Primary cytomegalovirus infection during pregnancy and congenital infection: a population-based, mother–child, prospective cohort study

Objective This study assessed maternal cytomegalovirus antibodies, and the occurrence of primary and congenital cytomegalovirus infections, and risk factors of congenital infection after a maternal primary infection. Study design We included 19,435 pregnant women in Japan, who were tested for serum cytomegalovirus antibodies before 20 gestational weeks. Immunoglobulin (Ig) G avidity was evaluated in women with both IgG and IgM antibodies; tests were repeated at ≥28 gestational weeks among women without IgG and IgM antibodies. Result Primary and congenital infections were 162 and 23 cases, respectively. The risk ratios for congenital infection were 8.18 (95% confidence interval: 2.44–27.40) in teenage versus older women, and 2.25 (95% confidence interval: 1.28–3.94) in parity ≥ 2 versus parity ≤ 1. Of 22 live birth congenital infection cases, three had abnormal neurological findings. Conclusion We demonstrated teenage and parity ≥ 2 pregnant women as risk factors of post-primary congenital infection.

Disseminated Tularemia: Finding the Needle in the Haystack

We report a case of disseminated tularemia in a previously healthy 8-month-old male. This case highlights an atypical presentation of tularemia with multisystem organ involvement. The diagnosis was complicated by concurrent primary cytomegalovirus infection. Bronchoalveolar lavage culture confirmed the diagnosis. The patient was successfully treated with gentamicin. Pertinent literature reviewed.