Human cytomegalovirus and relationship with abortion among Iraqi females: a systematic review
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Abstract
Background: Human cytomegalovirus (HCMV) seroprevalence is a significant health problem, especially among pregnant women in lower socioeconomic societies. This study aims to explore the prevalence of HCMV infections among women in Iraq.
Methods: A systematic review was designed to collect and summarize articles concerning the relationship between HCMV infection and abortion in Iraq. We identified the titles and abstracts of the publications from 2008 to 2022. A pre-defined keyword was recruited to recognize the publications and filter the articles to eliminate duplication and remove irrelevant articles. In the reviewed studies, the HCMV was detected using diagnostic methods such as enzyme-linked immunosorbent assay and immunochromatography (rapid test) or molecular methods such as polymerase chain reaction.
Results: Twenty-four eligible articles have been included in this review sourced data from about 5442 patients covering 15 of 18 provinces in Iraq. The prevalence of HCMV IgG and IgM was (0%-100%) and (0%-93%), respectively. Many factors influenced the varied results, including the design of the study and sociodemographic and clinical aspects.
Conclusion: The high prevalence of HCMV infection indicates a causative relationship with repeated abortion among Iraqi females.
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Al Mana H, Yassine HM, Younes NN, Al-Mohannadi A, Al-Sadeq DW, Alhababi D, et al. The Current Status of Cytomegalovirus (CMV) Prevalence in the MENA region: a systematic review. Pathogens. 2019;8 (4):213-236. https://doi.org/10.3390/pathogens8040213
Cannon MJ, Schmid DS, Hyde TB. Review of Cytomegalovirus Seroprevalence and Demographic Characteristics Associated with Infection. Rev Med Virol. 2010;20(4):202–213. https://doi.org/10.1002/rmv.655
Lachmann R, Loenenbach A, Waterboer T, Brenner N, Pawlita M, Michel A. Cytomegalovirus (CMV) Seroprevalence in the Adult Population of Germany. PLoS One. 2018;13 (7):e0200267. https://doi.org/10.1371/journal.pone.0200267
Crough T, Khanna R. Immunobiology of Human Cytomegalovirus: from bench to bedside. Clin Microbiol Rev. 2009;22(1):76–98. DOI: https://doi.org/10.1128/CMR.00034-08
Buxmann H, Hamprecht K, Meyer-Wittkopf M, Friese K. Primary Human Cytomegalovirus (HCMV) infection in pregnancy. Dtsch Arztebl Int. 2017;114(4):45-52. doi: 10.3238/arztebl.2017.0045.
Manicklal S, Emery VC, Lazzarotto T, Boppana SB, Gupta RK. The “Silent” global burden of congenital cytomegalovirus. Clin Microbiol Rev. 2013;26: 86–102. DOI: 10.1128/CMR.00062-12 [PMC free article] [PubMed] [Google Scholar]
Prendergast AJ, Goga AE, Waitt C, Gessain A, Taylor GP, Rollins N. Transmission of CMV, HTLV-1, and HIV through breastmilk. Lancet Child Adolesc Heal. 2019;3(4):264–273. https://doi.org/10.1016/S2352-4642(19)30024-0
R Schleiss M. Congenital cytomegalovirus infection: molecular mechanisms mediating viral pathogenesis. Infect Disord Targets (Formerly Curr Drug Targets-Infectious Disord. 2011;11(5):449–465. DOI: https://doi.org/10.2174/187152611797636721
Boppana SB, Ross SA, Fowler KB. Congenital cytomegalovirus infection: clinical outcome. Clin Infect Dis. 2013;57(suppl_4): S178–181. https://doi.org/10.1093/cid/cit629
Ho M. Cytomegalovirus: biology and infection. Springer Science & Business Media; 2013.
