Scandinavian Journal of Infectious Diseases
ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19
Congenital Rubella after Maternal Reinfection Marianne Forsgren, Gun Carlström & Katherine Strangert To cite this article: Marianne Forsgren, Gun Carlström & Katherine Strangert (1979) Congenital Rubella after Maternal Reinfection, Scandinavian Journal of Infectious Diseases, 11:1, 81-83, DOI: 10.3109/inf.1979.11.issue-1.14 To link to this article: http://dx.doi.org/10.3109/inf.1979.11.issue-1.14
Published online: 02 Jan 2015.
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Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=infd19 Download by: [University of California Santa Barbara]
Date: 06 May 2016, At: 15:59
Scand J Infect Dis 1 I : 81-83, 1979
Case Report
Congenital Rubella after Maternal Reinfection MARIANNE FORSGREN,' GUN CARLSTROM' and KATHERINE STRANGERT3
Downloaded by [University of California Santa Barbara] at 15:59 06 May 2016
From the lVirus Department. the Central Microbiological Laboratory of the Stockholm County Council, the =Department of Clinical Microbiology, Section of Virology, Karolinska Sjukhiiset, and the 3Department of Pediatrics, Karolinska Sjiikhuset, Stockholm, Sweden
ABSTRACT. This report concerns a boy with congenital rubella virus infection. The diagnosis was confirmed by virus isolation, demonstrationof rubella-specificserum IgM and by persistence of serum antibody at the age of 9 months. In 2 sera from the mother sampled 2 weeks apart 20 months before the birth of the boy, low titers of rubella antibody were demonstrated by hemagglutination-inhibition,hemolysis-in-geland complement fixation tests, but not by neutralization.Significant rises in titer were demonstrable by all serologic reactions-including neutralization-at the time of birth of the infected child. The mother was not aware of any rubella-like illness or exposure to such disease during pregnancy. The case is discussed against findings of neutralizing activity in sera from natural immunes and rubella vaccinees.
INTRODUCTION Due to the teratogenic potential of rubella virus special attention is focussed on factors influencing immunity to the infection. Our knowledge is incomplete and it seems essential to report and discuss cases of reinfection coming to knowledge. In this paper a case of congenital rubella is presented; serologic investigation of the mother gave results compatible with subclinical reinfection during the pregnancy.
MATERIALS AND METHODS Virus isolation Attempts to isolate virus were performed in Sirc cells (lo), human fibroblasts, cynomolgous monkey kidney and HeLa cells. The strain isolated was identified by neutralization with rabbit anti-rubella hyperimmune serum. Serologic tests Neutralization tests (NT) were carried out in Sirc cells (8). Sera were tested non-heated as a rule, undiluted as well as diluted 1 : 5 . Complement (guinea pig serum at a final dilution of 2%) was added to the virus-serum mixture, which was incubated for 60 min at 35°C and overnight at +4"C. Two tube cultures were used per serum dilution; they were observed for cytopathic effects for 2 weeks. Hemagglutination-inhibition (HI) tests were performed by the CDC standardized technique (heparin-MnCI, absorption and human 0 erythrocytes (2)), and the HI method described by Herrmann et al. (6) with GI-day-old chick red cells. Serum inhibitors were, however, absorbed
with heparin-MnCb at a final concentration of 500 USP/ml i n d 0.05 M,-respectively. Hemolysis-in-gel (HIG) was performed with I-day-old chick erythrocytes (12), and complement fixation (CF) tests by a microtechnique (14) with a crude alkaline cell extract a s antigen ( 5 ) . Rubella specific IgM activity was demonstrated by HI after fractionation of serum by centrifugation for 18 h at 135000 g in sucrose density gradients (1040%). Approximately 15 fractions were collected and titrated by HI (with overnight incubation). The presence of IgM activity was confirmed by demonstration of IgM but no IgA or IgG precipitating activity (Hyland antibody class specific antisera) and by reduction of HI activity with 0.01 M dithiotreitol. Sera for neutralization were selected from routine screening for rubella immunity of women of childbearing age. Postvaccination sera were selected from the routine diagnostic material; in addition some were provided by Dr Dorothy Horstmann, Yale University, New Haven, Conn., USA.
CASE REPORT Child A boy, J. S., was born December 19, 1974 after a normal pregnancy of 44 weeks. Birth weight was 3010 g. After birth he had some breathing difficulties and cyanosis. He recovered spontaneously within one day but developed hyperbilirubinemia (bilirubin 335 pmol/l). There was no incompatibility of blood groups and no bacteremia. Platelet count was normal. Rubella virus was isolated in Sirc cells from a throat specimen collected at 11 days of age but not from urine Sctorcl J Infcct Db 11
82
M . Forsgren et al.
Table I. Virologic investigation of the boy born Dec. 19, 1974 Serial sera from the boy and the mother were tested in the same test. Serology HI Date of sampling
Agein weeks
HI titer
HIG (mm)
CF titer
Dec. 30, 1974 Feb. 11, 1975 May21, 1975 Oct. I , 1975
If 7 21 40
80 160 20 (32)" 10 (16)"
12.5 9.4 6.0b
512 64 4 2
Rubella virus isolation
IgM
IgG
+ -
+ + +
NT titer
Throat
Urine
+
-
-
ISSN: 0036-5548 (Print) 1651-1980 (Online) Journal homepage: http://www.tandfonline.com/loi/infd19
Congenital Rubella after Maternal Reinfection Marianne Forsgren, Gun Carlström & Katherine Strangert To cite this article: Marianne Forsgren, Gun Carlström & Katherine Strangert (1979) Congenital Rubella after Maternal Reinfection, Scandinavian Journal of Infectious Diseases, 11:1, 81-83, DOI: 10.3109/inf.1979.11.issue-1.14 To link to this article: http://dx.doi.org/10.3109/inf.1979.11.issue-1.14
Published online: 02 Jan 2015.
