Cytomegalovirus cultured from different major leukocyte subpopulations: Association with clinical features in CMV immunoglobulin G-positive renal allograft recipients

Cytomegalovirus (CMV) cultured from peripheral blood mononuclear cells (PBM Cs) was shown to be associated more closely with clinical manifestations th an infectious CMV in polymorphonuclear leukocytes (PMNLs) of renal allograf t recipients with secondary CMV infection. Shell vial culture was carried o ut with ficoll-purified PBMCs and PMNLs of 71 CMV IgG-positive patients aft er kidney transplantation. Thirty-six patients experienced active CMV infec tions. Of these, 17 developed clinical symptoms. The diagnostic value of PM NLs and PBMCs viremia was determined in comparison to pp65 antigenemia, leu koDNAemia, plasma DNAemia, and detection of cytomegalic endothelial cells. In both PMNLs and PBMCs (with or without detectable endothelial cells), fre quencies and levels of viremia were significantly higher among symptomatic patients. Regarding the occurrence of clinical CMV manifestations, the sens itivity of culture from PMNLs and from PBMCs fractions was 100%. Viremia in PBMCs, however, was far more specific (94%) than in PMNLs (74%). Cutoff va lues established previously for pp65 antigenemia and leukoDNAemia, standard markers in the laboratory, had similar specificity (96% each) to PBMCs vir emia, but were less sensitive (88% each). Plasma DNAemia was both less sens itive (82%) and less specific (69%) than PBMCs viremia. Detection of endoth elemia showed maximal specificity (100%), but inferior sensitivity (47%). A ll patients had PBMCs viremia before the onset of symptoms. In conclusion, infectious CMV present in PBMCs may prove to be a determinant of clinical C MV manifestations in seropositive immunocompromised individuals. Factors in volved in PBMCs tropism may help to understand the pathogenetic mechanisms of CMV dissemination in this group of patients. J. Med. Virol. 61:488-496, 2000. (C) 2000 Wiley-Liss, Inc.