Zuhair M, Smit GSA, Wallis G, Jabbar F, Smith C, Devleesschauwer B. Estimation of the worldwide seroprevalence of cytomegalovirus: A systematic review and meta‐analysis. Rev Med Virol. 2019;29(3):e2034. https://doi.org/10.1002/rmv.2034
Kagan KO, Hamprecht K. Cytomegalovirus infection in pregnancy. Arch Gynecol Obstet. 2017;296(1):15–26. https://doi.org/10.1002/bdra.23601
Atik RB, Hepworth-Jones BE DP. Early pregnancy, chapter2, Risk factors for miscarriage. Cambridge university press,2010: 9-18.
Chow SSW, Craig ME, Jacques CFH, Hall B, Catteau J, Munro SC. Correlates of placental infection with cytomegalovirus, parvovirus B19 or human herpesvirus 7. J Med Virol. 2006;78(6):747–756. https://doi.org/10.1002/jmv.20618
Kim ID, Chang HS, Hwang KJ. Herpes simplex virus 2 infection rate and necessity of screening during pregnancy: a clinical and seroepidemiologic study. Yonsei Med J. 2012;53(2):401–407. DOI: https://doi.org/10.3349/ymj.2012.53.2.401
Zhou Y, Bian G, Zhou Q, Gao Z, Liao P, Liu Y. Detection of Cytomegalovirus, human parvovirus B19, and herpes simplex virus‐1/2 in women with first‐trimester spontaneous abortions. J Med Virol. 2015;87(10):1749–1753. https://doi.org/10.1002/jmv.24218
Fowler KB, Pass RF. Sexually transmitted diseases in mothers of neonates with congenital cytomegalovirus infection. J Infect Dis. 1991;164(2):259–264. https://doi.org/10.1093/infdis/164.2.259
Kawasaki H, Kosugi I, Meguro S, Iwashita T. Pathogenesis of developmental anomalies of the central nervous system induced by congenital cytomegalovirus infection. Pathol Int. 2017;67(2):72–82. https://doi.org/10.1111/pin.12502
Papazian L, Hraiech S, Lehingue S, Roch A, Chiche L, Wiramus S. Cytomegalovirus reactivation in ICU patients. Intensive Care Med. 2016;42(1):28–37. https://doi.org/10.1007/s00134-015-40669.
Nigro G, Anceschi MM, Cosmi E V, Group TCCDC. Clinical manifestations and abnormal laboratory findings in pregnant women with primary cytomegalovirus infection. BJOG An Int J Obstet Gynaecol. 2003;110(6):572–577. https://doi.org/10.1016/S1470-0328(03)01902-5
Collinet P, Subtil D, Houfflin-Debarge V, Kacet N, Dewilde A, Puech F. Routine CMV screening during pregnancy. Eur J Obstet Gynecol Reprod Biol. 2004;114(1):3–11. https://doi.org/10.1016/j.ejogrb.2003.09.016
Zaker Bostanabad S, Rahimi MK, Mahdavi Z, Pourazar SH. Evaluation of Cytomegalovirus (CMV) in Abortion Compared with Embryos Vaginal Delivery by Using PCR. Sarem J Reprod Med. 2017;2(1):43–48. http://saremjrm.com/article-1-28-en.html
Dollard SC, Grosse SD, Ross DS. New estimates of the prevalence of neurological and sensory sequelae and mortality associated with congenital cytomegalovirus infection. Rev Med Virol. 2007;17(5):355–363. https://doi.org/10.1002/rmv.544
Dahl H-HM, Ching TYC, Hutchison W, Hou S, Seeto M, Sjahalam-King J. Etiology and audiological outcomes at 3 years for 364 children in Australia. PLoS One. 2013;8(3):e59624. https://doi.org/10.1371/journal.pone.0059624
Ross S, Novak Z, Pati S, Boppana S. Overview of the diagnosis of cytomegalovirus infection. Infect Disord Targets (Formerly Curr Drug Targets-Infectious Disord. 2011;11(5):466–474. DOI: https://doi.org/10.2174/187152611797636703
