Cytomegalovirus in human abortion in Espírito Santo, Brazil

Despite the established implication of human cytomegalovirus (HCMV) in congenital infection, there are still conflicting reports regarding the association of HCMV with spontaneous abortion. Viral antigens and nucleic acid were already described in tissues from abortions cases, but did not indicate HCMV pathogenical role.

(1) To access viral seroprevalence (total and IgM antibodies) in pregnant, non-pregnant and in women in abortion process, (2) to evaluate if antigenemia assay can detect active infection in these populations, (3) to detect viral DNA in peripheral leukocytes, and (4) in abortion tissues.

Blood samples from 95 patients in abortion process and from two control groups (40 pregnant and 60 non-pregnant women) were obtained for determination of viral seroprevalence, for detection of antigen and viral DNA by PCR from peripheral leukocytes. Specimens obtained from 88 patients in abortion process, spontaneous or induced, were submitted to gB gene amplification (PCR and nested-PCR).

Viral seroprevalence were found in 97.3 with 2.5% of IgM positive cases. Antigenemia assay were negative in all cases, however, viral nucleic acid were found in 6.3 and in 6.0% of the patients in abortion and in control groups, respectively. Nucleic acid in conception tissue was present in 6.6%.

This high seroprevalence observed is according to previous surveys in Brazil. If active infection due to viral reactivation occurred during the abortion process, it cannot be accessed by antigenemia or anti-IgM assays. Nucleic acid found by PCR in peripheral blood cells enriched with polymorphonuclear cells (PMN) corresponds to viral circulation in immunocompetent person, as similar results were found for the three groups. Although viral DNA had been found in 6.6% from abortion tissues, this result does not support HCMV as a major abortion-related factor as we could not found any correlation between abortion and active HCMV infection.