False-positive IgM for CMV in pregnant women with autoimmune disease: a novel prognostic factor for poor pregnancy outcome

Abstract

Our aims were to assess the frequency of false-positive IgM antibodies for cytomegalovirus in pregnant women with autoimmune diseases and in healthy women (controls) and to determine their relationship with pregnancy outcome. Data from 133 pregnancies in 118 patients with autoimmune diseases and from 222 pregnancies in 198 controls were assessed. When positive IgM for cytomegalovirus was detected, IgG avidity, cytomegalovirus isolation and polymerase chain reaction for CMV-DNA in maternal urine and amniotic fluid samples were performed in order to identify primary infection or false positivity. A statistically significantly higher rate of false-positive IgM was found in pregnancies with autoimmune diseases (16.5%) in comparison with controls (0.9%). A worse pregnancy outcome was observed among patients with autoimmune disease and false cytomegalovirus IgM in comparison with those without false positivity: earlier week of delivery (p = 0.017), lower neonatal birth weight (p = 0.0004) and neonatal birth weight percentile (p = 0.002), higher rate of intrauterine growth restriction (p = 0.02) and babies weighing less than 2000 g (p = 0.025) were encountered. The presence of false cytomegalovirus IgM in patients with autoimmune diseases could be used as a novel prognostic index of poor pregnancy outcome: it may reflect a non-specific activation of the immune system that could negatively affect pregnancy outcome. Lupus (2010) 19, 844—849.

Keywords

false-positive IgM CMV autoimmune disease prognostic factors

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References

Denman AM

Systemic lupus erythematosus - is a viral aetiology a credible hypothesis?

J Infect 2000; 40: 229-233.

James JA , Neas BR , Moser KL , et al. Systemic lupus erythematosus in adults is associated with previous Epstein-Barr virus exposure. Arthritis Rheum 2001; 44: 1122-1126.

Nawata M. , Seta N. , Yamada M. , Sekigawa I. , Lida N. , Hashimoto H. Possible triggering effect of cytomegalovirus infection on systemic lupus erythematosus. Scand J Rheumatol 2001 ; 30: 360-362.

Tozzoli R. , Barzilai O. , Ram M. , et al. Infections and autoimmune thyroid diseases: parallel detection of antibodies against pathogens with proteomic technology. Autoimmun Rev 2008; 8: 112-115.

Sekigawa I. , Nawata M. , Seta N. , Yamada M. , Lida N. , Hashimoto H. Cytomegalovirus infection in patients with systemic lupus erythematosus . Clin Exp Rheumat 2002; 20: 559-564.

Borg EJT , Hoarst G. , Hummel E. , Limburg PC , Kallenberg CGM. Rises in anti-double stranded DNA antibody levels prior to exacerbations of systemic lupus erythematosus are not merely due to polyclonal B cell activation . Clin Immunol Immunopathol 1991; 59: 117-128.

Mendelson E. , Aboudy Y. , Smetana Z. , Tepperberg M. , Grossman Z. Laboratory assessment and diagnosis of congenital viral infections: Rubella, cytomegalovirus (CMV), varicella-zoster virus (VZV), herpes simplex virus (HSV), parvovirus B19 and human immunodeficiency virus (HIV). Reprod Toxicol 2006; 21: 350-382.

Miendje Deyi Y. , Goubau P. , Bodéus M. False-positive IgM antibody tests for Cytomegalovirus in patients with acute Epstein-Barr Virus infection. Eur J Clin Microbiol Infect Dis 2000; 19: 557-560.

Cannavan FP , Costallat LT , Bertolo MB , Rossi CL , Costa SC False positive IgM antibody tests for human cytomegalovirus (HCMV) in patients with SLE. Lupus 1998; 7: 61-62.

10.

Munro SC , Hall B. , Whybin LR , et al. Diagnosis of and screening for cytomegalovirus infection in pregnant women. J Clin Microbiol 2005; 43: 4713-4718.

11.

Haserick JR , Long R. Systemic lupus erythematosus preceded by false-positive serologic tests for syphilis: presentation of five cases . Ann Intern Med 1952; 37: 559-565.

12.

Rothfield NF , Evans AS , Niederman JC Clinical and laboratory aspects of raised virus antibody titres in systemic lupus erythematosus. Ann Rheum Dis 1973; 32: 238-246.

13.

Caruso A. , De Carolis S. , Ferrazzani S. , Valesini G. , Caforio L. , Mancuso S. Pregnancy outcome in relation to uterine artery waveforms and clinical characteristics in women with antiphospholipid syndrome. Obstet Gynecol 1993; 82: 970-977.

14.

Stratta P. , Colla L. , Santi S. , et al. IgM antibodies against cytomegalovirus in SLE nephritis: viral infection or aspecific autoantibody? J Nephrol 2002; 15: 88-92.

15.

Moler E. , Strom H. , Al-Balaghi S. Role of polyclonal activation in specific immune responses. Relevance for findings of antibody activity in various diseases. Scand J Immunol 1980; 12: 177-182.

16.

Rasmussen L. , Keisali D. , Nelson R. , et al. Virus-specific IgG and IgM antibodies in normal and immunocompromised subjects infected with cytomegalovirus. J Infect Dis 1982; 145: 191-199.

17.

Su BY , Su CY , Yu SF , Chen CJ Incidental discovery of high systemic lupus erythematosus disease activity associated with cytomegalovirus viral activity. Med Microbiol Immunol 2007; 196: 165-170.

18.

Lau R. , Forster GE False positive results of tests for syphilis and outcome of pregnancy . Br Med J 1987; 295: 925 (letter).

19.

Henriksen R. , Sögaard PE , Grennert L. , Hansen BU , Manthorpe R. , Nilsson IM Autoimmune antibodies and pregnancy outcome in women with false-positive syphilis test results. A retrospective controlled investigation of women from 5170 deliveries. Acta Obstet Gynecol Scand 1989; 68: 537-540.