Tan BH. Cytomegalovirus treatment. Curr Treat Options Infect Dis. 2014;6(3):256–270. DOI 10.1007/s40506-014-0021-5
Lischka P, Zimmermann H. Antiviral strategies to combat cytomegalovirus infections in transplant recipients. Curr Opin Pharmacol.2008;8(5):541–548. https://doi.org/10.1016/j.coph.2008.07.002
Ligat G, Cazal R, Hantz S, Alain S. The human cytomegalovirus terminase complex as an antiviral target: a close-up view. FEMS Microbiol Rev. 2018;42(2):137–145. https://doi.org/10.1093/femsre/fuy004
Biron KK, Harvey RJ, Chamberlain SC, Good SS, Smith III AA, Davis MG. Potent and selective inhibition of human cytomegalovirus replication by 1263W94, a benzimidazole L-riboside with a unique mode of action. Antimicrob Agents Chemother. 2002;46(8):2365–2372. DOI: https://doi.org/10.1128/AAC.46.8.2365-2372.2002
Goldberg MD, Honigman A, Weinstein J, Chou S, Taraboulos A, Rouvinski A. Human cytomegalovirus UL97 kinase and non-kinase functions mediate viral cytoplasmic secondary envelopment. J Virol. 2011;85(7):3375–3384. DOI: https://doi.org/10.1128/JVI.01952-10
AL-Jurani AHH. Seroprevalence of Anti-Cytomegalovirus IgM, IgG antibodies among pregnant women in Diyala province. DJPS. 2014;10(2-part 2):116–122. https://www.iasj.net/iasj/download/e3feba324fc007b3
Ghailan SH, Mohammed SS. Assessing the risk factors for cytomegalovirus and prediction the relationship between abortion and virus in Kirkuk City Hospitals. Mosul J Nurs. 2020;8(2):127–141. https://mjn.mosuljournals.com/article_166078.html
Hussein N, Balatay AA. The Seroprevalence of Toxoplasma, Cytomegalovirus and Rubella Infections in Women with Abortion in Kurdistan Region of Iraq: A Brief Report. Int J Infect. 2019;6(1): e86734. Doi: 10.5812/iji.86734.
Yasir SJ, AL-Khafaji YA-R, Al-Kelaby KKA. Cytomegalovirus UL83 Gene as Diagnostic Marker for Preliminary Infection in Pregnant Women in AL-Najaf City. Syst Rev Pharm. 2020;11(5):123–129. DOI: 10.31838/srp.2020.5.20
Al-Mishhadani JI, Al-Janabi AU. Toxoplasmosis and cytomegalovirus infection among aborted women in Al-Anbar Governorate. AJVS. 2008;6(1): 88-97 https://www.iasj.net/iasj?aId=15678&func=fulltext
Khudhair MK, Mohammed MR, Jassim N-AS. The Serologicalrates of Cytomegalovirus Among Women in Diyala Province, With a Study of Some the Immunological Markers. DJPS. 2017;13(3-part 3): 232-241 https://www.iasj.net/iasj/article/128777
Ali KS. The Sero-Prevalence of Cytomegalovirus Infection among Women with Abortion and Intrauterine Death in Erbil City Kurdistan Region, Iraq. DJM. 2020;18(1):77–90. https://www.djm.uodiyala.edu.iq/index.php/djm/article/view/535
Aljumaili ZKM, Alsamarai AM, Najem WS. Cytomegalovirus seroprevalence in women with bad obstetric history in Kirkuk, Iraq. J Infect Public Health. 2014;7(4):277–288. https://doi.org/10.1016/j.jiph.2013.08.006
Al-azzawi RHM. Seroprevalence of cytomegalovirus infection in pre-marital women in some Baghdad hospitals. Iraqi J Sci. 2012; 53:40–45. https://www.iasj.net/iasj/download/b324df73e8ae0f31
Al-Baiati AMH, Muhsin MA, Jabbar RN. Seroprevalence of human cytomegalovirus (HCMV) in aborted women in Baghdad. International J. Curr. Microb. Appl. Sci.2014;3(2):97-102.
