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Journal of Clinical Microbiology, December 2000, p. 4485-4491, Vol. 38, No. 12
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

Diagnostic Implications of Human Cytomegalovirus Immediate Early-1 and pp67 mRNA Detection in Whole-Blood Samples from Liver Transplant Patients Using Nucleic Acid Sequence-Based Amplification

M. J. Blok,1,* I. Lautenschlager,2 V. J. Goossens,1 J. M. Middeldorp,3 C. Vink,1 K. Höckerstedt,4 and C. A. Bruggeman1

Department of Medical Microbiology, University Hospital Maastricht, 6202 AZ Maastricht,1 and Department of Pathology, Free University Hospital, 1081 HV Amsterdam,3 The Netherlands, and Department of Virology2 and Transplantation and Liver Surgery Unit,4 Department of Surgery,4 University Hospital Helsinki, FIN-00130 Helsinki, Finland

Received 5 May 2000/Returned for modification 15 August 2000/Accepted 21 September 2000

Nucleic acid sequence-based amplification (NASBA) was used for detection of the human cytomegalovirus (CMV) immediate early-1 (IE) and the late pp67 mRNA in 353 blood samples collected from 34 liver transplant patients. The diagnostic value of these assays was compared to that of the pp65 antigenemia assay. Overall, 95 and 42% of the antigenemia-positive samples were IE NASBA and pp67 NASBA positive, respectively. Although the results from pp67 NASBA and the antigenemia assay appeared to correspond poorly, a clear correlation was seen between pp67 NASBA-negative results and low numbers of pp65 antigen-positive cells. Twenty patients (59%) were treated with ganciclovir after the diagnosis of symptomatic CMV infection. Before initiation of the antiviral therapy, the antigenemia assay detected the onset of symptomatic infection in all patients, whereas 95 and 60% of these patients were IE NASBA and pp67 NASBA positive, respectively. Although the sensitivity of IE NASBA was very high, the positive predictive value (PPV) of this assay for the onset of a symptomatic infection was only 63%. The PPV of the antigenemia assay as well as pp67 NASBA was considerably higher (80 and 86%, respectively). Thus, the detection of IE mRNA using NASBA appears to be particularly useful as a marker for early initiation of antiviral therapy in patients at high risk for the development of a symptomatic infection. Also, IE NASBA was found to be more sensitive than the antigenemia assay for monitoring CMV infection during antiviral therapy. On the contrary, pp67 NASBA did not appear to have additional diagnostic value compared to the antigenemia assay.

* Corresponding author. Mailing address: Department of Medical Microbiology, University Hospital Maastricht, P. Debyelaan 25, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands. Phone: 31 43 38 76 644. Fax: 31 43 38 76 643. E-mail: mbl{at}lmib.azm.nl.

Journal of Clinical Microbiology, December 2000, p. 4485-4491, Vol. 38, No. 12
0095-1137/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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