HCMV infections may be a cornerstone in preventing its complications. This cross-sectional study was conducted in Kassala and River Nile States to determine the seroprevalence and risk factors associated with HCMV infection in pregnant women. One hundred eighty-four (n = 184) blood specimens were collected from pregnant women from February 2018 to January 2020. Enzyme-linked immunosorbent assay (ELISA) was used to detect HCMV-specific IgG and IgM antibodies. Socio-demographical characteristics of the women were collected using structured questionnaires. The results showed that HCMV IgG was detected in 170 (92.4%) of the blood specimens, and IgM was detected in 29/93 (31.2%). There was a significant relationship between the history of miscarriage and the presence of IgG and IgM with a p-value = 0.001 and between HCMV IgM and gestational stage (p-value = 0.028). The study found a strikingly high seroprevalence of HCMV infections among pregnant women in the investigated States. This high percentage of illiterate housewives living in rural areas makes it possible to reduce the incidence of HCMV infection in pregnant women by improving their knowledge, attitude, and practice regarding the route of viral transmission, which may reflect in lowering the rate of congenital diseases in their infants.
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Affiliation(s)
- Ehssan H. Moglad
- Department of Pharmaceutics, College of Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, Kingdom of Saudi Arabia
- Department of Microbiology and Parasitology, Institute of Medicinal and Aromatic Plants Research, The National Center for Research, Khartoum, Sudan
| | - Ahmed O. Hassan
- Department of Microbiology, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Mawada S. Atta Elmanan
- Department of Microbiology, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Samar M. Saeed
- Department of Microbiology, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | - Wafaa Mohammed Abdalla
- Department of Microbiology, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
| | | | - Hatim T. Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Khalid University, Abha, Kingdom of Saudi Arabia
| | - Mohammed Siddig Abd Elaziz
- Department of Histology, Pathology and Cytology, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
- Scientific Affair, University of Science and Technology, Khartoum, Sudan
| | - Hind Haidar Ahmed
- Department of Microbiology, College of Medical Laboratory Science, Sudan University of Science and Technology, Khartoum, Sudan
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Behnezhad F, Parhizgari N, Shafiei-Jandaghi NZ, Yavarian J, Mokhtari-Azad T. Molecular Detection and Genotyping of Human Cytomegalovirus in Kidney Transplant Recipients under Ganciclovir Prophylaxis in Iran. Intervirology 2022; 66:1-7. [PMID: 35858540 PMCID: PMC10015764 DOI: 10.1159/000526095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Human cytomegalovirus (HCMV) infection is one of the most common viral complications in kidney transplant recipients. Although there are effective treatments strategies for the HCMV infection, this infection is still one of the causes of kidney transplant rejection. METHODS A total of 246 kidney transplant recipients participated in this cross-sectional study. Viral DNA was extracted from these plasma samples, and the presence of HCMV genome was determined by semi-nested PCR with specific primers for the HCMV B glycoprotein gene. Sanger sequencing analyses were carried out to determine HCMV genotypes, and the Mega x software was used for nucleotide alignment and construction of a phylogenetic tree. RESULTS HCMV DNA was detected in 11 (4.47%) recipients. According to the phylogenetic analysis, HCMV gB3 was 50% among kidney transplant recipients, followed by gB4 30% and gB1 20%; however, the gB2 genotype was not detected. CONCLUSIONS This study demonstrated that the HCMV infection in our patients is relatively low because all transplant recipients received appropriate prophylaxis, thereby antiviral prophylaxis is recommended for all patients at risk of HCMV infection after kidney transplantation. Also, gB3 was the most predominant genotype among our kidney transplant recipients that was related to the higher rate of prevalence of severe HCMV infections. Moreover, an elevated serum creatinine level was detected in patients at the time of detection of HCMV infection.
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Affiliation(s)
- Farzane Behnezhad
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran,
| | - Najmeh Parhizgari
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | | | - Jila Yavarian
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
| | - Talat Mokhtari-Azad
- Virology Department, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Abstract
Objective: We determined the prevalence and relationship of glycoprotein B (gB), glycoprotein N (gN), and glycoprotein H (gH) genotypes of cytomegalovirus (CMV) in CMV-associated thrombocytopenia (CAP). Methods: CMV gB, gN, and gH strains were determined by nested PCR and restriction length polymorphism from 24 CAP and 20 asymptomatic CMV infected infants. Results: The order of prevalence was gB1 (70.8%,17/24), gN4 (45.8%,11/24) and gH2 (54.2%,13/24). There was a greater prevalence of gB1(75.0%,15/20), gN4(50.0%,10/20) and gN2 (35.0%,7/20) in moderate to severe infection (p = 0.014 and p = 0.003). By logistic regression, gH2 (p = 0.031) had an elevated risk of thrombocytopenia. Reduced risks of thrombocytopenia were associated with gB2 (p = 0.020), gN1 (p = 0.018) and gN3 (p = 0.008). The most virulent were gB1 (p = 0.033) and gN2 (p = 0.038). Conclusions: There may be a potential association between the gH2 genotype of CMV and infantile thrombocytopenia.
