Anticomplement immunofluorescence test that uses isolated fibroblast nuclei for detection of antibodies to human cytomegalovirus

Comparison of two enzyme immunoassays and two latex agglutination assays for detection of cytomegalovirus antibody

Two commercially available enzyme immunoassays for cytomegalovirus (CMV) immunoglobulin G (IgG), Vidas and Diamedix, and two latex agglutination tests that detect both CMV IgG and IgM, CMV-Scan and CMV-Gen, were evaluated using 165 human serum specimens. Among these, 46.7% contained CMV-reactive antibody. The first three assays had sensitivities of 100%; the sensitivity of the CMV-Gen procedure was 98.7%. The specificities of the four tests were 100, 97.7, 97.3, and 93.2%, respectively.

Systemic viral infections and their retinal and choroidal manifestations

Viruses are one of the most common causes of infections involving the posterior segment of the eye. Such infections can occur either on a congenital or an acquired basis, and may affect primarily the retina or the choroid. Congenital cytomegalovirus (CMV) and rubella infections may result in retinitis. CMV retinitis is also the most common cause of acquired viral retinitis, primarily because of the acquired immunodeficiency syndrome (AIDS). Other types of viral retinitis, such as those caused by herpes simplex or herpes zoster, can occur in immunocompromised or immunocompetent individuals. Retinitis or choroiditis caused by viruses such as measles, influenza, Epstein-Barr virus, and Rift Valley fever virus, typically occurs subsequent to an acute viral systemic illness. The systemic and ocular manifestations, as well as the histopathology, laboratory tests, differential diagnoses, and treatment regimens for each of the individual viruses are discussed in detail.

Nonpulmonary manifestations of cytomegalovirus infection in immunocompromised patients

Nonpulmonary manifestations of cytomegalovirus (CMV) infection in immunocompromised patients include chorioretinitis, gastrointestinal infection, and central nervous system disease. Diagnosis of end organ disease, especially in the gastrointestinal tract, is best substantiated by histologic evidence of CMV inclusions. Positive cultures of CMV provide evidence for supporting infection but do not define actual end organ disease. Satisfactory treatment of the disease can be accomplished with ganciclovir or foscarnet, although these agents only suppress virus replication. In many instances, severe CMV-induced end organ disease in immunocompromised patients will progress despite treatment. In some instances, resistance to the antiviral agent is the basis for drug failure. Patients at high risk for CMV disease can be identified, and studies of prophylaxis are in progress.

Cytomegalovirus infection after organ transplantation: an update with special emphasis on renal transplantation

Cytomegalovirus infections are still the most important infectious complications after organ transplantation. Besides historical notes this review will deal with new aspects concerning the epidemiology of the CMV, diagnostic modalities of CMV infection, the delicate counterbalance between the immune system and the CMV, as well as the symptomatology of this infection. Furthermore, aspects like prophylaxis and new, promising therapeutic regimes for treatment of infection will be dealt with. Although this update is applicable for all types of solid organ transplantation, emphasis will be on renal transplantation.

An enzyme labelled nuclear antigen immunoassay for detection of cytomegalovirus IgM antibodies in human serum: specific and non-specific reactions

A mu-capture enzyme linked immunosorbent assay was developed for detection of IgM antibody to cytomegalovirus (CMV). Virus-specific IgM was detected using horseradish peroxidase labelled nuclear CMV antigen (CMV-ELA). False-positive reactions caused by Paul-Bunnell-Davidsohn (PBD) positive sera and antinuclear antibody (ANA) positive sera were identified in a combination assay employing enzyme labelled nuclear control antigen (CO-ELA) in parallel to the CMV-ELA. Four of five PBD positive and 30 of 31 ANA positive sera reactive with the CMV-ELA were identified as false positive reactions in the combined ELA-assay. The reactivity in PBD-positive sera could not be explained by antigenic cross reactivity between CMV and Epstein-Barr virus, and the results further suggested that different cell specified components of the CMV-ELA were responsible for the reactivity of PBD-positive as compared to ANA-positive sera. One of 314 healthy blood donors, 12 of 12 patients with primary CMV infection, and 11 of 15 patients with secondary CMV infection had detectable CMV IgM antibodies. Comparison of different CMV-ELAs revealed that pronounced differences in specificity as well as sensitivity may exist.

