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Immunoglobulins

Immunoglobulins

Question:

- In the second month of pregnancy, we performed analyzes for cytomegalovirus and herpes 1 and 2. Ig G were positive and Ig M negative for herpes and cytomegalovirus. The gynecologist told me that there is no problem, as long as Ig M is not positive. That is why I made these analyzes until the end of the pregnancy each month (IgG POSITIVE, Ig M NEGATIVE). However, the doctor recommended that I do Caesarean section and I did. But even so the baby was born with an eruption that was supposed to be due to herpesvirus infection. I did the blood test for the boy and - as well: Ig G positive and Ig M negative for cytomegalovirus and herpes 1 and 2. Please tell me what that means. Thank you very much!

Answer:

IgM (immunoglobulin type M) are antibodies that appear in the blood during an acute infection, then disappear; IgG (G-type immunoglobulins) are antibodies that appear in the blood during an infection and persist even after its healing. The presence of anti-cytomegalovirus and anti-herpes simplex IgG antibodies in the blood in your blood means that you had an infection with these viruses at some point in your life; the absence of Ig M antibodies shows that at the time of testing there is no acute infection.

The cytomegalic virus is a virus that belongs to the group of herpes viruses, and is transmitted by interpersonal contact, blood or blood products (transfusions). Most infections are asymptomatic (apparent) and severe forms occur in people with compromised immunity, including newborn and fetus, which can have very serious consequences.

If the pregnant woman becomes ill at any time during pregnancy, she can transmit the fetus virus in a percentage of 30-40. Therefore, serological monitoring in pregnancy is indicated, to detect the appearance of Ig M, which would indicate an acute infection.

In your case, the interpretation of a positive IgG result in the newborn is difficult, being known the transplacental transfer of IgG from the mother. CMV-specific Ig M being negative in the child, suggests that cytomegalvirus infection may not have been transmitted to the child, but the safest test would have been to detect CMV-DNA (Ig M is a pentamer, so high molecular volume does not allow him to cross the fetal-placental barrier).

Of the two types of herpes virus (HSV type 1 and HSV type 2), the newborn is more likely to become infected with the herpes virus type 2 (besides the risk of transmission during pregnancy, the possibility of transmission at the time of childbirth also appears vaginal).

Mothers who contact herpes infection for the first time during pregnancy have the highest risk of transmitting the baby's infection during birth. Transplacental transmission (during pregnancy) of the herpes virus is rare. Clinical manifestation in newborns consists of skin lesions, mucocutaneous (recurrent vesicles), keratoconjunctivitis; it is possible also the nervous damage, with encephalitis, with the serious neurological sequelae; however, the most serious form is the one of disseminated infection that starts from the first week of life, with pneumonia, encephalitis, multiple organic dysfunction, CID and hepatitis.

Herpes-positive IgG specific for newborns may mean either that herpes infection was transmitted to the child or that only Ig G antibodies were transmitted transplacially from the mother. Specific anti-herpetic Ig M cannot be detected before 3 weeks; It would have been useful to know the age of the child at the time of testing, thus being able to explain the negative Ig M result in the child despite the present herpes eruption, if the test was done before 3 weeks after birth. The presence of the characteristic herpetic eruption in the newborn shows, however, that despite the Caesarean birth, the transmission of the herpes infection occurred to the newborn (but the exact path through which this infection was transmitted cannot be specified).

Because it is not known exactly the route of transmission of the infection to the newborn (transplacental, during the crossing of the genital canal at birth or postnatal) and because there have been described cases of viral infection in children born by caesarean section, even without its membranes. be broken, the prophylactic value of caesarean section is not known and, therefore, it should not be indicated just to prevent transmission of the virus to the newborn; but only to the extent that the virus has altered the structure of the birth canal (eg, giant condylomas within the maternal infection with HPV = Human Papilloma Virus).

Dr. Ciprian Pop-Began

- Obstetrics and Gynecology -
Clinical Hospital of Obstetrics-Gynecology Prof. Dr. Panait Sarbu