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9/26/2014  |   2:45 PM - 3:15 PM   |  Ballroom B

Prognostic blood markers of brain damage in fetuses with congenital CMV infection

Human congenital cytomegalovirus (CMV) is a major infectious cause of sensorineural hearing loss and neurodevelopmental delay. We evaluated the usefulness of biological parameters in fetal blood when a high CMV load is detected in amniotic fluid in order to improve prenatal prognosis of intrauterine transmission. The results of fetal blood tests were correlated with the fetal histological examination. We enrolled 15 women at 20-21 weeks gestation with documented intrauterine transmission of CMV (amniotic fluid with a viral load >10^5 copies/mL) with or without abnormal ultrasound findings. The women elected to terminate the pregnancy and fetal blood was collected from the umbilical cord. A total of 12 immunological, haematological, biochemical and virological parameters were performed in fetal blood. CMV antigen expression and inflammatory response were studied in all fetal tissues using immunohistochemical staining procedures. We found no evidence of brain CMV infection by immunohistochemistry in 4 out of 15 foetuses and US brain imaging were both normal in these cases. Eleven foetal brains were CMV positive and a brain histological damage was observed. Considering the 11 fetuses with histological brain damage, US was pathological in 5 cases (45.4%). In non-parametric analysis (Wilcoxon test) only thrombocytopenia (platelet count <100.000 mm^3) and high levels of beta-2 microglobulin (>9.7 ng/mL-Roc curve) were significantly associated with the brain damage determined by histology (p<0.05). A trend to statistically differentiate between the groups of fetuses with and without brain damage was observed in the fetal DNAemia/viral load (p=0.07). Despite the statistical differences observed, the probability that the evaluation independently based on the three parameters can exclude or recognize the risk of the development of severe symptomatic infection is not 100%. At present, fetal blood sampling at 20-21 weeks gestation could not be justified for the prognosis of foetal CMV infection considering the high risk of fetal loss.

Tiziana Lazzarotto (Primary Presenter), tiziana.lazzarotto@unibo.it;
She graduated with a degree in Biological Science from the University of Bologna (Italy) and received her scientific training for her specialty degree in Microbiology and Virology at the University of Bologna (Italy). She is Associate Professor of Microbiology and Clinical Microbiology, Department of Specialised, Experimental and Diagnostic Medicine, School of Medicine at Alma Mater Studiorum University of Bologna (Italy). Head of the Laboratory of Virology at the Clinical Operative of Microbiology at St. Orsola Malpighi University General Hospital, Bologna (Italy). Since her thesis she has published more than 168 scientific papers (121 on international-selected Current Contents, and 47 on national and international journals). In particular she has made significant contributions in the diagnosis and prognosis of congenital cytomegalovirus infection. Visiting Professor in 2000 at the Department of Paediatrics, University of Alabama, Birmingham, USA.

ASHA DISCLOSURE:

Financial - No relevant financial relationship exist.

Nonfinancial - No relevant nonfinancial relationship exist.

Liliana Gabrielli (Author), liliana.gabrielli@aosp.bo.it;
She graduated with a degree in Medicine and Surgery from the University of Bologna (Italy). She is Medical Doctor, Specialist in Microbiology and Virology, Consultant at University Hospital of Bologna, St. Orsola Malpighi General Hospital. She works at the Clinical Operative of Microbiology, Laboratory of Virology. Since her thesis she has published more than 50 scientific papers (31 on international-selected Current Contents and 19 on national and international journals). Visiting Professor in 2000 at the Department of Medical Virology, University Hospital of Tubingen, Germany and the Department of Virology, University of Ulm, Germany to investigate some aspects of the mechanism of pathogenesis of congenital cytomegalovirus infection. Degree Honors and Awards: “AMCLI”, Italian Society for Clinical Microbiology (2000 and 2007) and “Eva contro Eva – tra biologia e società”, Italian Society of Gynaecology and Obstetrics (SIGO) (2005).

