A sensitive and specific polymerase chain reaction-based assay for the diagnosis of cytomegalovirus retinitis.
OBJECTIVE
To develop a sensitive and specific laboratory assay for the diagnosis of cytomegalovirus retinitis.


METHODS
We used a polymerase chain reaction-based assay for detection of cytomegalovirus DNA in vitreous samples. We attempted to detect cytomegalovirus DNA in 19 vitreous samples from patients with the acquired immunodeficiency syndrome (AIDS) who had untreated cytomegalovirus retinitis and in 40 vitreous samples from patients with AIDS who had been treated with systemic ganciclovir or foscarnet, or both. We also attempted to detect cytomegalovirus DNA in vitreous samples from 54 immunocompetent patients, including 32 with retinal detachment or macular hole, 11 with vitreous inflammation, and 11 with vitreous hemorrhage. Additionally, we attempted to detect cytomegalovirus DNA in 15 vitreous samples from patients with AIDS who had vitreoretinal inflammation not caused by cytomegalovirus.


RESULTS
Cytomegalovirus DNA was detected in 18 of 19 eyes with untreated cytomegalovirus retinitis. We detected cytomegalovirus DNA in 19 of 40 vitreous samples from patients with previously treated cytomegalovirus retinitis. Cytomegalovirus DNA was not detected in any of 69 patients who did not have a clinical diagnosis of cytomegalovirus retinitis. Thus, the assay had an estimated sensitivity of 95% in detecting untreated cytomegalovirus retinitis and a sensitivity of 48% in detecting cytomegalovirus retinitis that had been treated with systemic ganciclovir or foscarnet, or both. The assay did not give false-positive results in patients with vitreous hemorrhage or vitreous inflammation. Most important, the assay did not give false-positive results in AIDS patients with vitreous inflammation from causes other than cytomegalovirus retinitis.


CONCLUSIONS
We have developed a sensitive and specific diagnostic assay that will assist in the diagnosis of cytomegalovirus retinitis.
McCann
J D
JD
Francis I. Proctor Foundation for Research in Ophthalmology, University of California, San Francisco 94122-0944, USA.
Margolis
T P
TP
Wong
M G
MG
Kuppermann
B D
BD
Luckie
A P
AP
Schwartz
D M
DM
Irvine
A R
AR
Ai
E
E
D017088:AIDS-Related Opportunistic Infections / Q000175:diagnosis* / Q000188:drug therapy; D001483:Base Sequence; D003587:Cytomegalovirus / Q000235:genetics*; D017726:Cytomegalovirus Retinitis / Q000175:diagnosis* / Q000188:drug therapy; D017931:DNA Primers / Q000737:chemistry; D004279:DNA, Viral / Q000032:analysis*; D004359:Drug Therapy, Combination; D005128:Eye Diseases / Q000821:virology; D005189:False Positive Reactions; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D008969:Molecular Sequence Data; D016133:Polymerase Chain Reaction / Q000379:methods*; D012680:Sensitivity and Specificity; D014822:Vitreous Body / Q000821:virology; D014823:Vitreous Hemorrhage / Q000821:virology
D017931:DNA Primers; D004279:DNA, Viral; D017245:Foscarnet; D015774:Ganciclovir