[Laboratory diagnosis of cytomegalovirus infections and disease]

In the diagnosis of human cytomegalovirus diseases, marked developments and improvements are achieved through laboratory methods. Quantitative PCR-based technologies including the real-time PCR assay are used for the quantitation of CMV DNA and mRNA in blood, bronchoalveolar lavage, cerebrospinal fluid, and amniotic fluid with rapidity and high-level sensitivity. In immunocompromised hosts, these assays can detect CMV DNA from blood even prior to the onset of clinical symptoms, identifying individuals at risk of developing CMV diseases. These assays are also useful in monitoring responses to antiviral treatment and predicting clinical relapse. For preemptive therapy, the thresholds can be determined for the identifying risk of diseases in each group of patients with HIV/AIDS, hematopoietic stem transplantation, and solid organ transplantation, based on PCR assays as well as pp65-antigenemia. The standardization of PCR-based techniques and evaluation of preemptive therapy through multicenter trials will be needed.