Cytomegalovirus immunoglobulin human 3g powder for solution for infusion vials

Congenital cytomegalovirus (cCMV) is the leading infectious cause of long-term neuro-sensory impairment. Aim of meta-analysis was to evaluate the efficacy of antenatal immunoglobulin therapy-particularly cytomegalovirus-specific hyperimmune globulin (HIG)-in preventing vertical transmission and congenital cytomegalovirus infection (cCMV) in pregnancies complicated by primary maternal CMV infection. A search of PubMed, Cochrane Library, Embase, Scopus, ScienceDirect, Taylor & Francis Online, Wiley Online Library, ClinicalTrials.gov, and Google Scholar identified randomized controlled trials, prospective or retrospective cohort studies including pregnant women with serologically confirmed primary CMV infection. Eligible interventions included antenatal CMV-specific or nonspecific immunoglobulins (vs placebo, usual care, historical controls, or no treatment), although all included studies evaluated CMV-specific HIG. Controlled studies showed no significant reduction in transmission (RR 0.73, 95% CI .54-1.00; P = .051) with moderate heterogeneity. The pooled transmission rate after HIG was 27.2%, with substantial heterogeneity. Current evidence does not support routine antenatal immunoglobulin to prevent cCMV.

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ObjectiveThe aim of this systematic review (SR) is to evaluate the relationship between congenital infections (Toxoplasmosis, Cytomegalovirus, Rubella, Herpes simplex type 1 and 2, HIV, Zika, and Syphilis) and the development of Autism Spectrum Disorder (ASD).Data sourceThe authors seek to identify loopholes in the current knowledge about this content and to understand the role of congenital infections in children's neurodevelopment. After the systematic search, 32 articles were included. Quality of articles was evaluated by the e Newcastle-Ottawa Scale (NOS).FindingsThe data obtained were heterogeneous; the NOS varied from 4 to 9. In 19 studies, an association between congenital infection and the development of ASD and/or features of this spectrum was not observed. Furthermore, the present findings indicate that the link between congenital infections and ASD varies depending on the pathogen and there is no common causal factor among the diseases, as their mechanisms are not yet fully understood.ConclusionThis review highlights that there is a possible correlation between some congenital infections and the development of ASD, as is the case with CMV, Zika, Rubella and Toxoplasmosis infection. As the mechanisms are not yet fully understood, there is a need for further studies and research on this topic to bridge the existing knowledge gap regarding its mechanisms.

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BackgroundThe aspartate aminotransferase-to-platelet ratio index (APRi) has been proposed as a non-invasive biomarker of liver injury in biliary atresia (BA). However, conflicting evidence and varying cutoff values have left its association with histologically confirmed liver damage uncertain. This study assessed the relationship between APRi and liver injury severity (Meta-Analysis of Histological Data in Viral Hepatitis [METAVIR] F0-F4) in BA and evaluated its predictive value.MethodsA retrospective analytical review of electronic records was conducted for all BA patients treated at a South African academic hospital between 01 January 2009 and 31 December 2019.ResultsSixty-seven patients were included, 74.6% of whom were female. The most common subtypes were cytomegalovirus (CMV) immunoglobulin M-positive (IgM+) BA (34.3%) and isolated BA (31.3%); about one-third could not be classified because CMV serology was unavailable. Liver biopsy METAVIR scores were F1 (8.3%), F2 (50.0%), F3 (18.3%) and F4 (23.3%). In a sub-analysis (n = 39), APRi modestly differentiated ≤ F2 from ≥ F3 fibrosis at a cutoff of 2.69 (area under the receiver operating characteristic curve 0.61). Decision curve analysis suggested modest clinical utility despite a non-significant logistic regression model (odds ratio 1.25; 95% confidence interval 0.94-1.92; p = 0.2). Of the 55 patients with known outcomes, 94.5% (n = 52) had confirmed mortality or were referred for palliative care.ConclusionAminotransferase-to-platelet ratio index should not replace established clinical decision-making but may provide useful adjunctive information alongside clinical, biochemical and histological assessment. These findings provide contextual evidence from a South African resource-limited setting and support prospective multicentre validation before routine clinical implementation.ContributionThe study contributes evidence supporting continued evaluation of APRi as an adjunctive non-invasive biomarker in BA in the South African setting.

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