LABORATORY DIAGNOSIS OF HCMV-RELATED DISEASE IN RENAL-TRANSPLANT PATIENTS - PP65 ANTIGEN-DETECTION VERSUS NESTED PCR

Background: Sixty-five renal transplant (Tx) recipients were monitored for signs and symptoms of human cytomegalovirus (HCMV) infection. Obj ectives: Different diagnostic markers were evaluated for early and cor rect diagnosis of HCMV disease. Study design: Blood and urine samples were obtained in weekly intervals and the following markers were deter mined: (1) IgG and IgM antibodies in serum using immunofluorescence an d ELISA. tests; (2) viral shedding in urine by rapid centrifugation cu lture (RCC); (3) viral antigen (pp65) in peripheral blood leukocytes ( PBL) by immunofluorescence and (4) viral DNA in PBL by nested PCR (NPC R). Results: Twenty-two patients remained free of HCMV infection, 18 p atients developed clinical symptoms of HCMV disease, and 25 patients r emained asymptomatic in spite of laboratory signs of HCMV infection. F or the early detection of HCMV disease, the highest sensitivity was ac hieved using NPCR (100%) and pp65 antigen detection (94%). RCC and IgM serology were less sensitive (62% and 40% respectively). The differen ces of sensitivity were significant. Clinical specificity was 47% for NPCR, 79% for pp65 antigen detection, 66% for RCC, and 68% for IgM ser ology. Conclusion: In contrast to NPCR, pp65 antigen detection was clo sely correlated with the appearance of clinical disease and proved to be a useful marker in the monitoring of antiviral therapy.