MONITORING OF HUMAN CYTOMEGALOVIRUS INFECTIONS IN PEDIATRIC BONE-MARROW TRANSPLANT RECIPIENTS BY NUCLEIC-ACID SEQUENCE-BASED AMPLIFICATION

In the diagnosis of human cytomegalovirus (HCMV) infection, it is very important to distinguish symptomatic from asymptomatic infection. The nucleic acid sequence-based amplification (NASBA) technique was compa red with single and nested polymerase chain reaction (PCR) methods. Fo r NASBA detection, the beta(2.7) transcript was chosen as a target bec ause of its abundant active HCMV-specific expression. Of 20 pediatric bone marrow transplant (BMT) recipients, 8 developed HCMV-related clin ical symptoms. The clinical sensitivities and specificities were 50% a nd 100% for single PCR, 100% and 67% for nested PCR, and 100% and 83% for NASBA, respectively. Follow-up of HCMV infections in pediatric BMT recipients showed that NASBA could both detect viral transcript prior to the onset of clinical symptoms and reflect clinical improvement du e to antiviral therapy. These data suggest that NASBA should be useful for both predicting HCMV disease development and monitoring the effec t of antiviral therapy.