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Published on: July 10, 2014
Cytomegalovirus testing: antibody determinations and virus cultures with recommendations for use
1Department of Pathology, University of Wisconsin Hospital and Clinics, Madison 53792.
Insights
Human cytomegalovirus (CMV) can cause serious infections in immunocompromised individuals. This review details five diagnostic assays for CMV detection, aiding in appropriate clinical use.
Area of Science:
- Virology
- Immunology
- Clinical Diagnostics
Background:
- Human cytomegalovirus (CMV) is a common virus that establishes latency in immunocompetent hosts.
- CMV infections can lead to severe disease in immunocompromised patients, particularly transplant recipients.
- Accurate and timely diagnosis of CMV is crucial for patient management.
Purpose of the Study:
- To review and compare five distinct diagnostic assays for human cytomegalovirus (CMV).
- To discuss the advantages, limitations, and appropriate clinical applications of each CMV detection method.
- To guide the selection of optimal diagnostic tests for various clinical scenarios.
Main Methods:
- Latex agglutination (LA) test for antibody detection.
- Complement fixation (CF) test for seroconversion/reactivation.
- Immunofluorescent antibody-IgM (IFA-IgM) test for infant diagnosis.
- "Routine" CMV culture as the gold standard for viral detection.
- Shell vial assay for rapid virus detection.
Main Results:
- Each assay targets different aspects of CMV infection (antibody, active virus, IgM).
- LA and CF tests are valuable for serological assessment and monitoring.
- IFA-IgM is specific for diagnosing congenital/neonatal CMV.
- "Routine" culture provides definitive viral detection.
- Shell vial assay offers rapid results for treatment decisions.
Conclusions:
- A range of diagnostic tools exists for CMV detection, each with specific strengths.
- The choice of assay depends on the clinical context, patient population, and diagnostic question.
- Understanding the nuances of each test ensures effective management of CMV infections.
Abstract:
Human cytomegalovirus is a ubiquitous virus with the property of becoming latent in the immunocompetent host. It can also cause devastating infections in the immunocompromised patient. Several different assays are available to detect either cytomegalovirus antibodies or cytomegalovirus itself, five of which are used at the University of Wisconsin Hospitals and Clinics and the Wisconsin State Laboratory of Hygiene. The latex agglutination (LA) test is used to detect antibody positivity in transplant donors, transplant recipients, and others. The complement fixation (CF) test is used to detect seroconversion or reactivation of infection in the CMV positive host. The immunofluorescent antibody-IgM (IFA-IgM) test is used to diagnose infection in congenitally or neonatally infected infants. The "routine" CMV culture is the "gold standard" for the detection of the cytomegalovirus in patient secretions. The shell vial assay, a rapid method of detecting virus, is most useful when contemplating therapy for active CMV infection. The advantages and limitations, as well as the timing and appropriateness of each test, are reviewed.
