DIAGNOSIS OF CYTOMEGALOVIRUS (CMV) INFECTION IN PEDIATRIC TRANSPLANT PATIENTS BY THE ANTIGENEMIA, SHELL VIAL, AND CONVENTIONAL CULTURE ASSAYS PERFORMED ON BLOOD - CORRELATION WITH CMV-DISEASE

Background: Human cytomegalovirus (CMV) is a significant cause of morb idity and mortality in transplant recipients. Isolation of CMV from bl ood leukocytes (CMV viremia) is considered predictive of CMV disease i n transplant recipients. Therefore, investigation of methods for the r apid detection of CMV in the blood is important for diagnosis and mana gement of these patients. Objective: To compare three techniques for t he diagnosis and monitoring of CMV infection in a pediatric transplant population through the quantitative detection of CMV in peripheral bl ood leukocytes (PBL). Methods: Serial blood specimens were obtained fo r most patients. After separation of the PBL from each specimen, aliqu ots of the PBL were used for direct detection of CMV antigenemia by im munoperoxidase staining of acetone-fixed cells (CMV-vue kit, INCSTAR), and by immunofluorescence staining of formaldehyde-fixed cells (Compl ete 1C3 kit, Biosoft Argene). PBL were also inoculated into convention al cell culture tubes and shell vials. Patients' medical records were reviewed to ascertain the clinical significance of the results, Result s: A total of 154 specimens obtained from 38 pediatric transplant reci pients were evaluated. CMV was detected in 16 specimens obtained from eight patients: 11 specimens were found positive with the CMV-vue kit, 10 with the Complete 1C3 kit, four by conventional culture, and one b y the shell vial assay. Seven of the eight patients with CMV-positive PBL had clinical signs and other laboratory evidence of active CMV inf ection. In general, a high-level antigenemia was demonstrated in the p resence of clinical disease; but there were exceptions. Conclusions: T he two antigenemia kits were more sensitive than conventional culture and the shell vial assay for the detection of CMV in the blood of pedi atric transplant patients. Our results suggest that CMV antigenemia is a sensitive and specific rapid method for the diagnosis and monitorin g of CMV infection in our patient population.