Analysis by immunoblotting of human cytomegalovirus antibody in sera of renal transplant recipient

Human cytomegalovirus-infected cell polypeptides were immunoreacted by sera of renal transplant recipients and compared with those reactive with sera of healthy adult donors by means of the Western immunoblotting technique. At least 15 polypeptides with molecular weights of 155K, 123K, 102K, 89K, 79K, 71K, 65K, 60K, 55K, 50K, 46K, 42K, 38K, 33K, and 28K were immunoreacted. Sera obtained serially from renal transplant recipients reacted with most of these polypeptides and reacted more frequently and intensely with the smaller polypeptide species such as 38K, 33K, and 28K, compared with sera of healthy seropositive adults. The implications of these findings are discussed.

The importance of primary cytomegalovirus infection in childhood cancer

Sixty-eight paediatric patients with malignant tumours or leukaemia were followed for signs of infection with human cytomegalovirus (HCMV) over 1 year. HCMV was isolated from 24 out of 68 patients at some point during the observation period; from urine in 14, from both urine and throat in 9 patients, and from throat alone in 1 patient. Previous antibody analysis indicated the presence of HCMV antibodies in 10 of the 24 virus-shedding patients, while 7 patients were seronegative and 7 undefined. Thus the incidence of reactivation appears to be higher than that of primary infection in these immunocompromised patients. The mean duration of virus shedding was 4.2 months in the primary infection group, 1.7 months in the reactivation group and 1.1 months in the undefined group. No difference in the incidence of HCMV-associated illness was observed between patients with leukaemia and those with malignant tumours. Clinical symptoms associated with HCMV infection (pneumonia (2), fever (6) and hepatitis (1)) were observed in all patients with primary infections and in only five patients with reactivated infection.

Detection of human T-cell lymphotropic virus type III-related antigens and anti-human T-cell lymphotropic virus type III antibodies by anticomplementary immunofluorescence

Techniques presently available for detection of human T-cell lymphotropic virus type III (HTLV-III) antigens and antibodies are laborious or relatively nonsensitive. We adapted anticomplementary immunofluorescence (ACIF) for these purposes. In HTLV-III-infected cells, specific ACIF was demonstrated by a diffuse speckling pattern that often resulted in a peripheral cellular rim of fluorescence. A 97% concordance was demonstrated between the ACIF assay and other sensitive tests for HTLV-III antibody detection (Western blot and membrane immunofluorescence and fixed-cell immunofluorescence tests). The ACIF assay was both more sensitive and more specific when compared with the enzyme-linked immunosorbent assay. For detection of HTLV-III antigens, the ACIF assay appeared to be as sensitive as the reverse transcriptase assay and more sensitive, with less background reactivity, than the conventional immunofluorescence assay. The ACIF assay often detected low levels of HTLV-III antigens within 3 days of infection in vitro, compared with 5 to 7 days with the indirect immunofluorescence assay, and generally paralleled the reverse transcriptase assay. The ACIF assay is a simple, sensitive, and specific assay for detection of HTLV-III-related antigens and antibodies. It should prove useful in the diagnosis of HTLV-III infection, as well as in studies of pathogenesis.

Comparison of six methods for the detection of antibody to cytomegalovirus

Five commercial assays were compared to a standardized complement fixation (CF) test for the detection of antibody to cytomegalovirus. Two hundred and thirty serum specimens were analyzed. In addition, nine pairs of acute- and convalescent-phase sera were tested by two of the commercial assays. The assays were compared as to sensitivity, specificity, and positive and negative predictive value, as well as incidence of false-positive and -negative results. Samples which did not agree in all the assays were retested and tested with an indirect fluorescent-antibody assay. Of 228 specimens, 103 (45.2%) were positive by CF. Of the 230 samples, 2 (0.9%) were inconclusive by CF and readable in the other assays. Of the 230 specimens, 97 (42.2%) were positive by an enzyme immunoassay (EIA; Litton Bionetics), 100 (43.5%) were positive by a second EIA (Abbott Laboratories), 104 (45.2%) were positive by a third EIA (M. A. Bioproducts). One hundred and eight (47.0%) were positive by indirect hemagglutination (IHA; Cetus Corporation), and 110 (47.8%) were positive by latex agglutination (LA; Hynson, Westcott and Dunning). Sensitivity and specificity were similar with all the assays (93 to 100%). The greater numbers of positive results by IHA and LA were confirmed by repeat CF testing at less than 1:8 dilution, and by indirect fluorescent-antibody assay. Acute- and convalescent-phase serum pairs showed a significant rise in antibody titer when tested by anticomplement immunofluorescence, IHA, and LA. There was good agreement among the assays, with LA having the highest sensitivity.