Brunella Guerra (Author), brunella.guerra@unibo.it;
MD, Specialist in Obstetrics and Gynecology. Department of Obstetrics and Gynecology, Obstetrics and Prenatal Medicine Unit, University of Bologna. 2008: Head of clinic for infectious diseases in pregnancy, S.Orsola-Malpighi General Hospital, Bologna, Italy. 1985: Stage of Prenatal Medicine at the Mount Sinai Medical Center (Mount Sinai Hospital and Mount Sinai School of Medicine) New York, NY. Professor of Gynecology and Obstetrics. Author of 363 scientific papers (95 on international scientific journals, IF 339,416 ) Research areas: Vertical transmission of maternal infections, Prenatal diagnosis of congenital CMV infection, Identification of maternal and foetal prognostic markers in utero CMV transmission, National survey of antiretroviral treatment in HIV infected pregnant women. Member of scientific committee of the Italian Society for Cervical Pathology and Colposcopy since 2007. Member of scientific committee of Genital Pathology School, IRCCS- Oncologic Institute, Milan, Italy, since 2008

Tiziana D'Atena (Author), tiziana.datena@aosp.bo.it ;
She graduated with a degree in Medicine and Surgery, she is received her scientific training for her specialty degree in Clinical Pathology (Laboratory Chemical Analysis and Clinical Microbiology) Dr. D’Atena's main field of interest is immunological diseases.

Maria Paola Bonasoni (Author), bonasoni.mariapaola@asmn.re.it;
She graduated with a degree in Medicine and Surgery from the University of Bologna (Italy). She is Medical Doctor, Specialist in Pathology at the University of Bologna (Italy). She works at the Operative Unit of Pathology, St. Maria Nuova Hospital, Reggio Emilia, Italy.

Donatella Santini (Author), donatella.santini@aosp.bo.it;
She graduated with a degree in Medicine and Surgery from the University of Bologna (Italy). She received her scientific training for her specialty degree in pathological anatomy at the University of Bologna (Italy).

Angela Chiereghin (Author), angela.chiereghin@gmail.com;
She graduated with a degree in Biological Science from the University of Bologna (Italy) and received her scientific training for her specialty degree in Microbiology and Virology at the University of Bologna (Italy). She works at the Clinical Operative of Microbiology at St. Orsola Malpighi University General Hospital, Bologna (Italy). PhD in Medical Sciences.

Giulia Piccirilli (Author), giulia.piccirilli@yahoo.it;
She graduated with a degree in Biological Science from the University of Bologna (Italy) and she is receiving her scientific training for her specialty degree in Microbiology and Virology at the University of Bologna (Italy). She works at the Clinical Operative of Microbiology at St. Orsola Malpighi University General Hospital, Bologna (Italy).

Giuliana Simonazzi (Author), giuliana.simonazzi@unibo.it;
Giuliana Simonazzi is a Researcher in Gynaecology and Obstetrics at the University of Bologna and works assistant medical director at the Prenatal Medicine and Obstetrics Unit of S.Orsola Malpighi University Hospital, Bologna. She subsequently specialized in Gynaecology and Obstetrics at the same University and was awarded her specialization degree in 2004. She held a six-month post as research fellow at the Maternal - Fetal Medicine Division, Thomas Jefferson University di Philadelphia (PA, USA) from 2003 to 2004. In 2008 she was awarded a research doctorate in Mother, Infant and Child Medicine by the University of Bologna. Dr. Simonazzi's main field of interest is obstetric disease, focusing on the prenatal diagnosis and treatment of morphological and auxological abnormalities of foetal development. She has authored more than 40 scientific publications cited by the Journal Citation Report. She is an executive member of the Italian Society of Obstetric and Gynaecological Ultrasound (SIEOG).

Francesca Cervi (Author), cervi.fra@gmail.com;
She graduated in Medicine and Surgery at University of Bologna, with 110/110 cum laude votations. She is receiving her scientific training for her specialty degree in Gynaecology and Obstetrics at the University of Bologna (Italy). Dr. Cervi's main field of interest is obstetric diseaseS, focusing on the prenatal diagnosis and maternal-fetal infectous

Maria Paola Landini (Author), mariapaola.landini@unibo.it;
Bachelor in Biological Sciences - University of Parma. Degree in Medicine and Surgery - University of Bologna. Specialization in Virology - University of Bologna International experiences: Fellow in the Dept of Genetics, University of Cambridge (UK) Chercheur in the Dept of Medical Virology, Pasteur Institute, Paris, Visiting fellow Dept of Microbiology, University of Iowa, Iowa City, IA, USA, Visiting Professor Dept of Microbiology and Immunology of the University of Stanford, CA, USA. 1990 - University professor SSD MED07 University of Bologna, 1993-1996 Director of the Specialization School in Microbiology and Virology – Univ.of Bologna, 2001- 2007 Dean of the Faculty of Medicine and Surgery, University of Bologna. She has published on international Journals indexed in PubMed , 228 scientific papers regarding different aspects of viral and bacterial infections.

Presentation:
303TizianaLazzarotto.pdf

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