Al-dorri AZR. Estimation of some immunological biomarkers in aborted women infected with human cytomegalovirus (HCMV) in Salah Al-deen province. MJOTU. 2018;24(2):12–24. DOI: http://dx.doi.org/10.25130/mjotu.24.02.02
Al-Saeed MS, Muhsin MA, AL-Juburi GJ. Study the role of Toxoplasma gondii, cytomegalovirus, and anti-phospholipids antibodies in cases of abortion among women in Hilla city. QMJ. 2008;4(6):27–34.
Ali MK, Shia JS, and Al-marsome HD. Detection of HSV and CMV in Pregnant and Miscarriage women by ELISA and real time PCR Assay. Res J Pharm Technol, 2019. 12(9), 4090-4094. DOI: 10.5958/0974-360X.2019.00704.2
Jihad SA. Molecular Detection of Cytomegalovirus (CMV) Isolated from Repeated Miscarriage Women and Its Relation to TLR2 and ILT2 Receptors. MS.c Thesis Submitted to the Counsel of College of Science/Al-Nahrain, Supervised by Dr. Rehab Subhi Ramadhan 2015.
Raisan SJ, Al-Amara SSM. Determine anti-human cytomegalovirus antibodies (IgM, IgG) and heat shock protein 70 in aborted women. Eurasian J Biosci. 2020;14(1):265–268. https://www.proquest.com/openview/d871ae13f38f758cdbd44debbccbe84c/1?pqorigsite=gschola r&cbl=2042720
Khudhair SA, Al-Azzawi RH. Estimation of Anti-CMV Antibodies in Iraqi Pregnant Women Infected with Chronic Cytomegalovirus. J Glob Pharma Technol. 2018;10(11):52–56.
Naame, ZK, Thuwaini, MM, Mahdi, DS. Seroprevalence of Toxoplasma gondii, CMV, Rubella and HSV-1&2) in Aborted Women in Basra, Southern of Iraq, Ann. Trop. Med. Public Health. 2021; 24(5): 295-301. DOI: http://doi.org/10.36295/ASRO.2021.24543
AL-Ouqaili MT, AL-Karboli AY. Immunological Study of Cytomegalovirus Infection in Women with Recurrent Fetal Loss in Ramadi City, West of Iraq. AMJ. 2010;8(1):74-78
Saad A, Rahi SJ, Hussein BW. Serological Study for TORCH Infections by ELISA Method in Women with Bad Obstetric History in Kerbala City. KJM. 2013;6(2): 1621-1624
Hussein AA, Salman ST, Khashman BM. Frequency of Human Cytomegalovirus and Human Herpesvirus-1 Antigens in Product of Conceptus Tissues of Pregnant Women with Spontaneous Abortion. Iraqi J Med Sci. 2017;15(1):94-102
Al-shammary RN. Prevalence of Cytomegalovirus among pregnant women relation to congenital abnormalities in embryos and children in Wasit province, J KU. 2014;12(1):86-91 https://www.iasj.net/iasj/download/8f1d01530e853d1b
Saeed NAHAA, Ibraheem LJ, Mahmood SI. Immune Antibodies Diagnosis Of Pregnant Women In Iraq Infected With Herpes Simplex Virus And Human Cytomegalo Virus. WBPH, 2022,12, 35-42. https://scholarexpress.net/index.php/wbph/article/view/1126
Al-Mousawi, HT, and AL-Hajjar, QN. Immunogenic Diagnosis of Human Cytomegalovirus Infection in Aborted and Pregnant Women in Babylon Governorate. Journal of the college of basic education, 2020, Proceedings of the Second International Scientific Conference - Academics Syndicate Iraqi:215-227 https://www.iasj.net/iasj/download/0ea7cec68284aa4d
Hamoud, HR, Al-Kashwan, TAJ, Tarish, HR. Cytomegalovirus seropositivity among Iraqi women suffering from recurrent pregnancy loss. Al-Kufa University Journal for Biology, 2021 13(1):26-34 https://www.iasj.net/iasj/download/dbd3e8826ba4edb2
Lazim HH, Kadhim HS. Review of sero-prevalence of human cytomegalovirus in Iraq. J Microbiol Exp. 2018;6(2):50-55. doi: 10.15406/jmen.2018.06.00188.
