A Study on the Timeline of Onset of Opportunistic Cytomegalovirus: Infection in Renal Transplant Recipients and Comparison of Various Methods of Its Detection  

 Talat Masoodi 1 ,  Raman Sardana 1 ,  Ashfaq ul Hassan 3 ,  Sanjiv Jasuja 2 ,  D.K. Aggarwal 2 ,  Reetika Dawar 1 ,  Gowhar N. Mufti 4 ,  Leena Mendiratta 1 ,  Khalid Zaffar Masoodi 5
1. Department of Microbiology, Indraprastha Apollo Hospitals, New Delhi, India;
2. Department of Nephrology and Transplant Medicine, Indraprastha Apollo Hospitals, New Delhi, India;
3. Department of Anatomy/Histology, SKIMS Medical College, Bemina, India;
4. Department of Paediatric Surgery MAMC, New Delhi, India;
5. Department of Urology Research, Laboratories University of Pittsburgh, India;
Author    Correspondence author
International Journal of Molecular Medical Science, 2013, Vol. 3, No. 6   doi: 10.5376/ijmms.2013.03.0006
Received: 08 Apr., 2013    Accepted: 22 Apr., 2013    Published: 20 Jun., 2013
© 2013 BioPublisher Publishing Platform
This is an open access article published under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Preferred citation for this article:

Masoodi et al., 2013, A Study on the Timeline of Onset of Opportunistic Cytomegalovirus, International Journal of Molecular Medical Science, Vol.3, No. 6 pp.41-49 (doi: 10.5376/ijmms.2013.03.0006)

Abstract

Infectious complications are still a significant cause of morbidity and death in recipients of organ transplant. Among them Cytomegalovirus is the single most important agent affecting these patients, with at least two-thirds of these patients developing CMV infection 1~4 months after transplantation. This study was aimed to bring out the best and effective methodology or combination to detect CMV disease in post renal transplant Indian patients. We compared Quantitative CMV–DNA  Real time PCR with pp65 Antigenemia, serology (anti-CMV IgM/IgG antibody assay) and Anti-CMV IgG avidity. We tried to evaluate the time line of onset of Cytomegalovirus disease post renal transplant. Fifty consecutive renal transplant recipients with clinical suspicion of CMV disease were studied prospectively. CMV Disease was defined clinically based on some criteria. These patients were subjected to a detailed viral diagnostic workup. The clinical response to treatment was considered as a strong clinical evidence of CMV disease in retrospect. The time course of onset of CMV disease post-transplant in majority of patients was found to be between 8 to 14 weeks. Five tests were done in all 50 patients and 20 healthy subjects (control group).Out of the 50 patients who formed our study population, 32 (64%) were found to have CMV disease. All the diseased cases were picked by the Real-Time PCR giving a sensitivity of 100% and specificity of 88.8%. The sensitivity and specificity of pp-65 antigenemia was found out to be 53% and 100%. 32% of patients were found positive for CMV IgM antibody showing a sensitivity 47.05%. Out of the 32 positive patients, 9 had low avidity showing recent infection, 11 patients had high avidity showing long term infection and 12 patients had avidity in the indeterminate range. The Quantitative  Real Time PCR stood out as a sensitive test and detected all CMV infections which were considered to be clinically significant and went on to receive treatment whereas pp-65 antigenemia was found to be a more specific and confirmatory test. CMV DNA copy numbers of >500 detected by the Real-time PCR correlate 100% with the presence of CMV disease. We found CMV-IgM antibody assay was not sensitive enough for diagnosis and monitoring of active CMV disease since there is a prolonged presence of IgM antibodies after recent CMV infection. Anti-CMV IgG antibody avidity was found to have a marginal role in diagnosis of this disease. 

Keywords
Renal transplantation; Cytomegalovirus; Real-time PCR detection
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