Antigenemia, immunoblotting, and enzyme immunoassay for early diagnosis of cytomegalovirus infection in renal transplant patients

Fischer, Lutz; Rautenberg, Peter; Bienengräber, H.; Leimenstoll, G.

doi:10.1111/j.1432-2277.1993.tb00647.x

Cited by 11 publications

(10 citation statements)

References 25 publications

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“…The presence of IgM antibodies was not related to the develop- Weeks post t r a n s p l a n t with those reported in other studies [Landini and Michelson, 1988;Re and Landini, 1989;Landini et al, 1991;Fischer et al, 19931. Another observation is that the serostatus of the recipient has an influence on the IgM response.…”

Section: Virologic and Clinical Surveillancesupporting

confidence: 78%

IgM antibody detection of ppUL80a and ppUL32 by immunoblotting: An early parameter for recurrent cytomegalovirus infection in renal transplant recipients

et al. 1996

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The value of IgM detection for the early diagnosis of an active cytomegalovirus (CMV) infection in renal transplant recipients was evaluated prospectively. Sequential serum samples obtained from 22 allograft recipients with active CMV infection were tested for the presence of CMV-specific immunoglobulin M antibodies (IgM) by an enzyme-linked immunosorbent assay (ELISA) and a microparticle enzyme immunoassay (MEIA) and were compared with the Western-immunoblotting technique (IB). The time course of CMV IgM antibody detection was evaluated in relation to the shell vial assay (SVA), CMV disease, and immunosuppressive regimen. By IB, IgM antibodies against the capsid protein ppUL80a and the basic matrix phosphoprotein ppUL32 were detected in all 22 recipients with active CMV infection. Using the MEIA and the ELISA, the presence of CMV IgM antibodies was detected in 17 (77%) and ten (46%) of these 22 recipients, respectively. The SVA was the earliest parameter for detection of primary CMV infection in seven of nine (78%) recipients, in contrast to two of 13 (15%) patients with recurrent CMV infection (P < .05). The detection of IgM antibodies by IB was the earliest parameter for detection of recurrent CMV infection in seven out of 13 (54%) recipients in contrast to one out of nine (11%) patients with primary CMV infection (P < .05). During a primary CMV infection, the development of an abundant IgM antibody response was associated with recovery from CMV disease and the end of the viremic phase.

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Section: Virologic and Clinical Surveillancesupporting

confidence: 78%

IgM antibody detection of ppUL80a and ppUL32 by immunoblotting: An early parameter for recurrent cytomegalovirus infection in renal transplant recipients

et al. 1996

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Section: Discussionmentioning

confidence: 95%

“…In renal transplant recipients, CMV IgG seroconversion was observed to occur on average 1 day earlier than IgM. 16 In a separate study by Lazzarotto and coworkers, 25 the CMV IgG response was diagnostically superior to IgM for detecting CMV infection in liver transplant recipients.In contrast, the superior performance of the AxSYM CMV IgM assay in our seroconversion panels did indicate a potential advantage of CMV IgM detection in early primary infection. The AxSYM CMV IgM assay was positive before the CMV Total AB EIA and AxSYM CMV IgG (9 AU/mL) assay in 3 and 5 of the 13 panels, respectively.…”

mentioning

confidence: 95%

“…However, in the rare cases in which IgM is detected before IgG, the delay is small (1-2 days). 15,16 In consideration of the requirement for optimal sensitivity, blood donor screening assays have traditionally been designed to detect at least CMV IgG and IgM with some also including IgA detection. 17 The relatively high rate of false-positive results associated with IgM detection is however a disincentive to its inclusion in blood screening assays.…”

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confidence: 99%

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Validation of an automated immunoglobulin G–only cytomegalovirus (CMV) antibody screening assay and an assessment of the risk of transfusion transmitted CMV from seronegative blood

