CMV antibodies | IgG avidity | Interpretation | Implications |
IgM– and IgG– | Not applicable | Uninfected or very early infection | Counsel about behavioral measures to reduce risk of acquiring infection |
IgM+ and IgG– | Not applicable | Early primary infection or false positive (90%) due to another virus, autoimmune disease, laboratory methods | Repeat in two weeks Consider ancillary testing for features of acute infection: complete blood count, liver chemistries, blood or urine CMV PCR |
IgM+ and IgG+ | Low | Recent infection (within 2 to 4 months) Seroconversion is diagnostic of primary infection | Counsel about likelihood of fetal infection, possible sequelae, and options for prenatal diagnosis and management |
IgM+ and IgG+ | High | Excludes recent primary infection (within 3 months) A significant rise (at least double) in serial IgG titers suggests reactivation or reinfection | Counsel about low risk of fetal infection, but possible sequelae if fetus is infected |
IgM– and IgG+ | High | Excludes recent primary infection (within 3 months) Absence of a significant rise in serial IgG titers suggests absence of reactivation or reinfection | Counsel about low risk of fetal infection and possible sequelae No need for further testing |
IgM– and IgG+ | Low | Unclear because all validation studies of avidity have been in the setting of true positive IgM |
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