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Affiliation(s)
- Hongbo Hu
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Wenwen Peng
- Department of Laboratory, Hubei Provincial Hospital of Integrated Chinese and Western, Wuhan, China
| | - Qiaoying Peng
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Ying Cheng
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
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Chelbi H, Jelassi R, Belfkih S, Ben Amor A, Saidi N, Ben Salah H, Mzoughi N, Ben Dhifallah I, Boujelben N, Ammi R, Bouratbine A, Zidi I, Aoun K. Association of CCR5Δ32 Deletion and Human Cytomegalovirus Infection With Colorectal Cancer in Tunisia. Front Genet 2022; 12:598635. [PMID: 34976001 PMCID: PMC8719653 DOI: 10.3389/fgene.2021.598635] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 11/11/2021] [Indexed: 12/24/2022] Open
Abstract
Background and objectives: Human cytomegalovirus (HCMV) and genetic polymorphisms of the chemokine receptor 5 have been suggested as factors associated with the progression of colorectal cancer (CRC). The aim of the study was to evaluate the associations of both CCR5Δ32 genetic deletion and/or HCMV virus infection with CRC in Tunisia. MATERIALS AND METHODS The association between HCMV and CRC was validated by Nested PCR technology performed for HCMV and HCMV-specific serum IgG and IgM antibodies were investigated by enzyme-linked immunosorbent assay. Experiments were carried out on 40 tumor and 35 peri-tumor tissues, 100 blood from CRC patients and on 140 blood samples from healthy subjects and finaly serum samples of 80 patients with CRC and 100 healthy individuals. A conventional PCR has been optimized for the detection of CCR5Δ32 in100 CRC patients and 100 healthy subjects. RESULTS Our results show that HCMV is significantly active in 93% of patients compared to 60% in controls (p < 0.0001, OR = 8.85, 95% CI: 3.82 -20.50). Compared to the healthy controls, the titers of IgG and IgM antiCMV antibodies in CRC patients were significantly higher than in healthy subjects (p value < 0,0001 for IgG and IgM). Statistical analysis revealed a lack of association between CCR5Δ32 mutation and colorectal cancer (p = 0.788, OR = 1.265, 95% CI: 0.228-7.011). CONCLUSION our data confirmed that the HCMV infection was related to the development of CRC and that CRC cells may be infected more favorably by HCMV. Given the importance of the CCR5 in inflammation and therefore CRC progression, further studies still needed to evaluate CCR5 role as a potential candidate gene for CRC susceptibility under other polymorphisms.
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Affiliation(s)
- Hanen Chelbi
- Laboratory of Medical Parasitology, Biotechnologies, and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Refka Jelassi
- Laboratory of Medical Parasitology, Biotechnologies, and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia.,Faculty of Sciences of Bizerte, University of Carthage, Tunis, Tunisia
| | - Sarra Belfkih
- Laboratory of Medical Parasitology, Biotechnologies, and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Amor Ben Amor
- Public Relations Department, Emirates College of Technology, Media College, Abu Dhabi, United Arab Emirates
| | - Nasreddine Saidi
- Laboratory of Medical Parasitology, Biotechnologies, and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Hamza Ben Salah
- Laboratory of Medical Parasitology, Biotechnologies, and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia.,Faculty of Sciences of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Nabiha Mzoughi
- Laboratory of Medical Parasitology, Biotechnologies, and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Imen Ben Dhifallah
- Laboratory of Clinical Virology, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Nadia Boujelben
- Department of Pathology, Salah Azaïez Institute, Tunis, Tunisia.,Laboratory of Microorganismes and Active Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Radhia Ammi
- External Consultants Service, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Aida Bouratbine
- Laboratory of Medical Parasitology, Biotechnologies, and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia
| | - Ines Zidi
- Laboratory of Microorganismes and Active Biomolecules, Sciences Faculty of Tunis, University of Tunis El Manar, Tunis, Tunisia
| | - Karim Aoun
- Laboratory of Medical Parasitology, Biotechnologies, and Biomolecules, Pasteur Institute of Tunis, Tunis, Tunisia
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Hu H, Cheng Y, Peng Q, Chen K. Clinical Features, Treatment Courses, and Distribution of Cytomegalovirus Genotypes among Thrombocytopenia Patients Aged Younger than 12 Months. Am J Perinatol 2021; 38:1403-1411. [PMID: 32526777 DOI: 10.1055/s-0040-1713001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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.
