EARLY DETECTION OF HUMAN CYTOMEGALOVIRUS VIREMIA BONE-MARROW TRANSPLANT RECIPIENTS BY DNA AMPLIFICATION

Surveillance blood cultures for human cytomegalovirus (HCMV) are commo nly used to identify the bone marrow transplant (BMT) recipients with the highest risk of serious HCMV disease and for whom early interventi onal ganciclovir therapy would be beneficial. We monitored 36 allogene ic BMT recipients weekly for the presence of HCMV in the blood from 0 to 100 days posttransplantation. Viable HCMV in leukocytes (WBC) was d etected by shell vial and tube culture methods. HCMV DNA in WBC and pl asma was detected by PCR and DNA hybridization using primers and a pro be from the EcoRI fragment D region of HCMV AD169. A uracil-N-glycosyl ase-dUTP PCR protocol was used to prevent false-positive results due t o amplicon carryover. Seventeen patients had multiple consecutive posi tive samples containing HCMV DNA in plasma or WBC, In 14 of 17 patient s, HCMV was also detected by blood culture. HCMV DNA was detected spor adically in six patients, none of whom had positive cultures. One pati ent had HCMV viremia detected by WBC culture only. The remaining 12 pa tients had no positive PCR assays or blood cultures, For the patients with positive blood cultures, PCR detection of HCMV DNA in plasma prec eded detection of HCMV in culture by a mean of 8 days and detection in WBC preceded detection in culture by 6 days, HCMV disease (interstiti al pneumonia) was documented for two patients with viremia (blood cult ure and PCR positive) and one patient without viremia (blood culture a nd PCR negative). The earlier recognition of high-risk patients provid ed by detection of HCMV DNA in plasma or WBC may improve the efficacy of early interventional antiviral therapy.