Journal of Clinical Virology 35 (2006) 313–316 Case report Breast milk as a source for acquisition of cytomegalovirus (HCMV) in a premature infant with sepsis syndrome: Detection by real-time PCR Benjamin T. Kerrey a , Ardythe Morrow b , Sheela Geraghty b , Nanette Huey c , Amy Sapsford b , Mark R. Schleiss d,∗ a Pediatric Residency Training Program, Children’s Hospital Research Foundation, 3333 Burnet Avenue, Cincinnati, OH 45229, USA b Division of Epidemiology, Children’s Hospital Research Foundation, 3333 Burnet Avenue, Cincinnati, OH 45229, USA c Division of Immunology, Children’s Hospital Research Foundation, 3333 Burnet Avenue, Cincinnati, OH 45229, USA d Division of Infectious Diseases and Immunology, Department of Pediatrics, University of Minnesota School of Medicine, 420 Delaware Street SE, MMC 296, Minneapolis, MN 55455, USA Received 31 May 2005; received in revised form 22 September 2005; accepted 22 September 2005 Abstract Symptomatic disease due to human cytomegalovirus (HCMV) has been increasingly recognized in low birth weight (LBW) premature infants. Breast milk has been identified as a potential source for these infections. At approximately 60 days of life a LBW, premature infant was diagnosed with HCMV sepsis syndrome, prompting further investigation of the source for HCMV acquisition. The infant had received a combination of both fresh and frozen breast milk from his mother throughout his first 2 months of life. We utilized a real-time PCR assay for HCMV DNA to retrospectively examine viral genome copy number in serial samples of stored, frozen breast milk. This analysis indicated an increase in breast milk viral load over the first 45 days of life, heralding the HCMV sepsis syndrome that was observed clinically. Real-time PCR may be a useful tool in the evaluation of HCMV viral load in breast milk. © 2005 Elsevier B.V. All rights reserved. Keywords: Cytomegalovirus; Real-time PCR; Breast milk; Premature infant; Neonatal viral infections; TORCH infections; Congenital CMV infection 1. Introduction Infection with human cytomegalovirus (HCMV) in newborn infants may have severe short- and long-term consequences (Demmler, 1996; Revello and Gerna, 2002). Perinatal transmission of HCMV can occur in the birth canal (during the labor and delivery process), or via blood transfusion or breast-feeding (Schleiss, 2003; Yeager et al., 1981; Adler, 1986; Stagno et al., 1980; Jim et al., 2004). Infections acquired by breast-feeding are common, but are seldom of clinical importance to normal term infants (Hayes et al., 1972; Yeager et al., 1981; Dworsky et al., 1983). However, in premature and/or low birth weight (LBW) infants, breast milk-acquired HCMV infection can have serious consequences (Vochem et al., 1998). In a ∗ Corresponding author. Tel.: +1 612 624 1112; fax: +1 612 624 8927. E-mail address: schleiss@umn.edu (M.R. Schleiss). prospective study, HCMV transmission was observed in 33 of 87 HCMV-exposed infants: of particular concern, 16 of these babies (48%) developed symptomatic HCMV disease, including hepatitis, neutropenia, thrombocytopenia, and a sepsis-like state (Maschmann et al., 2001). There are no guidelines on how to identify those premature infants who are at risk for acquisition of HCMV from breast milk. One rapid and sensitive technique for quantifying HCMV is the use of real-time PCR, but there are limited data available about PCR analysis of breast milk. We recently diagnosed HCMV sepsis syndrome in a premature infant convalescing in our hospital, which prompted us to examine the infant’s banked, stored breast milk using a real-time PCR assay. 2. Case report An 18-year-old primiparous woman underwent caesarean section for breech presentation and fetal distress at 25 weeks 1386-6532/$ – see front matter © 2005 Elsevier B.V. All rights reserved. doi:10.1016/j.jcv.2005.09.013