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This is because pregnant women can produce IgM during reactivations or reinfections. In addition, virus-specific IgM may persist for months after natural infection and anti-CMV IgM antibodies have been detected in some pregnant women 6�C9?months after the end of the acute phase of primary infection. False-positive results are common and may arise in patients with other viral infections (e.g. parvovirus B19, Epstein�CBarr virus) or autoimmune diseases or as the result of interference by rheumatoid factor of the IgM class, and finally false-positive results may also be ascribed to the laboratory methods used [19�C21]. Hence, the detection of IgM in the serum of pregnant women may simply be a starting point for further diagnostic investigations [22]. Immunoblotting with purified native viral proteins and purified recombinant proteins (structural and non-structural) has been shown to be an effective method to confirm the presence of CMV IgM antibodies Tryptophan synthase in serum with a high sensitivity (100%) and specificity (98.6%) [23]. In addition, analysis of the virus-specific IgM response to individual structural and non-structural CMV proteins allows the detection of fairly typical reactive profiles to distinguish primary from non-primary infection. Moreover, serum IgM from women who transmit CMV infection reacts with a higher number of antigen bands than serum learn more IgM from women who do not transmit the infection, probably because transmitting women have a higher viral load. (p? binds to a multivalent antigen. During the first weeks following primary infection, IgG antibodies show a low avidity for the antigen, but they progressively and slowly mature, initially acquiring a moderate and then a high avidity. This process reflects the maturation of the immune response and the high avidity antibodies are maintained for many years. For this reason, low avidity CMV-IgG antibodies are found only after primary antigenic stimulation and usually last for approximately 16�C18?weeks after the onset of CMV infection PI3K inhibitor [25,26]. A low avidity index indicates the presence of low-avidity IgG antibodies in serum during an acute or recent primary CMV infection [27,28]. A high avidity index during the first 12�C16?weeks of gestation could be considered a good indicator of past infection [29]. The determination of anti CMV antibody avidity carried out before weeks 12�C16 of gestation is therefore a helpful tool to identify all pregnant women who may give birth to an infected newborn (100% sensitivity). If the IgG avidity index is determined later during pregnancy (after 18�C20 weeks of gestation), the sensitivity is drastically reduced (62.5%) [25].
