[Cytomegalovirus infection after transplantation. Virological diagnosis, antiviral treatment].
Cytomegalovirus (CMV) is an important cause of morbidity in organ transplant recipients with two major clinical effects: allograft rejection and pneumonitis. The issue of effective therapy has increased the need for accurate and rapid laboratory methods for diagnosis of viral infections. ELISA, as the most serological sensitive tests, are useful for the identification of active CMV infection, and the serological response can be sometimes detected before viral excretion. There are several commercial reagents for the detection of IgG or IgM CMV antibody, and a great variability in terms of sensibility and specificity. Because of the slow process of isolating CMV in cell cultures, immediate-early antigen detection in infected cells within one or two days of culture, increases twice the sensitivity of viral isolation for leukocyte or bronchoalveolar (BAL) specimens. Differences in sensitivity of the direct detection of CMV antigen in BAL specimens has been reported. Direct detection of CMV antigen in leukocytes is particularly important because CMV viremia is considered to be predictive of significant CMV disease. CMV antigen detection within leucocytes, by immunofluorescence with the aid of monoclonal antibodies to CMV phosphoprotein PP-65, appears to be as specific, more sensitive, and allows a more rapid diagnosis than virus isolation techniques. Some specific CMV probes are now available, but the hybridization techniques involving dot-blot assays of urine or BAL are not enough sensitive to detect small amounts of virus. Closely sensitivity to isolation in culture has nevertheless been reported in the polymorphonuclear fraction of the blood cells.(ABSTRACT TRUNCATED AT 250 WORDS)
Freymuth
F
F
Laboratoire de Virologie, Centre Hospitalier Universitaire, Caen, France.
Petitjean
J
J
Eugene-Ruelland
G
G
Daon
F
F
Galateau
F
F
D000914:Antibodies, Viral / Q000032:analysis; D000956:Antigens, Viral / Q000302:isolation & purification; D003587:Cytomegalovirus / Q000235:genetics / Q000276:immunology / Q000302:isolation & purification; D003586:Cytomegalovirus Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000209:etiology / Q000276:immunology; D004279:DNA, Viral / Q000032:analysis; D004797:Enzyme-Linked Immunosorbent Assay; D017245:Foscarnet / Q000627:therapeutic use; D015774:Ganciclovir / Q000627:therapeutic use; D006801:Humans; D016377:Organ Transplantation / Q000009:adverse effects*; D016133:Polymerase Chain Reaction; D011183:Postoperative Complications
D000914:Antibodies, Viral; D000956:Antigens, Viral; D004279:DNA, Viral; D017245:Foscarnet; D015774:Ganciclovir
Infection à cytomégalovirus après transplantation. Diagnostic virologique, traitement antiviral.