et al. 2008

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BACKGROUND:Cytomegalovirus (CMV) antibody donor screening assays have predominantly included both immunoglobulin G (IgG) and immunoglobulin M (IgM) detection. However, since in the majority of cases both CMV IgG and IgM are detected concomitantly during early seroconversion, CMV assays based only on IgG are now widely applied for donor screening. STUDY DESIGN AND METHODS:The performance of an automated microparticle CMV IgG assay (Abbott AxSYM CMV IgG microparticle enzyme immunoassay [MEIA]) was compared with an established total antibody blood screening assay (Abbott CMV Total AB EIA). Sensitivity and specificity were assessed using 5050 random blood donors and 13 seroconversion panels. A risk analysis was undertaken to estimate the residual risk of transfusion-transmitted CMV (TT-CMV) from presumptive seronegative blood components. RESULTS: The EIA achieved marginally (but not significantly) better resolved sensitivity (100%) than the AxSYM IgG assay (99.93%). The AxSYM IgG resolved specificity (99.34%) was superior to the EIA (96.4%). This superiority was maintained (98.61%) when a modified cutoff was applied to the AxSYM IgG assay to achieve 100 percent resolved sensitivity. The seroconversion sensitivities of the EIA and the AxSYM IgG were equivalent, detecting the same bleed as positive in the majority of the seroconversion panels tested. The median TT-CMV residual risk estimate for the two assays was approximately 1 in 66,000 (range, 42,000-165,000). CONCLUSION: The AxSYM IgG MEIA is suitable for blood donor screening and was optimized by applying a modified cutoff of 9 AU per mL. The modeling predicts that implementing the AxSYM IgG assay would not negatively impact the already very low risk of TT-CMV associated with seronegative blood components in Australia.H uman cytomegalovirus (CMV) is a ubiquitous betaherpesvirus that generally causes asymptomatic infection in the 40 to 90 percent of individuals it infects.1 However, transfusiontransmitted CMV (TT-CMV) can cause serious morbidity and mortality in susceptible patients particularly when immunocompromised. At-risk patient populations include preterm CMV-seronegative neonates, seronegative recipients of autologous or allogeneic marrow or peripheral blood stem cell transplantation, solid organ transplant recipients, and CMV-seronegative AIDS patients. [2][3][4] The primary mechanism for TT-CMV is thought to be the infusion of latently infected mononuclear cells; however, reinfection or reactivation in seropositive recipients has also been reported. 5,6 The detection of CMV DNA in the plasma of some newly infected blood donors suggests the possibility that plasma viremia might also contribute to the incidence of TT-CMV. 7 The incidence of TT-CMV in susceptible patients, which was reported in the range of 10 to 40 percent in the 1970s and 1980s, has declined substantially to 1 to 4 percent as a result of CMV antibody screening and more recently leukodepletion of donated blood. 8,9 There has been substantial debate about the value of maintaining CMV antibo...

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“…Experience with patients on immunosuppressive therapy based on azathioprine, cyclosporine A, and prednisone with or without immunoinduction therapy using earlier monoclonal or polyclonal anti-T-cell antibodies suggests there is up to a 67% incidence of CMV infection in pediatric transplant recipients [4][5][6][7]. Infection is usually due to reactivation of prior in-fection in the recipient or new infection transmitted via the donor organ, irrespective of the recipient's prior CMV immune status [1].…”

Section: Introductionmentioning

confidence: 99%

Fatal cytomegalovirus disease in a high-risk renal transplant recipient

Tenney

Şakarcan

2001

Pediatr Nephrol

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The incidence of CMV infection in pediatric renal transplant recipients has increased as immunosuppression levels deepen following the use of newer immunosuppressive agents. It has been thought that 3-5 months of anti-CMV prophylaxis offers sufficient protection for these patients. We present a case of late-onset fatal CMV disease in a pediatric renal transplant recipient who received prolonged anti-CMV prophylaxis while on "quadruple" immunosuppression with daclizumab, mycophenolate, tacrolimus, and prednisone. Our case has prompted us to reassess CMV surveillance, prophylaxis, and immunosuppression levels in our pediatric renal transplant patients.

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Antigenemia, immunoblotting, and enzyme immunoassay for early diagnosis of cytomegalovirus infection in renal transplant patients

Cited by 11 publications

References 25 publications

IgM antibody detection of ppUL80a and ppUL32 by immunoblotting: An early parameter for recurrent cytomegalovirus infection in renal transplant recipients

IgM antibody detection of ppUL80a and ppUL32 by immunoblotting: An early parameter for recurrent cytomegalovirus infection in renal transplant recipients

Validation of an automated immunoglobulin G–only cytomegalovirus (CMV) antibody screening assay and an assessment of the risk of transfusion transmitted CMV from seronegative blood

Fatal cytomegalovirus disease in a high-risk renal transplant recipient

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