Overview of diagnostic tests for cytomegalovirus infection
- Angela M Caliendo, MD, PhD
Angela M Caliendo, MD, PhD
- Executive Vice Chair of Medicine
- Brown University
Cytomegalovirus (CMV) generally produces an asymptomatic or minimally symptomatic acute illness in immunocompetent patients. In immunocompromised hosts, however, CMV infection can result in a broad array of clinical presentations, including a nonspecific syndrome (which may include fever, malaise, weakness, myalgias, arthralgias, leukopenia, and/or thrombocytopenia in the setting of viremia) or end-organ disease such as retinitis, pneumonitis, encephalitis, hepatitis, or gastrointestinal tract ulceration. These manifestations are associated with significant morbidity and mortality.
An overview of the diagnostic tests for the diagnosis of CMV infections will be presented here. The approach to the diagnosis of CMV is discussed separately. The manifestations of CMV in immunocompetent and immunocompromised patients are also presented elsewhere. (See "Approach to the diagnosis of cytomegalovirus infection" and "Epidemiology, clinical manifestations, and treatment of cytomegalovirus infection in immunocompetent adults" and "Cytomegalovirus infection in pregnancy" and "Acquired cytomegalovirus infection in children", section on 'Laboratory diagnosis' and "Pathogenesis, clinical manifestations, and diagnosis of AIDS-related cytomegalovirus retinitis", section on 'Diagnosis' and "Cytomegalovirus infection as a cause of pulmonary disease in HIV-infected patients" and "AIDS-related cytomegalovirus gastrointestinal disease" and "Clinical manifestations, diagnosis, and treatment of cytomegalovirus infection in lung transplant recipients" and "Clinical manifestations, diagnosis, and management of cytomegalovirus disease in kidney transplant recipients".)
The clinical features, diagnosis, and management of congenital CMV infection are also presented separately. (See "Congenital cytomegalovirus infection: Clinical features and diagnosis" and "Congenital cytomegalovirus infection: Management and outcome".)
The testing methods described in this topic have advantages and disadvantages and must be interpreted in the context of the clinical presentation and other diagnostic assessments. Molecular amplification methods are now the standard of care for diagnosing cytomegalovirus (CMV) infection; in the past, serologic testing and viral cultures from multiple sites were the cornerstones of diagnosis.
Appropriate diagnostic tests are essential for the management of CMV infection and disease in immunocompromised patients. Several diagnostic modalities are available, including serology, qualitative and quantitative polymerase chain reaction, pp65 antigenemia, culture, and histopathology (table 1). The techniques for detecting CMV (quantitative polymerase chain reaction and CMV pp65 antigenemia) have improved considerably.
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- Recent or acute infection
- Past infection
- Risk of acquisition
- MOLECULAR ASSAYS (PCR)
- International standard
- Comparisons of tests
- - Whole blood versus plasma
- - Different assays
- CMV ANTIGENEMIA ASSAYS
- Conventional culture
- Shell vial culture
- RESISTANCE TESTING