APPLICATION OF PCR TO MULTIPLE SPECIMEN TYPES FOR DIAGNOSIS OF CYTOMEGALOVIRUS-INFECTION - COMPARISON WITH CELL-CULTURE AND SHELL VIAL ASSAY

Human cytomegalovirus (CMV) is a herpesvirus that is responsible for s ignificant morbidity and mortality in congenitally infected infants an d immunocompromised patients. Antiviral therapies are available, thus making timely diagnosis of significant importance to at-risk patients. A PCR system was devised. The newly devised system, unlike previously described systems, can be applied to a wide variety of specimen types in a clinical microbiology laboratory setting. Specimens from all sit es routinely accepted for CMV culture were shown to be acceptable for CMV PCR. Sensitivity and specificity were established in comparison wi th those of both monolayer culture and shell vial assay (SVA). The sen sitivity and specificity of PCR for detection of CMV in specimens excl usive of urine and blood were 97.5 (77 of 79 specimens) and 87.2% (41 of 47 specimens), respectively. The sensitivity and specificity of PCR for urine and blood specimens were 100 (10 of 10) and 95.7% (45 of 47 ) and 66.7 (4 of 6) and 78.8% (41 of 52), respectively. Discrepancies of positive PCR results with negative culture or SVA results occurred for specimens flanked chronologically by other culture- or SVA-positiv e specimens and were likely culture failures, increasing the specifici ty (100%) of PCR. Discrepancies of negative PCR results with positive culture or SVA results occurred in specimens with few cells or infecti ous foci by SVA or culture and may represent sampling variability asso ciated with low vims titers.