Sensitivity of the Cytomegalovirus Antigenemia Assay to Diagnose Cytomegalovirus Retinitis
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Background: Cytomegalovirus (CMV) retinitis is one of the most important tissue-invasive CMV diseases in immunocompromised patients. Since 1980, non-invasive diagnostic methods, notably the CMV antigenemia assay, have been widely used as adjunct tests to diagnose tissue-invasive CMV diseases. However, there are limited data on the diagnostic value of the CMV antigenemia assay for diagnosing CMV retinitis. Materials and Methods: We performed a retrospective review of all cases of CMV retinitis at Asan Medical Center, Seoul, South Korea over a 9-year period. The diagnosis of CMV retinitis was made by experienced ophthalmologists according to medical history and an ophthalmoscopic appearance of typical retinopathy, together with absence of an alternative diagnosis. Results: We analyzed 44 patients with CMV retinitis (affecting 57 eyes) for whom the CMV antigenemia assay was performed. Of the 44 patients, 31 (70%) were HIV-uninfected and 13 (30%) were HIV-infected. The overall sensitivity of the CMV antigenemia assay was 66% (95% confidence interval [CI] 50–80%). The test’s sensitivity showed a non-significant trend towards being higher in HIV-infected patients than in HIV-uninfected patients (sensitivity 85% vs 58%, respectively, P = 0.16). In a subgroup analysis of the 35 patients without other concurrent tissue-invasive CMV disease, the sensitivity of the CMV antigenemia assay was 57% (95% CI 40–74%). Conclusions: The CMV antigenemia assay has limited value as a non-invasive diagnostic adjunct test for CMV retinitis. Therefore, the results of the assay need to be interpreted in the context of underlying disease, clinical presentation, and ophthalmoscopic findings.
Abstract
Background: Cytomegalovirus (CMV) retinitis is one of the most important tissue-invasive CMV diseases in immunocompromised patients. Since 1980, non-invasive diagnostic methods, notably the CMV antigenemia assay, have been widely used as adjunct tests to diagnose tissue-invasive CMV diseases. However, there are limited data on the diagnostic value of the CMV antigenemia assay for diagnosing CMV retinitis. Materials and Methods: We performed a retrospective review of all cases of CMV retinitis at Asan Medical Center, Seoul, South Korea over a 9-year period. The diagnosis of CMV retinitis was made by experienced ophthalmologists according to medical history and an ophthalmoscopic appearance of typical retinopathy, together with absence of an alternative diagnosis. Results: We analyzed 44 patients with CMV retinitis (affecting 57 eyes) for whom the CMV antigenemia assay was performed. Of the 44 patients, 31 (70%) were HIV-uninfected and 13 (30%) were HIV-infected. The overall sensitivity of the CMV antigenemia assay was 66% (95% confidence interval [CI] 50–80%). The test’s sensitivity showed a non-significant trend towards being higher in HIV-infected patients than in HIV-uninfected patients (sensitivity 85% vs 58%, respectively, P = 0.16). In a subgroup analysis of the 35 patients without other concurrent tissue-invasive CMV disease, the sensitivity of the CMV antigenemia assay was 57% (95% CI 40–74%). Conclusions: The CMV antigenemia assay has limited value as a non-invasive diagnostic adjunct test for CMV retinitis. Therefore, the results of the assay need to be interpreted in the context of underlying disease, clinical presentation, and ophthalmoscopic findings.
참고문헌 (32)
- Rafailidis PI, "Severe cytomegalovirus infection in apparently immunocompetent patients: a systematic review", Virol J, 5, pp.47~ (2008)
- Gallant JE, "Incidence and natural history of cytomegalovirus disease in patients with advanced human immunodeficiency virus disease treated with zidovudine. The Zidovudine Epidemiology Study Group", J Infect Dis, 166, pp.1223~1227 (1992)
- Xhaard A, "Increased incidence of cytomegalovirus retinitis after allogeneic hematopoietic stem cell transplantation", Transplantation, 83, pp.80~83 (2007)
- Kuo IC, "Clinical characteristics and outcomes of cytomegalovirus retinitis in persons without human immunodeficiency virus infection", Am J Ophthalmol, 138, pp.338~346 (2004)
- van den Berg AP, "Cytomegalovirus antigenemia as a useful marker of symptomatic cytomegalovirus infection after renal transplantation--a report of 130 consecutive patients", Transplantation, 48, pp.991~995 (1989)
