Summary
91 newborns with hyperbilirubinemia who had been given one or more blood exchange transfusions at the Childrens' Hospital of the University of Freiburg i. Br. Medical School were controlled for evidence of active cytomegalovirus (CMV) infection. Specimens for CF tests were obtained from all mothers and newborns before exchange transfusion, from all blood donors, and from infants on follow up examinations 2 to 4 and 6 to 9 months later. Virus excretion in urine was studied in nearly all infants during the newborn period, and later in those who were suspected of an active infection on follow-up examinations.—73 of the 91 infants were seen for at least one follow-up examination, and were included in this study.
Two out of 25 seropositive infants at birth who had received seronegative blood showed infection: these are prenatally acquired infections. The highes rate of infections was found in infants who were seronegative at birth and received seropositive blood: 8 of 15 such infants developed CMV infection, which could only have been caused by the blood transfused. Obviously, maternal antibodies are capable of protecting the infant against CMV infection due to exchange transfusion, because infection developed in only 2 out of 13 infants seropositive at birth and who had been given seropositive blood. The etiology of 2 infections is unknown. In the control group with seronegative infants who received seronegative blood, none of the 20 infants developed infection. In the follow-up examinations, urine specimens were obtained from 9 infants with serological reaction. CMV was isolated from all specimens. Unfortunately, urine specimens could not be obtained in the newborn period from the two infants who were later found to be prenatally infected.
No post-transfusion illness or other remarkable troubles were observed in any of the patients. The infants are now 6 to 12 months old. In three of the twelve patients, hepatitis occurred reflected by increased levels of serum glutamic pyruvic transaminase or positive thymol turbidity test, yet without clinical signs. SGPT showed also transient elevation in 4 out of 43 infants examined who did not develop CMV infection. This study indicates that about 50% of susceptible (seronegative) infants who received seropositive blood developed clinically asymptomatic CMV infections. It may be assumed that about 50% of seropositive blood donors, i.e. 15% of all our donors have viremia, perhaps intracellularly persisting virus.
Zusammenfassung
Die im Jahre 1969 in der Freiburger Universitäts-Kinderklinik mit Blutaustauschtransfusionen behandelten Neugeborenen wurden systematisch erfaßt und nachuntersucht, um pränatal oder durch Blutaustausch erworbene Cytomegalievirus (CMV)-Infektionen zu erkennen.
Bei 91 Kindern, deren Müttern und den 116 Blutspendern der Neugeborenen wurden die komplementbindenden Antikörper gegen Cytomegalievirus (CMV-KBR) bestimmt, bei möglichst vielen Kindern wurde außerdem der Urin auf CMV-Ausscheidung untersucht.
73 Kinder erschienen einige Monate später zu Nachuntersuchungen, bei denen durch serologische und virologische Befunderhebungen das Vorliegen einer CMV-Infektion getestet wurde.
12 der 73 nachuntersuchten Kinder boten eindeutige Zeichen einer aktiven CMV-Infektion. Durch die vor der Austauschtransfusion und bei den Blutspendern ermittelten serologischen Daten konnten 8 dieser Infektionen als durch Austauschblut erworben eingeordnet werden. 2 Infektionen blieben hinsichtlich ihres Herkommens ungeklärt. Die 8 durch Austauschblut übertragenen Infektionen sind in einer Gruppe von 15 seronegativen Kindern erfolgt, die seropositives Spenderblut erhalten haben. Das bedeutet, daß etwa jeder 2. Blutspender mit positiver CMV-KBR (30% der Blutspender waren seropositiv) den Erreger auf einen suszeptiblen Empfänger übertrug. Diaplacentar übertragene mütterliche Antikörper waren offensichtlich in der Lage, das Kind vor einer Infektion durch Spenderblut zu schützen, denn nur 2 von 13 Neugeborcnen, die seropositiv waren und seropositives Austauschblut erhalten haben, zeigten später eine Infektion. Bei 20 seronegativen Kindern, die seronegatives Spenderblut erhalten hatten, entwickelte sich in keinem Falle eine CMV-Infektion.
Wesentliche klinische Reaktionen auf die CMV-Infektion konnten bei den 12 infizierten Kindern nicht gesehen werden, in 3 Fällen wurden Transaminase-Erhöhungen (SGPT) gefudnen.
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Diese Untersuchung wurde mit Mitteln der Deutschen Forschungsgemeinschaft im Rahmen des SFB 31 (Med. Virologie) durchgeführt.
Die Veröffentlichung enthält wesentliche Teile der Dissertation von H. Siebert, Med. Fakultät Freiburg 1970.
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Luthardt, T., Siebert, H., Lösel, I. et al. Cytomegalievirus-Infektionen bei Kindern mit Blutaustauschtransfusion im Neugeborenenalter. Klin Wochenschr 49, 81–86 (1971). https://doi.org/10.1007/BF01497304
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DOI: https://doi.org/10.1007/BF01497304