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Congenital rubella syndrome after maternal reinfection

Rötelnembryopathie nach einer mütterlichen Reinfektion

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Summary

This report concerns a case of congenital rubella syndrome (CRS) with atypical immune response affecting an infant whose mother had repeated evidence of immunity before pregnancy. Laboratory diagnosis of CRS could only clearly be achieved by virus isolation after the second month of life despite typical clinical features of CRS and multiple organ involvement. After the first month of age, low concentrations of specific IgM antibodies were revealed by ELISA and confirmed by a reference test system (IgM-specific haemagglutination inhibition assay). Persistent and increasing high levels of IgM antibodies were detected only after the 6th month of life. Later on IgG antibody levels decreased. Immunological investigations showed an IgG1-hypoglobulinaemia. The unusual feature of the present case report is not only the failure of the maternal rubella immunity to prevent CRS, but the defect of the child's immune system, probably attributable to congenital infection. As a consequence, laboratory diagnosis of CRS could not be achieved initially by the proved serological methods.

Zusammenfassung

Wir berichten über eine kongenitale Rötelninfektion mit atypischer Immunreaktion bei einem Kind, bei dessen Mutter eine Rötelnimmunität wiederholt vor der Schwangerschaft nachgewiesen worden war. Die Labordiagnose war ab dem 2. Lebensmonat nur eindeutig anhand der Virusisolierung möglich, obwohl das klassische klinische Erscheinungsbild eines kongenitalen Rötelnsyndroms vorlag und mehrere Organe involviert waren. Nach dem ersten Lebensmonat wurden vorübergehend spezifische IgM-Antikörper mit 2 ELISA-Tests in schwacher Konzentration nachgewiesen und mit einem Referenzverfahren (Inhibierung der Hämagglutination mit der isolierten IgM-Fraktion) bestätigt. Persistierende IgM-Antikörper in ansteigender Konzentration waren ab dem 6. Lebensmonat nachweisbar. Im weiteren Verlauf sanken die spezifischen IgG-Antikörper ab. Die immunologische Analyse wies eine IgG1-Hypoglobulinämie nach. Die Besonderheit des geschilderten Falles liegt nicht nur im Versagen der mütterlichen Immunität, eine kongenitale Rötelninfektion zu verhindern, sondern auch im Defekt des kindlichen Immunsystems, welcher möglicherweise durch die kongenitale Rötelninfektion bedingt war, so daß über die bewährten Methoden der Infektionsserologie die Labordiagnose zunächst nicht gestellt werden konnte.

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Authors and Affiliations

  1. Abt. für Medizinische Virologie, Zentrum der Hygiene, Universitätskliniken Frankfurt, Paul-Ehrlich-Str. 40, W-6000, Frankfurt a. M. 70

    B. Weber,  H. Rabenau &  H. W. Doerr

  2. Abt. für Neonatologie, Zentrum der Kinderheilkunde, Universitätskliniken Frankfurt, Paul-Ehrlich-Str. 40, W-6000, Frankfurt a. M. 70

    R. Schößer & B. Wegerich

  3. Institut für Humangenetik, Universitätskliniken Frankfurt, Paul-Ehrlich-Str. 40, W-6000, Frankfurt a. M. 70

    R. Koenig

  4. Institut für Medizinische Virologie und Infektionsepidemiologie e.V., Lenzhalde 85, W-7000, Stuttgart 10, Germany

    Gisela Enders

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  1. B. Weber
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  2. H. Rabenau
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  3. H. W. Doerr
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  4. R. Schößer
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  6. R. Koenig
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  7. Gisela Enders
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Weber, B., Rabenau, H., Doerr, H.W. et al. Congenital rubella syndrome after maternal reinfection. Infection 21, 118–121 (1993). https://doi.org/10.1007/BF01710747

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  • DOI: https://doi.org/10.1007/BF01710747

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