Overview of the diagnosis of cytomegalovirus infection.
Overview of the diagnosis of cytomegalovirus infection.
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DOI：
10.2174/187152611797636703
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发表时间：
2011-10
期刊：
影响因子：
--
通讯作者：
Boppana SB
中科院分区：
文献类型：
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作者：
Ross SA;Novak Z;Pati S;Boppana SB
巨细胞病毒（CMV）是人类最常见的先天性病毒感染，也是免疫功能低下宿主发病和死亡的重要原因。这种对侵袭性CMV疾病在免疫缺陷和先天性CMV感染儿童中的临床重要性的认识，导致了新的诊断程序的发展，用于快速鉴定免疫功能低下的CMV疾病个体以及先天性感染的胎儿和婴儿。通过IgM和低IgG亲合力的存在诊断急性母体CMV感染需要确认胎儿感染，这通常通过羊水的CMV PCR进行。出生后两周内的尿液和唾液病毒培养仍然是诊断先天性感染婴儿的金标准。来自婴儿的干血斑的PCR检测尚未显示出具有足够的灵敏度来鉴定大多数先天性CMV感染的婴儿。然而，唾液PCR检测目前正在评估作为一个有用的先天性CMV感染的筛查方法。在免疫功能低下的宿主中，较新的快速诊断测定如pp65抗原血症和血液或血浆的实时CMV PCR允许抢先治疗，降低发病率和死亡率。然而，缺乏标准化的实时PCR方案阻碍了不同中心数据的比较，以及免疫功能低下个体侵袭性CMV感染管理的统一指南的制定。
Cytomegalovirus (CMV) is recognized as the most common congenital viral infection in humans and an important cause of morbidity and mortality in immunocompromised hosts. This recognition of the clinical importance of invasive CMV disease in the setting of immunodeficiency and in children with congenital CMV infection has led to the development of new diagnostic procedures for the rapid identification of immunocompromised individuals with CMV disease, as well as fetuses and infants with congenital infection. Diagnosis of acute maternal CMV infection by the presence of IgM and low IgG avidity requires confirmation of fetal infection which is typically performed by CMV PCR of the amniotic fluid. Viral culture of the urine and saliva obtained within the first two weeks of life continue to be the gold standard for diagnosis of congenitally infected infants. PCR assays of dried blood spots from infants have not been shown to have sufficient sensitivity for the identification of most infants with congenital CMV infection. However, saliva PCR assays are currently being assessed as a useful screening method for congenital CMV infection. In the immunocompromised host, newer rapid diagnostic assays such as pp65 antigenemia and real-time CMV PCR of blood or plasma have allowed for preemptive treatment reducing morbidity and mortality. However, lack of standardized real-time PCR protocols hinders the comparison of the data across different centers and the development of uniform guidelines for the management of invasive CMV infections in immunocompromised individuals.