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Query: UMLS:C0025362 (mental retardation)
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Cytomegalovirus remains the most common congenital infection worldwide, with approximately 1% of all newborns infected in utero. Of those infected in utero, approximately 10% will have signs and symptoms of cytomegalovirus infection at birth and develop sequelae, especially mental retardation, hearing deficit, or both. Recent data indicate that more than 90% of symptomatic infections or infections causing sequelae occur following a primary maternal infection during pregnancy. The overall risk of delivering an infant who will develop significant handicaps following a primary maternal infection is between 10% and 20%. Between 1% and 2% of seronegative women may acquire a primary cytomegalovirus infection during pregnancy, but seronegative women at high risk include day-care workers, who have a 10% to 20% annual infection rate, and the seronegative mothers of infected children under 2 years of age, 50% of whom will acquire cytomegalovirus annually from their children. Adolescents are another group who may have a high infection rate during pregnancy. Although a cytomegalovirus vaccine is still many years from introduction, these observations strengthen the need and feasibility for a cytomegalovirus vaccine. Pending vaccine development and evaluation, several possible strategies for intervention to prevent primary infection for high-risk pregnancies are suggested.
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PMID:Cytomegalovirus and pregnancy. 132 51

Interest in the human cytomegalovirus (HCMV) mainly derives from its associations with congenital malformations, mental retardation, and severe or fatal infections in immunosuppressed individuals such as transplant patients, tumor and AIDS patients. It is evidenced that there has been a need for a rapid and sensitive methods to detect an ongoing acute infection. The recent studies showed that high titers of antibody to the glycoprotein 52kd are present in sera of patients undergoing acute HCMV infection. However, purification of individual glycoprotein from HCMV-infected cells is a daunting prospect. HCMV glycoprotein 52 kd expressed via recombinant DNA techniques are a promising approach to solve this problem. In order to evaluate the diagnostic value of the recombinant glycoprotein 52 kd antigenic code region for HCMV infection, we have used the polymerase chain reaction (PCR) and recombinant DNA techniques to construct successfully the high-level expression plasmid pHCMV containing the HCMV GP-52 kd antigenic code region, with the predicted protein at levels up to 20% in total bacterial protein. The expressed protein was purified from SDS-PAGE, used as an antigen in Western-blot, and reacted with 12 cases of the positive sera, 4 cases of the negative sera, following by reaction with HRP-labelled horse IgG antibody against human. The results indicated that the approach we are using to detect antibody to HCMV acute infection are as sensitive as general serological methods such as ELISA, with the advantages of easy preparation of antigen with high quantity, and clinical practicability.
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PMID:[Preliminary use of recombinant glycoprotein 52kd as an antigen in the diagnosis of human cytomegalovirus infection]. 132 25

Since 1976, sera obtained serially from 10,218 pregnant women during the first, second, and third trimesters of gestation and cord sera were tested for CMV complement-fixing (CF) and immunofluorescent (IF) antibodies. CMV IgG-IF antibody was positive in 9,735/10,218 (95%) in the first trimester, and a significant rise of CF antibodies during pregnancy was found in 70/9,206 (0.76%) of the seropositive group and in 5/438 (1.14%) of the seronegative group. IgM antibody was found in 6/9,206 (0.06%) of seropositive women during the first trimester and in 7/70 (10.0%) of seropositive mothers with CF antibody rise and in 4/5 of seroconverted mothers of the seronegative group, suggesting that the incidence of primary infection with CMV during pregnancy was approximately 1% of susceptible women. All the mothers with immune response had infants with neither viruria nor IgM antibody in the cord blood, whereas seropositive mothers without an immune response had infants with viruria (7/1,826; 0.4%) or with IgM antibody in the cord blood (6/9,136; 0.06%). None of these 13 babies, shedding CMV or with IgM IF antibody, had physical or mental retardation. CMV IgG-IF antibody was present in almost 80% of infants between 7 and 12 months of age in 1988, suggesting that perinatal or postnatal CMV infection may occur in infants born to seropositive mothers in 70-80% of pregnancies.
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PMID:Prospective study on maternal, intrauterine, and perinatal infections with cytomegalovirus in Japan during 1976-1990. 132 4

Twenty-seven infants with cytomegalovirus hepatitis were followed up for 15-40 months after onset of the illness. They had recovered from the hepatitis, but microcephaly was present in 2 (7.4%), sensorineural hearing loss in 5 (18.5%), quadriplegia, mental retardation, ventricular septal defect and tooth defects in 1 (3.7%) each. The patients with congenital infection had more severe and complex defects, some with perinatal infection had mild defects, those with postnatally acquired infection had no sequelae. The mean MDI and frequency of expressive language delay in the former group differed significantly from those of the other 2. Five patients still excreted cytomegalovirus in the urine at follow-up.
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PMID:Effects of cytomegalovirus hepatitis on growth, development and nervous system of infants. A follow-up study. 165 27

