Orta Anadolu bölgesinde tersiyer bir merkeze başvuran gebe hastalarda Sitomegalovirüs CMV tarama sonuçları

Amaç: Anneden çocuğa geçen enfeksiyonların önemli bir nedeni olan insan sitomegalovirüsü CMV , etkilenen bebeklerde uzun dönemde ciddi sekellere yol açabilir ve yenidoğanlarda genetik olmayan konjenital işitme kaybının en yaygın nedenini oluşturmaktadır. Gelişmekte olan ülkelerde CMV prevalansının gelişmiş ülkelere oranla daha yüksek olduğu bilinmektedir ve seroprevalansın ülkeler, hatta bölgeler arasında dahi ciddi farklılık gösterdiği bildirilmektedir. Bu çalışmanın amacı, bir bölge referans hastanesine başvuran gebe kadınlarda CMV seroprevalansının değerlendirilmesi ve gebelik sırasında CMV taramasının etkinliğinin araştırılmasıdır. Yöntem: Ocak 2016 ile Eylül 2018 tarihleri arasında bir üniversite hastanesi gebe polikliniğine ayaktan başvuran toplam 3362 hasta çalışmaya dahil edilmiştir. Serolojik inceleme sonrasında aktif enfeksiyon olduğu düşünülen olgularda avidite testi uygulanmıştır. Bu test sonucu düşük avidite izlenen olgulara invaziv amniyosentez işlemi önerilmiştir ve alınan örnekler Polimeraz Zincir Reaksiyonu PCR metodu ile incelenmiştir. Bulgular:CMV immunglobulin Ig G ve Ig M seropozitiflik oranları sırasıyla %96,40 ve %1,75 olarak bulunmuştur. CMV enfeksiyonu düşünülen hastalardaki avidite test sonuçları incelendiğinde 10 %20,83 olguda düşük avidite, 3 %6,25 olguda ara düzeyde avidite ve 35 %72,91 olguda yüksek avidite olduğu izlenmiştir. Düşük avidite saptanan 10 olguda yapılan PCR analiz sonucunda bu hastaların üçünde akut primer enfeksiyon bulguları gözlenmiştir. Doğum sonrası yapılan muayenelerde bu yenidoğanların birinde konjenital CMV enfeksiyonu bulguları saptanmıştır. Sonuç: CMV enfeksiyonunun tedavisinde kullanılan ajanların gerek maliyet, gerek terapötik etkinliği ile ilgili yeterli çalışma bulunmaması nedeniyle gebelikte rutin CMV taraması önerilmemektedir. Ancak, özellikle gelişmekte olan ülkelerdeki riskli gruplarda serolojik değerlendirme faydalı olabilir. Aşı ve anti-viral tedavi hakkında yapılacak sonraki geniş kapsamlı çalışmalar ile taramanın gerekliliği ve etkinliği hakkında daha fazla bilgi sahibi olunabilir.

Anahtar Kelimeler:

CMV, konjenital enfeksiyon, gebelik, tarama, seroloji

Cytomegalovirus CMV screening results in pregnant women admitted to a tertiary center in the middle Anatolia

Objective: Human cytomegalovirus CMV is a common cause of mother-to-child infection that may lead to severe long-term sequelae in affected infants and is the most common non-genetic cause of hearing loss. CMV prevalence is reported to be higher in developing countries and seroprevalence varies between countries and even regions. The aim of this study was to evaluate the seroprevalence of CMV in pregnant women who applied to regional reference hospital and to investigate the efficacy of antenatal CMV screening. Methods: A total of 3362 patients admitted to a university hospital pregnant outpatient clinic between January 2016 and September 2018 were included in the study. After serological examination, avidity test was performed in cases with results suggestive of active infection. Amniocentesis was recommended to patients with low avidity and these patients were evaluated by Polymerase Chain Reaction PCR method. Results: The frequency of CMV immunglobulin Ig G and M seropositivity rates were 96.40% and 1.75%, respectively. According to avidity test results of patients with CMV infection; low, intermediate and high avidity levels were found in 10 20.83% , 3 6.25% and 35 72.91% patients, respectively. PCR analysis results showed primary infection in 3 of the cases with low avidity. Only one infant had signs of congenital CMV infection at the time of birth. Conclusion: Although routine CMV screening in pregnancy is not recommended due to lack of adequate studies on the validity of treatment and costeffectiveness, serological examination may be beneficial especially in risky groups in developing countries. Further studies on vaccination and anti-viral therapy may provide more comprehensive information about the necessity and efficacy of screening.

Keywords:

CMV, congenital infection, pregnancy, screening, serology,

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