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Affiliation(s)
- Hongbo Hu
- Department of Laboratory, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Ying Cheng
- Department of Pediatrics, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Qiaoying Peng
- Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Wuhan, China
| | - Kun Chen
- Department of Laboratory, Wuhan Ninth Hospital, Wuhan, China
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Wang HY, Valencia SM, Pfeifer SP, Jensen JD, Kowalik TF, Permar SR. Common Polymorphisms in the Glycoproteins of Human Cytomegalovirus and Associated Strain-Specific Immunity. Viruses 2021; 13:v13061106. [PMID: 34207868 PMCID: PMC8227702 DOI: 10.3390/v13061106] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 06/04/2021] [Accepted: 06/07/2021] [Indexed: 12/18/2022] Open
Abstract
Human cytomegalovirus (HCMV), one of the most prevalent viruses across the globe, is a common cause of morbidity and mortality for immunocompromised individuals. Recent clinical observations have demonstrated that mixed strain infections are common and may lead to more severe disease progression. This clinical observation illustrates the complexity of the HCMV genome and emphasizes the importance of taking a population-level view of genotypic evolution. Here we review frequently sampled polymorphisms in the glycoproteins of HCMV, comparing the variable regions, and summarizing their corresponding geographic distributions observed to date. The related strain-specific immunity, including neutralization activity and antigen-specific cellular immunity, is also discussed. Given that these glycoproteins are common targets for vaccine design and anti-viral therapies, this observed genetic variation represents an important resource for future efforts to combat HCMV infections.
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Affiliation(s)
- Hsuan-Yuan Wang
- Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065, USA;
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC 27710, USA;
| | - Sarah M. Valencia
- Duke Human Vaccine Institute, Duke University Medical Center, Durham, NC 27710, USA;
| | - Susanne P. Pfeifer
- Center for Evolution & Medicine, School of Life Sciences, Arizona State University, Tempe, AZ 85281, USA; (S.P.P.); (J.D.J.)
| | - Jeffrey D. Jensen
- Center for Evolution & Medicine, School of Life Sciences, Arizona State University, Tempe, AZ 85281, USA; (S.P.P.); (J.D.J.)
| | - Timothy F. Kowalik
- Department of Microbiology and Physiological Systems, University of Massachusetts Medical School, Worcester, MA 01655, USA;
| | - Sallie R. Permar
- Department of Pediatrics, Weill Cornell Medicine, New York, NY 10065, USA;
- Correspondence: ; Tel.: +1-212-746-4111
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Al Mana H, Yassine HM, Younes NN, Al-Mohannadi A, Al-Sadeq DW, Alhababi D, Nasser EA, Nasrallah GK. The Current Status of Cytomegalovirus (CMV) Prevalence in the MENA Region: A Systematic Review. Pathogens 2019; 8:pathogens8040213. [PMID: 31683687 PMCID: PMC6963600 DOI: 10.3390/pathogens8040213] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Revised: 10/19/2019] [Accepted: 10/21/2019] [Indexed: 12/16/2022] Open
Abstract
Human cytomegalovirus (CMV) is a highly prevalent herpesvirus worldwide. According to the Centers for Disease Control and Prevention (CDC) and the World Health Organization (WHO), CMV infects people of all ages, and by the age of five, approximately one-third of children in the United States are infected. Although the infection is generally asymptomatic, it can cause severe disease in immunocompromised patients, transplant and transfusion recipients, as well as newborn neonates. The objective of this study is to systematically review published literature on CMV in the MENA region to estimate its incidence in the region and describe its epidemiological and clinical significance. The literature was searched through four scientific databases: PubMed, Scopus, Science Direct, and Web of Science. A total of 72 studies from 11 countries satisfied the inclusion criteria, covering a period from 1988-2019. The CMV IgG seroprevalence ranged from 8.7%-99.2% (SD = 38.95%). CMV incidence in these countries ranged between 1.22% and 77% in transplant and transfusion recipients, with an increase in incidence with advanced age. However, the incidence rate was unclear for congenital CMV due to the variability of the reporting. This review highlights the need for more robust and well-designed studies to better estimate CMV incidence in the MENA region, standardize diagnostic criteria, and consider prophylactic and pre-emptive treatments to limit the morbidity and mortality of the disease.
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Affiliation(s)
- Hassan Al Mana
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.
| | - Hadi M Yassine
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.
| | - Nadin N Younes
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
| | - Anjud Al-Mohannadi
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
| | - Duaa W Al-Sadeq
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.
| | - Dalal Alhababi
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
| | - Elham A Nasser
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
| | - Gheyath K Nasrallah
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, PO Box 2713, Qatar.
- Biomedical Research Center, Qatar University, Doha, PO Box 2713, Qatar.
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