Although rubella virus and cytomegalovirus (CMV) are important causes of congenital infections, information on their prevalence in our country is scarce. We studied a total of 249 infants suspected of having congenital infections from January 1988 to September 1989. Serum samples of these infants were tested for rubella and cytomegalovirus specific IgM antibodies by mucapture ELISA. Thirty (12%) infants were positive for rubella IgM antibody, and 50 (20%) had CMV specific IgM antibody. In the group presenting with hepatosplenomegaly (n = 56) rubella and CMV specific IgM antibodies were detected in 1 (1.7%) and 25 (44.6%) infants respectively. In the group presenting with congenital malformations (n = 90), 23 (25.5%) were positive for rubella, and only 9 (10%) had CMV IgM antibodies. Of the infants presenting with mental retardation (n = 39), only CMV infection was detected in 3 (7.7%) infants, whereas amongst the group showing intrauterine growth retardation (n = 16), 5 (31.25%) had CMV specific IgM antibodies and 2 (12.5%) had rubella specific IgM antibodies. In the miscellaneous group (n = 48), 4 (8.3%) and 8 (16.6%) infants had rubella and CMV IgM antibodies respectively. CMV infection was prevalent in a significantly higher number of children with hepatosplenomegaly than rubella while in infants with congenital malformations a significantly higher number had rubella infection. It is concluded that rubella and CMV infections are commonly seen in children with intrauterine infections in our population.
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PMID:Prevalence of rubella virus and cytomegalovirus infections in suspected cases of congenital infections. 165 69

Congenital infection by human cytomegalovirus (CMV) is presently the leading infectious cause of mental retardation and congenital deafness in the United States. Live CMV vaccines in healthy adults have been shown to be safe and to induce immune responses similar to those that occur with natural CMV infection. Yet, only recently has a live CMV vaccine been tested for its protective ability. To evaluate the cost benefit and effectiveness of the proposed live CMV vaccine, we compared the following strategies: routine immunization, selective immunization of those women screened and found to be seronegative, and no immunization. Our results show that, when direct costs alone are considered, routine immunization of healthy women aged 15-25 years is cost beneficial even in populations with CMV seroprevalence as high as 87%. In populations with lower seroprevalence (55%-70%), for every 100,000 women immunized, more than 24 cases of symptomatic congenital CMV infection at birth and a similar number of cases with late sequelae (mainly deafness) would be prevented yearly. Such immunization would result in a net annual saving of $2.5 million.
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PMID:Effectiveness and cost benefit of a proposed live cytomegalovirus vaccine in the prevention of congenital disease. 215 28

Cytomegalovirus infection is spread in various ways--from mother to fetus or baby, from small children in day-care centers to caregivers and parents, by blood transfusions, by sexual contact. Although the illness is usually inconsequential, congenital infection can have severe consequences, including mental retardation and hearing loss. Dr Bean describes the different aspects of this virus and discusses a promising vaccine that may prevent congenital disease.
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PMID:Cytomegalovirus. An update for primary care physicians. 217 49

The neurodevelopmental state of 41 children with congenital cytomegalovirus infection and their controls was assessed at 2 years using the Griffiths scale. The scores achieved by children with congenital cytomegalovirus but with no associated neurological abnormality (asymptomatic) were similar to those of the control children, whereas the mean score of the five children with congenital infection and neurological impairment (symptomatic) was significantly lower. This study, which has the statistical power to detect differences in developmental quotient as small as five points, gave no evidence that at 2 years cytomegalovirus infection was associated with mental retardation in the absence of other neurological impairment. Thus 90% of children with congenital cytomegalovirus infection at 2 years are neurologically and developmentally normal.
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PMID:Neurodevelopmental assessment after congenital cytomegalovirus infection. 242 40

Developmental enamel defects in primary teeth have been found at least twice as frequently in children with cerebral palsy or mental retardation as in control children, and frequently also in children with sensori-neural hearing deficits. The developing tooth germ is sensitive to a range of systemic disturbances, some of which may also affect neurologic development. Because the enamel cannot recover once it is damaged, it may provide a repository of information on the timing and nature of insults potentially affecting other ectodermally derived structures, including the brain. This paper reviews the literature on developmental defects of enamel in primary teeth, asking whether these might be useful as biological markers of the timing and in some cases the nature of insults. Among systemic factors related to development of enamel that might also have implications for neurologic development are certain genetic disorders including tuberous sclerosis, premature birth, neonatal nutritional disturbances (especially hypocalcemia), viral infections (such as rubella and cytomegalovirus during gestation), thyroid disorders, and maternal diabetes. It is concluded that further research is warranted concerning whether developmental defects of dental enamel can be useful markers for the timing of intra-uterine or perinatal events associated with certain neurologic and sensory disorders of children.
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PMID:Developmental enamel defects in primary teeth in children with cerebral palsy, mental retardation, or hearing defects: a review. 270 Nov 56

Cytomegalovirus (CMV) is the most common agent of prenatal (peri- and early postnatal) infection of the newborn with an incidence of 0.2-2.0% (5-10%) depending on the socio-economic status. Only one out of 20 congenitally CMV-infected newborns shows serious symptoms. Another two may reveal mental retardation and other significant handicaps in later age. Perinatal CMV infection occasionally causes atypical pneumonia, mostly combined with Pneumocystis carinii infections similar to reports of AIDS cases. The risk of vertical infection has been quantified. About 2-4% of pregnant seronegative women (40-60% of all) pass a primary, 10-20% of seropositives a recurrent CMV infection. Every third primary infection may result in vertical CMV transmission with poor prognosis in about 25% (40%) of the offspring infected (in the first half of pregnancy). Sources of vertical infection are semen, maternal cell-associated viraemia, ascending genital virus (prenatally), cervical secretion (perinatally), breast milk and saliva (early postnatally). Laboratory diagnosis of CMV infection is performed by many virological and immunological techniques for detecting viral infectivity, structural components, humoral and cellular immunoresponses. Routine diagnostic service is mainly established by virus cultivation in human fibroblasts and by ELISAs on antibodies and antigens.
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PMID:Cytomegalovirus infection in pregnancy. 282 48


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