VIROLOGICAL ANALYSIS OF 1,000 BLOOD-SAMPL ES PROCESSED FOR CYTOMEGALOVIRUS ISOLATION (VIREMIA) AND PP65 ANTIGENEMIA IN IMMUNOSUPPRESSED PATIENTS

BACKGROUND: TO study the principal virological aspects of 1,000 blood samples processed for cytomegalovirus (CMV) isolation (viremia) and pp 65 antigenemia assay in immunosuppressed patients, and to compare the diagnostic efficacy of both technics. PATIENTS AND METHODS: All the bl ood samples collected with EDTA, were fraccionated by dextran sediment ation. The polymorfonuclear rich fraction was used for the isolation o f CMV by the shell-vial cell culture and the pp65 antigenemia assay. T he cell cultures were stained at 18-24 hours with a monoclonal antibod y against p72 CMV antigen. RESULTS: The 1,000 blood samples studied be longed to 363 patients (299 infected by the HIV, 49 renal transplant r ecipients, and 15 patients with haematologic diseases). 78 patients (2 1.4%) developed a CMV infection and/or disease. The overall results ob tained in the comparative study for the CMV detection in peripheral bl ood were 86.7% for the antigenemia assay and 58.5% for the shell-vial culture (p = 0.0001). Of 49 patients with renal transplant, 20 (40.8%) presented with a CMV infection versus 19.3% in the HIV-positive group . The transplant recipient patients presented most frequently positivi ty for both diagnostic technics, and the HIV-positive patients a highe r percentage of antigenemia-positive with culture negative. The shell- vial culture (viremia) had most diagnostic efficacy in the transplant recipients group. CONCLUSIONS: In the immunosuppressed patients the pp 65 antigenemia assay has demonstrated a high diagnostic efficacy for C MV detection in peripheral blood. However because the antigenemia not always correlates with a replicative viral load, it is necessary to ro utinely perform culture of the blood in a cell culture system, prefere ntly by the shell-vial method, because this system allows to make the diagnosis of CMV infection in a short period of time.