Human cytomegalovirus (HCMV) infections are frequently observed as well in
immunocompetent as in immunocompromised patients. Diagnostic techniques for
HCMV detection have greatly improved during the recent years. Detection of
HCMV by culture has been bettered by centrifugating samples in a shell via
l and by using monoclonal antibody to the immediate early antigen. Detectio
n of antigens in leucocytes was facilitated by using whole blood instead of
leucocytes separated by dextran sedimentation. Detection of HCMV recently
sharpened by using molecular biology methods mainly based on the detection
of the genome. Under certain circumstances, and especially in pregnant wome
n, diagnosis of HCMV infection is essentially based on the detection of IgG
and IgM antibodies. However, as IgM antibody is not a marker of primary in
fection, complementary tests are needed to help in the datation of the infe
ction. Among them, the measurement of IgG avidity greatly improved the diag
nosis of primary infections. In immunocompromised patients, very sensitive
techniques are needed to diagnose HCMV infections. Detection of antigenemia
and HCMV DNA are the methods of choice for an early detection of the infec
tion. Diagnosis of HCMV-organ diseases largely depends on the infected orga
n and the presence of HCMV in the organ is, sometimes, difficult to interpr
et. Today, diagnosis of congenital infections is possible by detecting HCMV
in the amniotic fluid. However, in order to reliably detect HCMV, amniocen
tesis must be performed after 21 week's gestation and at least 6 weeks afte
r seroconversion. As all HCMV infections do not induce disease, prognostic
markers are needed, as well in immunocompromised patients as in fetuses. Ma
ny studies were conducted in immunocompromised patients to find prognostic
markers of HCMV infection in order to introduce preemptive therapy when nee
ded. It seems that quantitative determination of HCMV DNA could be very use
ful to predict HCMV disease. Qualitative determination of mRNA could also b
e useful as a prognostic marker of HCMV disease. Determination of viral gen
otypes is more controversial. As for the infected fetuses, little was publi
shed about the prediction of sequelae. Some factors, such as viral load in
amniotic fluid or in fetal blood or level of IgM antibody in fetal blood, m
ay be predictive of sequelae, but these data require further studies. (C) 2
001 Elsevier Science B.V. All rights reserved.