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, et al. (2009) The PRISMA Statement for Reporting Systematic Reviews and Meta-Analyses of Studies That Evaluate Health Care Interventions: Explanation and Elaboration. PLoS Med 6(7): e1000100. doi: 10.1371/journal.pmed.1000100.
Jerman J, Jones RK, Onda T. Characteristics of US abortion patients in 2014 and changes since 2008, a report. 2016:1-26
Cannon MJ. Congenital cytomegalovirus (CMV) epidemiology and awareness. J Clin Virol. 2009;46:S6–10. https://doi.org/10.1016/j.jcv.2009.09.002
Fowler KB, Stagno S, Pass RF, Britt WJ, Boll TJ, Alford CA. The outcome of congenital cytomegalovirus infection to maternal antibody status. N Engl J Med. 1992;326(10):663–667. DOI: 10.1056/NEJM199203053261003
Ahlfors K, Ivarsson S-A, Harris S, Svanberg L, Holmqvist R, Lernmark B. Congenital cytomegalovirus infection and disease in Sweden and the relative importance of primary and secondary maternal infections: preliminary findings from a prospective study. Scand J Infect Dis. 1984;16(2):129–137. https://doi.org/10.3109/00365548409087131
Zhang S, Zhou Y-H, Li L, Hu Y. Monitoring human cytomegalovirus infection with nested PCR: comparison of positive rates in plasma and leukocytes and with quantitative PCR. Virol J. 2010;7(1):1–7. https://doi.org/10.1186/1743-422X-7-73
Schoenfisch AL, Dollard SC, Amin M, Gardner LI, Klein RS, Mayer K. Cytomegalovirus (CMV) shedding is highly correlated with markers of immunosuppression in CMV-seropositive women. J Med Microbiol. 2011;60(6):768–774. https://doi.org/10.1099/jmm.0.027771-0
Tilburgs T, Strominger JL. CD 8+ Effector T Cells at the Fetal–Maternal Interface, Balancing Fetal Tolerance and Antiviral Immunity. Am J Reprod Immunol. 2013;69(4):395–407. https://doi.org/10.1111/aji.12094
Hamid KM, Onoja AB, Tofa UA, Garba KN. Seroprevalence of cytomegalovirus among pregnant women attending Murtala Mohammed Specialist Hospital Kano, Nigeria. Afr Health Sci. 2014;14(1):125–130. https://DOI: 10.4314/ahs. v14i1.19
Rawlinson W, Scott G. Cytomegalovirus: a common virus causing serious disease. Aust Fam Physician. 2003;32(10): 789-793
Hameed MY, Aziz IH. Detection of Cytomegalovirus in Iraqi Recurrent Miscarriage Women. J. Pharm. Pharm. Sci. 2015;5(1):79-89.
Al-Samarrai MAM, Al-Rawi RA, Yaseen SM, Ali Jadoo SA. Knowledge, attitude, and practice of mothers about complementary feeding for infants aged 6-12 months in Anbar Province, Iraq. Journal of Ideas in Health 2020 May 09;3(1):125-9. doi: 10.47108/jidhealth.vol3.iss1.17.
Ogbaini-Emovon E, Oduyebo OO, Lofor PV, Onakewhor JU, Elikwu CJ. Seroprevalence and Risk Factors for Cytomegalovirus Infection among Pregnant Women in Southern Nigeria. J. Microb. Infect. Dis.2013 ;3(03):123-127 https://doi.org/10.5799/ahinjs.02.2013.03.0094
Pembrey L, Raynor P, Griffiths P, Chaytor S, Wright J, Hall AJ. Seroprevalence of cytomegalovirus, Epstein Barr virus and varicella zoster virus among pregnant women in Bradford: a cohort study. PLoS One.2013; 8(11): e81881https://doi.org/10.1371/journal.pone.008188