RECOGNITION AND RAPID DIAGNOSIS OF UPPER GASTROINTESTINAL CYTOMEGALOVIRUS-INFECTION IN MARROW TRANSPLANT RECIPIENTS - A COMPARISON OF 7 VIROLOGICAL METHODS

This is a retrospective study of 54 consecutive upper gastrointestinal endoscopies in marrow graft recipients performed to determine the inc idence and distribution of CMV infection in symptomatic patients and t o compare the sensitivities of 7 CMV detection techniques. At each end oscopy, 3 biopsies were obtained from the esophagus, stomach, and duod enum. Each of the 3 biopsies was assayed for CMV by different techniqu es. Enteric CMV was identified by one or more techniques in 52 of 486 (11%) biopsies from 14 infected patients. All patients infected with C MV initially had nausea and vomiting. In 13 of these patients, there w as esophageal CMV, often associated with stomach (10 patients) and duo denal (7 patients) involvement. CMV infection of the esophagus was nev er identified cytologically in esophageal imprints or histologically, immunohistologically, or by DNA hybridization in esophageal epithelial cells. The most sensitive diagnostic methods were conventional and ce ntrifugation cultures, which each identified CMV in 17 of the 30 (57%) organs positive by any technique. Indirect fluorescent antibody (IFA) staining for a late CMV antigen detected 53%, followed by in situ DNA hybridization (40%), IFA and immunoperoxidase (IP) staining for an ea rly CMV antigen (37% and 43%), and routine histology (30%). Although n o single detection technique is completely adequate for the rapid iden tification of CMV in small endoscopic biopsies, centrifugation culture is the method of choice, with supplementary immunohistology and in si tu hybridization of archival tissue if needed.