- Pérez JL, "Comparison of several fixation methods for cytomegalovirus antigenemia assay", J Clin Microbiol, 33, pp.1646~1649 (1995)
- Podzamczer D, "pp65 antigenemia as a marker of future CMV disease and mortality in HIV-infected patients", Scand J Infect Dis, 29, pp.223~227 (1997)
- Jang EY, "Diagnostic performance of the cytomegalovirus (CMV) antigenemia assay in patients with CMV gastrointestinal disease", Clin Infect Dis, 48, pp.e121~e124 (2009)
- Moon SM, "Diagnostic yield of the cytomegalovirus (CMV) antigenemia assay and clinical features in solid organ transplant recipients and hematopoietic stem cell transplant recipients with CMV pneumonia", Transpl Infect Dis, 14, pp.192~197 (2012)
- Ko GB, "Increased incidence of herpes zoster in the setting of cytomegalovirus preemptive therapy after kidney transplantation", Transpl Infect Dis, 15, pp.416~423 (2013)
- Tark Kim, "Differences of cytomegalovirus diseases between kidney and hematopoietic stem cell transplant recipients during preemptive therapy", The Korean Journal of Internal Medicine, 31(5), pp.961~970 (2016), 대한내과학회[DOI]
- Okamoto T, "Successful treatment of severe cytomegalovirus retinitis with foscarnet and intraocular injection of ganciclovir in a myelosuppressed unrelated bone marrow transplant patient", Bone Marrow Transplant, 20, pp.801~803 (1997)
- Alain S, "Failure of ganciclovir treatment associated with selection of a ganciclovir-resistant cytomegalovirus strain in a lung transplant recipient", Transplantation, 63, pp.1533~1536 (1997)
- Miyamoto T, "Early viral complications following CD34-selected autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma", Br J Haematol, 100, pp.348~350 (1998)
- Ishikawa K, "Cytomegalovirus retinitis during immunotherapy for common variable immunodeficiency", J Infect, 44, pp.55~56 (2002)
- Shimakawa M, "CMV retinitis after renal transplantation", Transplant Proc, 34, pp.1790~1792 (2002)
- Stewart MW, "Cytomegalovirus retinitis in an immunocompetent patient", Arch Ophthalmol, 123, pp.572~574 (2005)
- Kim HR, "Cytomegalovirus retinitis in a patient with dermatomyositis", Clin Rheumatol, 26, pp.801~803 (2007)
- 정혜원, "Bilateral Toxoplasma Retinochoroiditis Simulating Cytomegalovirus Retinitis in an Allogeneic Bone Marrow Transplant Patient", Korean Journal of Ophthalmology, 22(3), pp.197~200 (2008), 대한안과학회
- Asano-Mori Y, "Clinical features of late cytomegalovirus infection after hematopoietic stem cell transplantation", Int J Hematol, 87, pp.310~318 (2008)
- Haerter G, "Cytomegalovirus retinitis in a patient treated with anti-tumor necrosis factor alpha antibody therapy for rheumatoid arthritis", Clin Infect Dis, 39, pp.e88~e94 (2004)
- 배소현, "Cytomegalovirus Retinitis after Intravitreal Bevacizumab Injection in an Immunocompetent Patient", Korean Journal of Ophthalmology, 27(1), pp.61~63 (2013), 대한안과학회
- Cheung CY, "Cytomegalovirus oral lesions: harbinger of retinitis in the absence of viraemia", Ann Hematol, 93, pp.1613~1615 (2014)
- 박윤선, "거대세포바이러스 망막염의 임상 양상 및 치료에 대한 고찰", Infection and Chemotherapy, 38(3), pp.116~122 (2006), 대한감염학회
- 윤창기, "한국인 후천면역결핍증후군 환자에서 발생한 거대세포바이러스 망막염의 시력예후", 대한안과학회지, 50(1), pp.92~98 (2009), 대한안과학회
- 최수미, "조혈모세포이식 환자에서 발생한 Cytomegalovirus 질환의 특징 : 일개 대학병원에서 최근 10년간의 경험", Infection and Chemotherapy, 41(1), pp.9~19 (2009), 대한감염학회
- 권영교, "거대세포바이러스 망막염의 임상양상 및 예후에 대한 고찰", 대한안과학회지, 51(2), pp.203~209 (2010), 대한안과학회
- Mori T, "Risk-adapted pre-emptive therapy for cytomegalovirus disease in patients undergoing allogeneic bone marrow transplantation", Bone Marrow Transplant, 25, pp.765~769 (2000)
- Eid AJ, "Clinical features and outcomes of cytomegalovirus retinitis after transplantation", Transpl Infect Dis, 10, pp.13~18 (2008)
- Allice T, "Evaluation of a novel real-time PCR system for cytomegalovirus DNA quantitation on whole blood and correlation with pp65-antigen test in guiding pre-emptive antiviral treatment", J Virol Methods, 148, pp.9~16 (2008)
- Cariani E, "Relationship between pp65 antigenemia levels and real-time quantitative DNA PCR for Human Cytomegalovirus (HCMV) management in immunocompromised patients", BMC Infect Dis, 7, pp.138~ (2007)
- Kim DJ, "Real-time PCR assay compared with antigenemia assay for detecting cytomegalovirus infection in kidney transplant recipients", Transplant Proc, 39, pp.1458~1460 (2007)