Coxsackievirus B infection is highly related with missed abortion in Korea

Abstract

Purpose: This study investigated the possible relationship between viral infection and first trimester pregnancy loss.

Materials and methods: A prospective study was performed on 51 gravidas with missed abortion, fetal anomaly, pre-term delivery, and full-tem delivery at Hanyang University Hospital. Enteroviruses were detected by semi-nested reverse transcription-polymerase chain reaction (RT-PCR) and immunohistochemistry in abortive tissues and placentas. Enterovirus serotypes were confirmed by genome sequencing. Herpesviruses were detected by PCR.

Results: Coxsackievirus B3 (CVB3) was detected in 8 of 14 missed abortion cases, 1 of 27 full-term cases, and none of the 9 pre-term cases. Coxsackievirus B1 (CVB1) was detected in an encephalocele case. Herpes simplex virus type 1 was found in 4 full-term cases, 3 pre-term cases, and none of the missed abortion cases.

Conclusion: The prevalence of CVB3 was significantly higher in missed abortion cases compared to full-term or pre-term delivery cases. CVB infection may therefore be an important etiological agent of missed abortion.

Keywords: Coxsackievirus; fetal anomaly; missed abortion.

Fig. 1

Ultrasound examination of a malformation case revealed a single female fetus with an irregular, predominantly cystic, heterogeneous mass. The mass, measuring 2.0×1.3 cm, protruded externally from the occiput, disfiguring the head of the fetus.

Fig. 2

Immunohistochemistry for CVB3 in tissues using anti-CVB3 monoclonal antibody. The cytoplasms of endometrial glandular epithelial cells are strongly stained in the three CVB3 positive missed abortive tissues with brown color (A, B, and C). There are no specific staining in CVB3 negative missed abortive tissue (D), full-term (E), and pre-term (F) placentas. CVB3, Coxsackievirus B3.

Fig. 3

The immunohistochemical analysis of the enteroviral VP1 capsid protein from tissues in an encephalocele case. VP1 was highly expressed in the epithelium and muscle layer of the tongue (A) and respiratory epithelium (B), mucosal and muscle layer of the small intestine (C), and leg muscles (D).