CYTOMEGALOVIRUS MONONUCLEOSIS IN A FIRST TRIMESTER PREGNANT FEMALE WITH TRANSMISSION TO THE FETUS

Abstract

An understanding of the pathogenesis of congenital cytomegalovirus (CMV) infections is hampered by the fact that the majority of adult infections are subclinical. This prevents documentation of the time of fetal infection. In the instance described, a 17-year-old pregnant female developed cytomegalovirus mononucleosis during her first trimester. CMV was recovered from her convalescent urine at 12 weeks' gestation and from amniotic fluid at 21 weeks' gestation. Following a therapeutic abortion at 22 weeks' gestation, CMV was recovered from multiple fetal organs. Cord serum contained 14 mg/100 ml IgM which is elevated for a 22-week fetus. The IgM fraction of the cord serum contained specific CMV antibodies as demonstrated by indirect hemagglutination and indirect immunofluorescence techniques. This suggests that, under abnormal circumstances such as intra-uterine infections, fetuses may be capable of synthesizing detectable levels of specific IgM antibodies as early as 22 weeks' gestation.