Antibodies to cytomegalovirus-induced pre-early nuclear antigen in the anticomplement-immunofluorescent test in comparison to IgG and IgM antibodies in the indirect and direct enzyme-linked immunosorbent assay in diagnosing cytomegalovirus infections

Development of antibody to pre-early nuclear antigen (anti-PENA) in persons with primary cytomegalovirus (CMV) infection was tested in serial serum specimens of four renal transplant patients and four patients undergoing open heart surgery using the anticomplement-immunofluorescent test (ACIF). In patients undergoing open heart surgery seroconversion of anti-PENA was mostly concomitant with the rise of IgG or IgM antibodies determined in the indirect or direct enzyme-linked immunosorbent assay (ELISA) whereas in all renal transplant patients developing anti-PENA a delayed rise of this antibody compared to IgG and IgM antibodies was observed. Significant rise of anti-PENA accompanied by an increase of IgG and IgM antibodies in indirect and direct ELISA was also found in three patients undergoing open heart surgery with recurrent CMV-infection. Anti-PENA was shown to persist longer than IgM antibody. Moreover, anti-PENA was present in the serum of nearly two-thirds of 30 persons with IgG antibody but without IgM antibody. It is concluded that antibody determination to PENA can serve as an additional means of diagnosing primary and recurrent CMV infections. Because of its long persistence only seroconversion or significant rise of this antibody may be considered evidence of infection. In some patients a delayed development of anti-PENA must be taken into consideration.

Immunologic abnormalities in patients with hemophilia A

To assess the immunologic status of healthy persons with hemophilia A, we performed studies of T cell immunity in 21 patients, 10 given only cryoprecipitate and 11 given factor VIII concentrate. Patients in the factor VIII group had significantly decreased helper/suppressor T cell ratios. Both groups had diminished mononuclear cell response to phytohemagglutinin and normal mixed lymphocyte culture, compared with controls. Abnormalities in T cell number or function did not correlate with the presence of antibody to cytomegalovirus, Epstein-Barr virus, or hepatitis B. Physicians caring for patients with hemophilia A should realize that asymptomatic individuals may have early evidence of immunodeficiency.

Evaluation of murine cytomegalovirus antibody detection by serological techniques

Naturally acquired murine cytomegalovirus (MCMV) infection in laboratory strains of mice induces antibody levels which are generally undetectable by standard techniques; therefore, MCMV has not been included routinely in mouse viral antibody screening programs. The relative sensitivity of three assay systems, the nuclear anticomplement immunofluorescence (NACIF), the enzyme-linked immunosorbent assay (ELISA), and the complement fixation (CF) test, was evaluated for the detection of MCMV antibodies. Sera were harvested from CD1 male mice (33 days old) infected intraperitoneally with salivary gland-passaged MCMV (Smith strain). The sera were assayed separately at weeks 1 through 8, and at week 11, 16, and 25 post-inoculation; a total of 167 mice in 11 groups were tested. The animals tested at 1 week post-inoculation had low levels of antibodies to MCMV as measured by the NACIF test (1:10), whereas only 25% were positive by ELISA, and none was positive by CF until 5 weeks post-inoculation. A higher titer of MCMV antibodies was measured by CF (1:640) than by NACIF (1:40) at 6 months post-inoculation; yet, a titer of 1:3,200 was detected by ELISA from the same serum. The ELISA technique was more sensitive for detecting persistent infection with MCMV, and NACIF was more useful for detecting acute MCMV infection. Since MCMV can have significant long-term effects on the immune system, it is recommended that testing for antibodies to MCMV be included in mouse viral antibody screening protocols.

Cytomegalovirus and Kaposi's sarcoma in young homosexual men

10 homosexual men with Kaposi's sarcoma (KS) were studied for evidence of cytomegalovirus (CMV) infection. IgG and IgM antibodies to CMV were detected in 9 out of 9 and in 7 out of 9 of these patients, respectively. CMV was recovered from body secretions or peripheral blood of 7 patients. Viral cultures of KS tumour biopsy specimens were negative in 8 out of 8 patients, but CMV RNA was detected by in-situ hybridisation in 2 out of 3 and CMV antigen(s) by immunofluorescence in 6 out of 9. Normal tissue specimens from 3 KS patients were negative for CMV antigen. These observations suggest an association of CMV with KS.