Submit your article to this journal
View related articles
Full Terms & Conditions of access and use can be found at http://www.tandfonline.com/action/journalInformation?journalCode=infd19 Download by: [University of California Santa Barbara]
Date: 06 May 2016, At: 15:59
Scand J Infect Dis 1 I : 81-83, 1979
Case Report
Congenital Rubella after Maternal Reinfection MARIANNE FORSGREN,' GUN CARLSTROM' and KATHERINE STRANGERT3
Downloaded by [University of California Santa Barbara] at 15:59 06 May 2016
From the lVirus Department. the Central Microbiological Laboratory of the Stockholm County Council, the =Department of Clinical Microbiology, Section of Virology, Karolinska Sjukhiiset, and the 3Department of Pediatrics, Karolinska Sjiikhuset, Stockholm, Sweden
ABSTRACT. This report concerns a boy with congenital rubella virus infection. The diagnosis was confirmed by virus isolation, demonstrationof rubella-specificserum IgM and by persistence of serum antibody at the age of 9 months. In 2 sera from the mother sampled 2 weeks apart 20 months before the birth of the boy, low titers of rubella antibody were demonstrated by hemagglutination-inhibition,hemolysis-in-geland complement fixation tests, but not by neutralization.Significant rises in titer were demonstrable by all serologic reactions-including neutralization-at the time of birth of the infected child. The mother was not aware of any rubella-like illness or exposure to such disease during pregnancy. The case is discussed against findings of neutralizing activity in sera from natural immunes and rubella vaccinees.
INTRODUCTION Due to the teratogenic potential of rubella virus special attention is focussed on factors influencing immunity to the infection. Our knowledge is incomplete and it seems essential to report and discuss cases of reinfection coming to knowledge. In this paper a case of congenital rubella is presented; serologic investigation of the mother gave results compatible with subclinical reinfection during the pregnancy.
MATERIALS AND METHODS Virus isolation Attempts to isolate virus were performed in Sirc cells (lo), human fibroblasts, cynomolgous monkey kidney and HeLa cells. The strain isolated was identified by neutralization with rabbit anti-rubella hyperimmune serum. Serologic tests Neutralization tests (NT) were carried out in Sirc cells (8). Sera were tested non-heated as a rule, undiluted as well as diluted 1 : 5 . Complement (guinea pig serum at a final dilution of 2%) was added to the virus-serum mixture, which was incubated for 60 min at 35°C and overnight at +4"C. Two tube cultures were used per serum dilution; they were observed for cytopathic effects for 2 weeks. Hemagglutination-inhibition (HI) tests were performed by the CDC standardized technique (heparin-MnCI, absorption and human 0 erythrocytes (2)), and the HI method described by Herrmann et al. (6) with GI-day-old chick red cells. Serum inhibitors were, however, absorbed
with heparin-MnCb at a final concentration of 500 USP/ml i n d 0.05 M,-respectively. Hemolysis-in-gel (HIG) was performed with I-day-old chick erythrocytes (12), and complement fixation (CF) tests by a microtechnique (14) with a crude alkaline cell extract a s antigen ( 5 ) . Rubella specific IgM activity was demonstrated by HI after fractionation of serum by centrifugation for 18 h at 135000 g in sucrose density gradients (1040%). Approximately 15 fractions were collected and titrated by HI (with overnight incubation). The presence of IgM activity was confirmed by demonstration of IgM but no IgA or IgG precipitating activity (Hyland antibody class specific antisera) and by reduction of HI activity with 0.01 M dithiotreitol. Sera for neutralization were selected from routine screening for rubella immunity of women of childbearing age. Postvaccination sera were selected from the routine diagnostic material; in addition some were provided by Dr Dorothy Horstmann, Yale University, New Haven, Conn., USA.
CASE REPORT Child A boy, J. S., was born December 19, 1974 after a normal pregnancy of 44 weeks. Birth weight was 3010 g. After birth he had some breathing difficulties and cyanosis. He recovered spontaneously within one day but developed hyperbilirubinemia (bilirubin 335 pmol/l). There was no incompatibility of blood groups and no bacteremia. Platelet count was normal. Rubella virus was isolated in Sirc cells from a throat specimen collected at 11 days of age but not from urine Sctorcl J Infcct Db 11
82
M . Forsgren et al.
Table I. Virologic investigation of the boy born Dec. 19, 1974 Serial sera from the boy and the mother were tested in the same test. Serology HI Date of sampling
Agein weeks
HI titer
HIG (mm)
CF titer
Dec. 30, 1974 Feb. 11, 1975 May21, 1975 Oct. I , 1975
If 7 21 40
80 160 20 (32)" 10 (16)"
12.5 9.4 6.0b
512 64 4 2
Rubella virus isolation
IgM
IgG
+ -
+ + +
NT titer
Throat
Urine
+
-
-
