title: Detection of human cytomegalovirus antigenaemia: a rapid diagnostic technique for predicting cytomegalovirus infection/pneumonitis in lung and heart transplant recipients.
abstract: BACKGROUND
  New rapid diagnostic techniques offer the opportunity of early diagnosis of human cytomegalovirus (CMV) infection in immunocompromised patients at risk of developing CMV disease. The use of human CMV antigenaemia as a predictor of clinical CMV infection and disease in lung and heart transplant recipients was studied prospectively.
  
  
  METHODS
  Twenty three heart and nine lung transplant recipients who survived 40 days were observed by standard CMV surveillance with serological testing, culture, and by sequential testing for CMV antigenaemia. CMV antigenaemia testing is a rapid and quantifiable technique in which a viral lower matrix protein is detected in cytospin preparations of peripheral blood polymorphonuclear leucocytes (PMNLs) by immunofluorescent staining.
  
  
  RESULTS
  Eleven patients developed CMV infection and five developed CMV disease (four pneumonitis, one duodenitis). These clinical events occurred at a median of 65 days following transplantation. CMV antigenaemia occurred in 17 patients at a median of 35 days following transplantation. Detection of CMV antigenaemia had a sensitivity of 100%, a specificity of 93.7%, and a positive predictive value of 94.1% for CMV related illness. CMV antigenaemia was positive at a significant interval before the clinical event. High levels of CMV antigenaemia (> 50 CMV antigen positive cells/2 x 10(5) PMNLs) occurred in 11 patients and five of these developed disease. CMV antigenaemia of > 50 CMV antigen positive cells/2 x 10(5) PMNLs had a positive predictive value of 45.5% for disease but a negative predictive value of 100%. Patients with disease had higher levels of antigenaemia than those without disease.
  
  
  CONCLUSIONS
  CMV antigenaemia is a rapid diagnostic technique which can identify patients likely to develop CMV disease, potentially allowing early treatment.
authors.affiliation: North West Lung Centre, Wythenshawe Hospital, Manchester, UK.
authors.forename: J J
authors.initials: JJ
authors.lastname: Egan
authors.forename: L
authors.initials: L
authors.lastname: Barber
authors.forename: J
authors.initials: J
authors.lastname: Lomax
authors.forename: A
authors.initials: A
authors.lastname: Fox
authors.forename: N
authors.initials: N
authors.lastname: Yonan
authors.forename: A N
authors.initials: AN
authors.lastname: Rahman
authors.forename: C S
authors.initials: CS
authors.lastname: Campbell
authors.forename: A K
authors.initials: AK
authors.lastname: Deiraniya
authors.forename: K B
authors.initials: KB
authors.lastname: Carroll
authors.forename: J
authors.initials: J
authors.lastname: Craske
mesh_terms: D000956:Antigens, Viral / Q000097:blood*; D003587:Cytomegalovirus / Q000276:immunology / Q000302:isolation & purification*; D003586:Cytomegalovirus Infections / Q000175:diagnosis*; D016027:Heart Transplantation / Q000009:adverse effects*; D006801:Humans; D016867:Immunocompromised Host; D016040:Lung Transplantation / Q000009:adverse effects*; D011446:Prospective Studies; D013997:Time Factors
chemical_list: D000956:Antigens, Viral